April 27, 2018

Eczema is the name given to skin conditions which are itchy, red, inflamed and dry. The word comes from an ancient Greek term meaning to 'boil over' which is a fairly apt description of how the skin can feel to a sufferer. Around 12% of adults have eczema and approximately 20% of the UK child population suffer with this troublesome condition. There is no cure for it currently but there are very exciting treatments on the horizon. That said, the main treatments available are emollients (moisturisers), avoidance of known irritants, steroid preparations used appropriately, antibiotics when infection is an issue and dietary manipulation under direct supervision. The later is more relevant in the under 18 months category when milk, egg, nuts and soya are common allergies. Much attention is paid to the quest to find the ultimate diet and sadly for many it does not hold the cure. That is what makes everyday control of eczema quite challenging.

However it can be controlled and for most people it will improve with age, although they may always have a tendency towards dry and 'sensitive' skin.


Finding a sympathetic healthcare professional is absolutely essential to help you manage this chronic condition or to clarify which specific type of eczema it is (there are several) Your GP, practice Nurse, health visitor, Dermatologist and Dermatology Specialist Nurses are all examples of professionals you may have contact with, the last two will need a special referral from your GP but may prove very useful to you if your skin  is not managed well and is affecting you or your child's life.


I have worked with children and adults who have eczema for over 25 years in my nursing career. My top tips for managing the condition are:




Moisturise all over at least twice a day or more during the winter when the central heating drys out the skin


Make sure the mosituriser (often called emollient) is the right one for you or your child. There is absolutely no point in being prescribed one you don't like the smell of, the texture or the feel of.  It will sit on the shelf unused whilst your skin drys and cracks more! There are many to choose from and you may need a little help with this from your GP, Nurse or even pharmacist. The one that's best for you is the one you like and that fits into your lifestyle.


Don't run out! I see this happen a lot where repeat prescriptions are not asked for or forgotten about. It only takes a day or less for your skin to become dry and the itching to restart. Keep a spare one in stock and remember that during busy times like holidays there may be a delay in getting what you need..plan ahead.


Don't forget to detox.. by this I mean take a good look at what chemicals and products you use on your body, hair and also in your environment. For example if you suffer with bad facial eczema, check your shampoo and conditioner are fragrance and colour free and ditch the aerosol room sprays , scented candles and diffusers. They can causes facial flare ups and itchy eyes.


Bubbles are trouble! As a rule of thumb, anything that lathers up really well is detergent based and best avoided with eczema. So this means soap, bubble bath, foaming washes and fragranced shampoo's. The barrier function of the skin for those with eczema is not as resilient as normal and easily offended by certain products. Keep it simple and bubble free!


A word on essential oils... they may be 'natural' but that doesn't mean they are eczema friendly. They are highly concentrated, highly scented products and many will irritate eczema prone skin. Trust me on this one as I did my diploma in aromatherapy way back in the 1990's and found many of the oils gave me hand dermatitis! Needless to say I only use them for olfactory purposes now and never directly on skin. 


Flammability. Some of the thick paraffin based oils and ointments could be flammable if near a naked flame. take care.


If your eczema is bad and affecting your daily life, treat it and I mean with topical steroids, antibiotics or immunomodulators like Elidel or Protopic (these work in a similar way to reduce eczema inflammation but do not have the long term skin thinning side effects. They are licensed for 2 years and over but will need a Dermatologist consultation usually.)


Steroids. These topical (applied on the skin) medications have gotten a bad rep over the years. However they have been used for over 50 years and are very useful at relieving the symptoms of many skin conditions. If you think about it, each and every drug available to us has a side effect or several if used inappropriately. Its always about balance but what I would say to anyone suffering badly from an inflamed skin condition or anyone who has a child suffering is use them! Use them as directed by someone who has an interest in skin/Dermatology and will be monitoring you or your child. 

One of my jobs over the years has been to teach patients how to get the best out of their meds. Too often, mixed messages and advice are given out by professionals or even the media about how to apply Dermatology creams. Please do apply in the correct way. Not too thin as this wont work and not at the same time as your emollients as it will be diluted. Mind the gap! leave a gap either way of about 20-30 minutes. The last pearl of wisdom is not to ad hoc with steroids. Use them daily for a set period of time as discussed with your health care provider then taper or wean them off. For example to alternate days for a week then perhaps twice a week for a couple of weeks to prevent symptoms rebounding (coming back too soon after stopping).


Different potencies will be prescribed for different areas so do get up to speed with your creams...I completely appreciate how many there are on the market but do take time to know the basics. Knowing about your skin and how to use the treatments properly can make a massive difference to your life. My analogy would be: imagine if you were a newly diagnosed diabetic and you never got much education about how to use your insulin or alter your diet. You would very quickly become poorly and need medical attention. I guess because on the whole eczema or many skin conditions are not life threatening ( that said I have nursed plenty of children and adults with overwhelming skin infections which required admission to hospital and intravenous medication) people underestimate how important treatments are.

However the impact on health is different and more chronic. It can cause lack of sleep, worsening of symptoms, discomfort, poor attainment at school or work, days off sick, psychological problems such as anxiety, stress and changes in body image or perhaps a hospital admission. I have sadly seen all of these problems during my career.


Diet. Diet is only one of the triggers for eczema and probably mostly in the young, particularly under 1-2 years of age.

It is possibly the most talked about issue in clinic and causes the most anxiety as it is rarely clear cut and straightforward.

I'm not even going to go into detail about diet in this blog apart from giving basic advice. If your child is under 12 months and frequently vomiting after feeds or having loose stools or constipation and colic on the other hand, do seek advice quickly. If your child also has eczema and there is a family history there would be even more reason to see a specialist, particularly if they were losing weight.


Seeing an allergy/dermatology specialist may differ up and down the UK in terms of access but your GP should be able to refer you to somewhere suitable where hopefully you will have access to a dietitian and specialist nurse to give you support. Taking major food groups out of a small child's diet is a risky business and needs a sensible and supervised approach. Remember there is a big difference between a fully blown allergy and a possible intolerance and it is essential to talk to professionals who have experience in deciphering these issues. Eczema is a multi-factorial complaint and frustrating as it seems can differ from person to person. The hope would be that you can find a number of ways to control the symptoms and ensure you or your child are not affected by them detrimentally.


My last point , which is one I feel almost evangelical about is healthy balanced diets in general!  As a children's nurse I have come into contact with many families over the years so have a good idea about typical diets. On the whole we eat too much processed food, take aways, crisps, sweets any other empty calories. Nothing new here , neither is the rise in childhood obesity for the same reasons. To date there hasn't been as much research into junk food and allergies. However I remember reading an article published in 2013 by Elwood et al (Do fast foods cause asthma, rhinoconjunctivitis and eczema ) which was very compelling. The authors undertook a large study analysing data from 319,196 teenagers and 181,631 children aged 6-7 years over a 12 month period. Their diet was scrutinized carefully and the results were pretty conclusive in my mind. They confirmed that eating fast food 3 or more times a week was associated with a 39% increased risk of severe asthma in teenagers and a 27% increased risk among children. Additionally there was an increased risk of eczema and rhinoconjunctivitis. Interestingly fruit intake seemed to have a protective effect. 


I'm sure as future studies are carried out, there will be much more discussion on the link between processed food and allergies in general. 


Environmental triggers. These could range from house dust mite, pollen, grass, cats, dogs, rabbits, horses, or moulds and fungi. More common in older children and again worth looking into by a specialist if you have notice a pattern with symptoms. I would also take a good look at what you use within your house. What perfumed cleaning products do you use, any air fresheners or scented candles? If so think about reducing them or swapping completely to non toxic and non perfumed alternatives perhaps? Anti house dust mite covers for the pillows , duvet and mattress are worth investing in if you have a HDM allergy. Make sure you get the ones which fully encase the pillows duvet and mattress not just elasticated. Damp dust and invest in a good hoover. Also make sure there is no damp in the house, especially bedrooms. HDM love damp and thrive in these conditions! A good website with info on HDM eradication is allergyuk.org


Check out much much more about eczema and treatment in the following websites






British Association of Dermatologists (bad.org.uk)


NICE guidelines on atopic eczema, revised March 2017 (cks.nice.org.uk)










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