Dry Skin & Eczema

What are the symptoms of this condition?

Eczema is a term used to describe a number of skin conditions characterised by flakiness, itching, redness and sometimes weeping of the skin. The term 'dermatitis' is sometimes used interchangeably with eczema to indicate the same condition. It may be confined to one or two small areas of the body, or, in some cases, it may affect large areas of the body. The severity of the symptoms can vary considerably from person to person, and also over time with the same person.

Thickening of the skin can occur in severe cases, and the inflamed areas may feel very itchy and hot. Because of the intense irritation, excessive scratching of the skin may increase the risk of a secondary infection in the affected areas.

All ages may be affected; childhood eczema is a common hereditary condition which affects around one in every eight babies, and may be classed as 'atopic eczema' - that is, eczema which is related to a family history of common allergic conditions including eczema, hay fever, and asthma, all of which have a similar underlying cause (it's quite common for children with eczema to suffer from one or both of these other conditions too). Most commonly, eczema occurs on the inner creases of the elbows and knees in children, and on the face and neck in babies. Childhood eczema generally first appears between the ages of 6 months and 2 years; if you already have one child with eczema, there is a one in four chance that your next child will have it too, although this risk is increased if both parents suffer from the symptoms. However, babies who are breast-fed are less likely to suffer from eczema. It is unclear whether this is due to an intolerance to cows' milk, or to nutrients in breast milk which are not found in cows' milk.

Childhood eczema often diminishes by the mid-teens, with many cases settling down before the age of 6; however, the symptoms may reappear later in adult life, especially in times of stress, when it commonly reoccurs on the hands.

What is the cause of the condition?

As there are several different types of eczema, there are many possible causes.

Atopic eczema, an inherited condition most commonly found in childhood, is often seen in children who also suffer from hay fever or asthma; there may also be an allergic reaction to certain factors in the child's environment which makes the symptoms worse.

Adult eczema may be a recurrence of childhood eczema, and can be triggered by sensitivities to environmental factors, or stress. Allergic reactions can act as triggers for eczema. Many substances can, with repeated exposure, cause the symptoms of eczema or dermatitis. This may be a problem that develops at work or in the home; chemicals found in some industries, such as acids, alkalis, dyes, oils or bleaches are known to trigger eczema, and household products, including detergents, can also precipitate attacks. Sometimes the reaction follows long and repeated exposure; sometimes it occurs on first contact.

Contact dermatitis is the name given to a skin reaction which is initiated by skin contact with certain materials, and can develop with exposure to materials that in most individuals do not usually cause problems; nickel in watch straps is a common example. Some make-up products, rubber, some glues and even plants can be irritant to certain individuals. Eczema-like skin rashes and irritation may occur in later life or in the elderly. This probably results from a slow decline in the ability of the sebaceous (sebum producing) glands, attached to the hair roots and found all over the body, to function properly. Sebum is an oily substance that is used to lubricate the surface of the skin and to keep it flexible; if insufficient quantities are produced, the skin can become dry and scaly and is easily irritated.

Sunshine is good for eczema - although the skin does get itchy if becomes too hot, so it's important to avoid over-exposure to the sun, and always use a sunscreen to prevent burning. However, the ultra-violet (UV) component in sunlight can, in a small number of individuals, cause a 'photophobic' or light-sensitive eczema rash. Some drugs and medications are known to cause this as a side effect. Complicating this particular type of eczema is the difficulty of minimising exposure to sunlight; strong sunblock creams are generally recommended wherever possible. If you are concerned that the medicines you are taking may be responsible for an eczema-like reaction, the Pharmacy2U pharmacists can give you more advice.

What complications might occur?

Eczema tends to be a long term, or chronic, condition. In the vast majority of cases, it can be controlled without leading to any serious complications. However, for a small number of people, the eczema can be very severe and may spread over a large area of the body. The intensity of the inflammation and the damage caused to the structure of the skin may cause permanent scarring; persistent scratching, or otherwise damaging the inflamed and weakened areas of skin, can introduce bacterial infections, which will require attention from your doctor.

Complications arising from eczema can be social in nature, as well as physical; if the rash is on the face or other exposed parts of the body, it can be unsightly and may be damaging to a person's self-esteem, especially in children and young adults. However, there are many products available which can help to minimise the discomfort and the visible symptoms which are common in eczema.

What can I do to treat myself?

Effective self-treatment depends on finding the causative factors, if any, and eliminating or avoiding them, and the use of suitable soothing and emollient creams to hydrate the skin, and medications to ease the discomfort of the rash if necessary. Further details of the medications and remedies available for the relief of eczema that can be purchased from Pharmacy2U will follow in the next section.

Childhood eczema
Although there is no cure for childhood eczema, it is usually possible to keep the condition under control. Emollients are the main therapy used by doctors and dermatologists in the treatment of eczema, and should form the basis of regular daily treatment for childhood eczema. These products leave an oily layer on the skin which reduces moisture loss and rehydrates the skin. Roughness and scaling are reduced, and itching and irritation are relieved.

Children with eczema may benefit from using an emollient bath product; these are formulated to work with the bath water to rehydrate and moisturise the skin. The water penetrates the skin and is then sealed in by the emollient, which creates a protective barrier. Bathing helps keep the skin free from crusts and scales, which in turn helps to prevent infection.

Emollient creams may be used between bathing, whenever required, to soothe irritation and so help prevent scratching. However, most children will suffer from eczema flare-ups from time to time; areas of skin then become red and inflamed. Flare-ups can be made worse by bacteria which live on the skin An antiseptic bath emollient will reduce the level of bacteria on the skin, at the same time as moisturising it and relieving irritation.

Your GP may also prescribe a topical steroid cream or ointment, such as hydrocortisone, to be applied to inflamed areas. If the inflammation leads to infection, an antibiotic may be prescribed.

You can make your home environment less likely to aggravate your child's eczema. Choose cotton underclothes and bed linen, and avoid wool or synthetic materials next to the skin; cotton helps keep the skin cool, and allows it to 'breathe'. Wash clothing and bedclothes using a mild soap product, and make sure everything is rinsed thoroughly. Even the mildest soap can cause skin dryness and worsen the condition; use a bath emollient or an emollient cleansing bar instead of soap. Pets such as cats and dogs often aggravate eczema. They don't have to come into direct contact with the child to cause a problem, so it really is best not to have any furry pets in the house. Avoid freshly mown grass, as children with eczema are often allergic to grass pollen; and finally, ban smoking in the home - tobacco fumes may irritate the skin further.

Adult eczema
In adults, many cases of eczema or dermatitis seem to result from exposure to allergens (substances that can trigger an allergic reaction). Limiting the extent and severity of the skin rash will be made much easier and more effective if any allergens can be identified.

As mentioned above, many common household or workplace substances and materials can cause eczema symptoms; this is often the result of repeated exposure over long periods of time. Detergents, used for washing clothes or in washing-up liquids, are a likely cause of rashes on the hands, fingers and wrists. This is a form of contact dermatitis and is mainly due to constant exposure to the substance. As well as treating the rash with appropriate creams or ointments, you should avoid the allergen wherever possible; wearing gloves when washing-up or washing clothes should help.

Eczema rashes which appear on the face, around the hair line, or on the scalp, may be caused by a reaction to make-ups, soaps or shampoos. Strong perfumes and scents in skin products are not always well tolerated by people with sensitive skins; preservatives and other chemical constituents in make-ups present similar problems, and this type of reaction may only become apparent after a prolonged period of use. If you suspect a contact reaction of this kind, try switching to shampoos and soaps that are unperfumed and labelled as hypoallergenic. Similarly, choose hypoallergenic make-up products.

Men are not immune to these problems either; shaving preparations can cause face rashes, and the alcohol present in aftershaves can be irritant, as can perfumes and fragrances in aftershaves and shaving creams or soaps. Try to choose a product that is hypoallergenic and that contains few substances likely to irritate the skin.

What treatments are available for me to purchase?

A wide range of products can be purchased to help you manage eczema or dermatitis. Advice can be sought from the Pharmacy2U pharmacist if you need assistance on selecting suitable products. Treatments for eczema and other dry skin conditions include emollients (moisturisers), hydrocortisone and anti-pruritics (anti-itch preparations).

Emollients
The most important factor in treating eczema is keeping the skin well moisturised. As the skin becomes dry, inflammation increases as does itching. Emollients help to smooth, sooth and moisturise the skin but their effects are quite short-lived. Therefore, they should be applied frequently to the affected skin and should be used continuously to prevent 'flare-ups'. It is also important to use emollients liberally. Aqueous Cream is a useful and cheap emollient, which can also be used as a soap substitute. However, many people find more oily products such as Balneum, Diprobase and Unguentum M are more effective and longer lasting. E45 and Diprobase are also more effective and have the advantage of being easy to apply. It is advisable to try a range of products, as different products suit different people. Rarely, there may be an allergic reaction to one of the ingredients; if you believe this has occurred contact the Pharmacy2U pharmacist for advice.

Bathing removes natural oils from the skin and can make the symptoms of eczema worse. There are a number of products that may be used in the bath or shower to prevent this, including E45 Bath and products in the Oilatum and Balneum ranges.

To view the full range of emollients available from Pharmacy2U Click here.

Hydrocortisone
Hydrocortisone is a mild steroid which may be used on the skin to treat contact/allergic dermatitis, mild to moderate eczema and insect bites. It is an anti-inflammatory and will reduce redness, inflammation and itching. It is useful in treating mild eczema flare-ups but may only be used for up to 7 days and should not be used on the face or anogenital areas, on broken or infected skin, on children under 10 or in pregnant or breast-feeding women.

Anti-pruritics
Anti-pruritics help to reduce itching on the skin. Products include Eurax Cream and Lotion, and E45 Itch Relief Cream. These should be used with care as sensitivity reactions to the ingredients can occur.

To view products containing hydrocortisone and anti-pruritics available from Pharmacy2U Click here.

What treatments are available from my doctor?

Severe cases of eczema, where there is much inflammation of the skin, weeping or infection, will need advice and treatment from a doctor or a dermatologist. There are several treatments that can be prescribed to deal with severe eczema. It may require a potent topical steroid to reduce the inflammation. If the eczema has become infected then antibiotic treatment may be required.

What additional investigations might be needed?

Many cases of eczema have an allergic component; isolating and identifying the responsible allergen(s) can be undertaken in specialist units, in cases where other measures have failed.

Any other information I should have?

Self-help and advice groups do exist for sufferers of eczema. The National Eczema Society provides information on how to live with eczema and advice on treating and managing the condition.