Expert: Eczema and How To Manage It
Atopic eczema is a very common skin condition, affecting one in five children. In this article, the Irish Skin Foundation provides an overview of eczema and discusses emollient therapy, which plays an essential role in protecting and restoring the skin barrier, as part of the over-all management strategy of this chronic condition.
What is eczema?
The words eczema (which comes from the Greek word meaning ‘to boil’) and dermatitis (meaning inflammation of the skin) are often used interchangeably to describe several conditions that cause the skin to become inflamed or irritated.
There are a number of different types of eczema but atopic eczema (also called atopic dermatitis) is the most common form affecting young children. The word atopic refers to hypersensitivity to something in the environment.
Atopic eczema is a very common, non-contagious, chronic (long-term) inflammatory skin condition. Although it can start at any time of life, it most frequently begins in infancy, affecting as many as one in five children and one in ten adults. For most children affected, the disease is mild. However, often those who have seemingly outgrown the condition will continue to have life-long sensitive skin and may have recurrences of eczema following long symptom-free spells.
What are the symptoms?
Eczema is recognizable by the presence of red, dry, itchy skin, which can sometimes weep, become blistered, crusted and thickened. However, the appearance of eczema, and the locations of the body affected, can vary greatly depending on the age of the person.
An intense itch is the major symptom of atopic eczema. Scratching only provides momentary relief, and leads to more itching (the itch-scratch cycle). Scratching worsens eczema and can make the skin more vulnerable to infection. The intense itch is very uncomfortable, can disrupt sleep and negatively impact on the child’s quality of life, as well as that of his/her parents and the wider family. Some children with more pronounced eczema can also experience social embarrassment due to the visibility of their condition.
Age related appearance and pattern
In infancy, the first noticeable signs of atopic eczema may be skin dryness and roughness, but other symptoms (e.g. red itchy skin which can affect the cheeks and forehead, and/or the trunk and outer aspects of arms and legs) do not usually occur before two months of age.
In older children, from about 1-2 years onwards, atopic eczema is most often seen on the inner sides of the arms at the elbow creases, behind the knees, and on the face and neck.
What causes atopic eczema?
While the exact cause has yet to be determined, certain factors are thought to be important in its development. These include a weakened skin barrier, along with altered inflammatory and allergy responses. Atopic eczema often runs in families and frequently occurs alongside other atopic conditions, including hay fever and asthma.
The condition can be triggered by a number of environmental irritants: Common examples include soap, bubble bath, shampoo, laundry detergents, fragrance, changes in temperature, or allergens like animal dander and the house dust mite; but sometimes no cause can be identified.
During a ‘flare up’, when eczema is very active; symptoms such as redness, dryness and itch worsen, while at other times, symptoms settle. Although there is no cure yet, treatments are available to manage the condition.
Managing your child’s eczema
The main aim is to improve symptoms and achieve long-term control. In atopic eczema, the skin’s protective barrier is weakened which allows moisture to be lost and irritants and allergens to pass through the skin more easily. Some common everyday substances e.g. soap, contribute to the weakening of the skin’s barrier and should be avoided.
It is important to remember that on-going (daily), frequent and generous use of emollients and the avoidance of trigger factors, form the basis of eczema management. But when your child’s eczema flares up, other treatments, such as topical steroids, are needed; and are usually prescribed by your healthcare professional.
Essential daily care
Emollients are an essential part of daily care, even when skin is clear. Emollients are moisturizers that are used in two ways – applied directly to the skin as a leave-on moisturizer, and as a soap substitute instead of soap or shower gel.
Used several times a day, emollients help to soothe dry, itchy skin and repair the skin’s barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares.
Soap substitutes/emollient wash products
Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, choose emollient wash products when bathing which leave the skin coated with a protective film afterwards.
Choosing an emollient
Emollients come as lotions, creams and ointments. Finding the right one is often a matter of trial and error, but the best emollients are ones that you (or your child) prefer, and will continue to use every day. Remember: A higher price doesn’t necessarily indicate a better product – ask your healthcare professional for advice.
Some practical tips for emollient therapy
Establish a good daily skin care routine and try to stick to it.
Don’t stop moisturising when your child’s skin is clear.
A child with atopic eczema often requires a minimum of 250g of ‘leave-on’ emollient per week.
Apply emollients in a smooth, downward motion, in the direction of the hair growth.
Teach your child how to apply their emollients correctly from a young age.
Remember – avoid soap, bubble bath and shower gel!
Use soap free products for bathing and specially-formulated shampoos.
Bathwater should be a lukewarm temperature; 5 minutes with an emollient bath additive is sufficient.
After bathing, gently pat skin dry. It is a great time to apply emollient all over when the skin is still ‘slightly humid’.
Remember to change your tub of emollient at least every six weeks, as it can become contaminated; or use a pump dispenser.
It is very important to establish the right diagnosis, so if you are concerned about your child’s skin, you should always speak with your doctor. For more detailed information, please see The Irish Skin Foundation’s ‘What You Need To Know About Eczema’ booklet available to download free at www.irishskin.ie.
As part of Eczema Awareness Week 2017 (11th-17th September), the Irish Skin Foundation (ISF) will host a free public meeting in the Red Cow Moran Hotel, Naas Road, Dublin on 16th September for those with, or caring for someone with eczema.