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Eczema

Eczema is the most common inflammatory disease of the skin and affects many millions of adults and children world-wide.

It is typically a chronic contagious inflammatory condition that appears as dry, red, scabbed, scaly, or blistering skin. Eczema can't be cured, but it can be managed. Other names for eczema include atopic dermatitis and atopic eczema. Atopic eczema is most common in children and is one of the so-called sensitivity conditions which also include asthma and hay fever. These disorders tend to run in families of people who are prone to allergic reactions.

Symptoms of Eczema

• Moderate-to-severely itching skin (this symptom separates eczema from other skin rashes). Some people with the disease develop red, scaling skin where the immune system in the skin is becoming very activated.

• Recurring rash - dry, red, patchy or cracked skin. (In infants and toddlers, the rash usually appears on the face, elbows or knees. In older children and adults, the rash appears less often on the face, and more commonly on the hands, neck, inner elbows, backs of the knees and ankles)

• Skin weeping watery fluid

• Rough, "leathery," thick skin. This condition is called lichenification.

• Lesions which may be infected by bacteria or viruses.

Causes of  Eczema

Although the exact cause of eczema is unknown, it appears to be linked to the following internal and external factors:
 

Internal factors

• A family history of eczema, asthma or hay fever (the strongest predictor) - if both parents have eczema, there is an 80 per cent chance that their children will too.

• Particular food and alcohol (dairy and wheat products, citrus fruits, eggs, nuts, seafood, chemical food additives, preservatives and colourings)

• Stress. Emotional stress is a well-known trigger of eczema flare-ups. Patients can have difficulties with anxiety, anger and hostility caused by having eczema. This only adds to the problem. Learning to reduce stress may lessen the frequency and, hopefully, the intensity of the flare-ups.

External factors

• Irritants - tobacco smoke, chemicals, weather (hot and humid or cold and dry conditions) and air conditioning or overheating.  Avoid materials that feel "itchy," things like wool, burlap, etc. Try to wear soft fabrics like cotton, which tend to be less irritating. It's also a good idea to wash all new clothes, linens, and towels before using them for the first time.

• Allergens - house dust mites, moulds, grasses, plant pollens, foods, pets and clothing, soaps, shampoos and washing powders, cosmetics and toiletries. Ingredients such as alcohol, astringents, and fragrances may trigger or worsen eczema.
   

A medical professional can usually identify eczema by looking at the rash and asking questions about how it appeared. He or she may scrape some scales off the rash and look at them under the microscope to make sure the rash is not caused by fungus. Other types of infection also must be ruled out.

The three key elements in identifying eczema are:

• Characteristic scaly rash.  To help you find out whether that itchy rash is actually eczema, check out the risk assessment questionnaire.

• Severe itching

• Atopy, or a personal or family tendency toward asthma, hay fever, and other allergies

There are all kinds of different creams and compounds that give relief to and even remove the symptoms of eczema. Some of these are more chemical based and others focus on more natural ingredients.

Emollients (Moisturisers)

Emollient creams are designed to add moisture to the skin. Apply moisturisers regularly each day to clean, dry skin. It is especially important to moisturise after showering and bathing, and when living or working in an air-conditioned or heated environment. You may need to try several different brands until you find the emollient that works best for you. See your doctor, dermatologist or chemist for advice.

Oral Antihistamines

Histamine is a chemical produced by the body that is responsible for many of the symptoms of inflammation including redness, swelling and itching. Antihistamines block the action of histamine and help to reduce eczema symptoms, particularly itching. Generally, oral antihistamines are best taken around half an hour before bed to help guarantee a good night's sleep, uninterrupted by the urge to scratch. Antihistamines are available from chemists without prescription, but remember that some types may cause drowsiness. Antihistamine creams should be avoided, as they can trigger an allergic skin reaction.

Corticosteroids
Since eczema is an inflammatory condition, it responds well to topical steroids (corticosteroids). These anti-inflammatory creams come in various strengths, and are available by prescription from your doctor. Generally, it is better to use the lowest dose you can. Using high dose topical steroids for extended periods of time, especially on delicate areas like the face, can cause side effects including thinning of the skin. It is best to apply the cream to the reddened areas after bathing, but make sure the skin is thoroughly dry.

In severe cases of eczema, a short course of oral corticosteroids may be necessary. This must be done under careful medical supervision because symptoms may become worse once the tablets are stopped.
 

Evening Primrose Oil

Evening primrose oil (or star flower oil) contains gamma linolenic acid. This type of fatty acid is thought to play an important role in maintaining healthy skin. Some studies have found that it is lacking in some people with eczema. If evening primrose oil is effective in controlling symptoms in those people, it may reduce the need for medicated creams such as topical steroids. Evening primrose oil is applied directly to the skin or can be taken orally in capsules.

Coal Tar

Another way to reduce the itch associated with eczema is to apply coal tar directly to the affected areas. Coal tar isn't a very 'user-friendly' product, since it has a strong smell and tends to stain any fabric it touches. Coal tar can irritate some people's skin. It should only be used under supervision of a doctor who is experienced in managing eczema.

Dietary Adjustments

In most cases, diet is thought to play no part in eczema but, occasionally, a person's symptoms are aggravated by eating certain foods such as dairy products. It is important to seek professional advice from your doctor or dietitian, and to undergo proper allergy tests. Avoid, Self-diagnosis and self-imposed dietary restrictions for they might lead to unnecessary nutritional deficiencies.

Ultraviolet Radiation Therapy (Phototherapy)

Exposure to ultraviolet radiation can help reduce the symptoms of chronic eczema. Exposure under medical supervision can be carefully monitored with the use of specially designed 'cabinets' - the patient stands naked within the cabinet and fluorescent tubes lining the device emit ultraviolet radiation, in a similar fashion to a solarium. The risks of unsupervised ultraviolet radiation therapy can be the same as for sunbathing - accelerated ageing of the skin and increased risk of skin cancer. A person with stubborn eczema may need up to 30 sessions.
 

Cyclopsorin Oral Medication

Cyclopsorin is an immune system depressant. It helps to manage the symptoms of severe eczema by preventing the immune system from launching special cells called lymphocytes into the affected areas of skin. Without lymphocytes, the inflammatory aspect of eczema is dramatically reduced. The side effects of this powerful drug can include high blood pressure, kidney problems, increased susceptibility to all types of infections, and a suspected increased risk of skin cancer. Because of the risk of significant side effects, and the need for close and regular monitoring, oral cyclosporin is only considered in severe cases of eczema that are difficult to control with other therapies.

  How to Manage Eczema

There are ways to alleviate the child's distress. It will help if you:

1. Gain the child's cooperation
2. Try to prevent scratching (by distracting the child)
3. Get to know your child's responses to environmental conditions
4. Read about the condition
5. Educate others (siblings, friends, relatives) to be sympathetic
6. Reduce associated stress for yourself and child.
7. Avoid wearing tight-fitting, rough, or scratchy clothing.

See your doctor if the eczema gets worse.
 

• Moisturisers can be used as often as necessary
• Use oisturiser or bath oil instead of soap in bath or shower
• Apply cool moisturising cream (keep in fridge) before bed
• Sorbolene and Aquasol are common moisturising creams
• Use moisturiser before and after swimming.

• Avoid dummies, dribbling and/or food around the mouth.

• Don't let your child overheat, particularly in bed or on long car trips.

• Avoid prickly materials (such as woollen or acrylic jumpers, car seat covers).

• Use cotton one-piece pyjamas and mittens.

• Don't use detergents, soaps, bubble baths or antiseptics.

• Avoid contact with pets.

People with skin infections like cold sores should not touch the child.

Medicines and creams

Doctors may prescribe a range of creams:

• Cortisone-based creams can control eczema

• Different strength creams may be prescribed

• If bacteria infect lesions, antibiotics may be needed

• Medication to relieve itching may be required.

Know More...

• www.emedicinehealth.com

Dated 18 November 2010