Atopic Eczema

Eczema is sometimes called dermatitis, which means ‘inflammation of the skin’. There are different types of eczema, atopic eczema being the most common of all. In this type of eczema, there is a typical pattern of skin inflammation, which causes the symptoms.

The main features of eczema are dry, itchy, red and inflamed skin. It can be a disruptive and distressing condition and can affect a person’s quality of life.

The cause of atopic eczema is not completely understood. Genetic factors may appear to play a strong role. The oily barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and tendency towards dry skin. The epidermis is the first line of defence between the body and the environment. An intact epidermis keeps the environmental irritant from entering the body.

Symptoms of Atopic Eczema

  • Itching of the skin (may be more intense and noticeable at night
  • Redness
  • Small bumps
  • Big patches
  • Skin flaking

Features of atopic eczema vary from one individual to another, and can change over time.

Features include:

  • Dry scales
  • Clogged hair follicles causing small bumps to develop, usually on the face, upper arms and thighs, known as keratosis pilaris
  • Inflammation around the lips
  • Increased skin creases on the palms and/or extra fold of skin under the eye
  • Darkening of the skin around the eye
  • In adults, it commonly affects the neck, the elbow creases, and the back of the knees

Many substances have been identified as triggers for patients with atopic eczema. These triggers may not be the same for everyone. It may be difficult to identify the exact ‘triggers’.

It may be:

  • Rough or coarse material that comes in contact with the skin
  • Extremes of temperature – too hot/too cold
  • Excessive sweating
  • Exposure to certain detergents, soaps, disinfectants
  • House dust mites
  • Upper respiratory tract infection
  • Stress

Eliminate aggravating factors:

  • Heat, perspiration and dry environment
  • Emotional stress and/or anxiety
  • Rapid and extreme temperature changes

1) Avoid irritants to the skin and other ‘triggers’ whenever possible

  • Avoid soap and bubble baths. They can dry the skin and make it more prone to irritation. Use a soap substitute instead.
  • Avoid scratching the eczema. Keep nails short
  • Wear cotton clothes rather than fabrics such as wool.
  • Avoid getting too hot or too cold. Extreme temperatures can irritate the skin.
  • Keep household clean by regular cleaning, paying attention to your bedroom and mattress.

2) Moisturise, moisturise, moisturise

  • Use a moisturiser regularly as people with eczema tend to have dry skin.
  • Apply the moisturiser all over the areas of skin liberally.
  • Use a moisturiser at least 3 – 4 times a day and after a bath or shower.
  • Moisturise everyday. Do not stop moisturising even when the skin appears good.
  • Pat your skin dry rather than rubbing it dry after each shower or bath.]

3) Medications

  • Corticosteroids reduce inflammation of the skin.
  • Strong topical steroids may be needed to control severe flares of eczema – only for a short period of time.
  • Creams are best for moist or weepy skin.
  • Ointments are ideal for skin that is dry and thickened.
  • Oral steroids are occasionally used to treat a severe episode of eczema though this is usually not recommended on a regular basis because of potential side effects.
  • Oral antihistamines help to relieve the itch of eczema. However, they may cause drowsiness as well and may affect your daily activities.

Note: Do not stop applying moisturiser as well when you are on a course of topical steroids.