This common skin condition can’t be cured, but there are plenty of simple ways to get it under control
At its most severe, eczema can dent confidence and disrupt daily life – and there’s no doubt that it’s on the increase. Take the most common type, atopic: 30 years ago only five per cent of children suffered in Western society, now it’s nearer 40 per cent. This rise can partly be attributed to our obsession with cleanliness – we ‘sterilise’ our children so their immune systems don’t get the chance to mature.
Who is affected?
Atopic eczema is overwhelmingly a childhood disease – by puberty 90 per cent of children grow out of it, but they will have sensitive skin as adults. And we’re seeing more cases of people relapsing later in life – stress is the main factor, but it’s also due to exposure to chemicals and over-zealous cleaning. About one in 12 adults in the UK suffer from eczema. Women are slightly more susceptible, perhaps because professions involving daily contact with irritant substances, like hairdressing and nursing, are more popular among women.
Which type?
Here are the main types:
Atopic – dry, inflamed patches, which can become scaly and pimply and commonly appear in flexural areas like elbow and knee creases, plus on the face and neck. There’s often a family history and people who develop atopic also have a massive tendencyto develop asthma and hay fever, to which it’s genetically linked.
Discoid eczema – coin-shaped intolerably itchy patches which can appear anywhere on the body. Asteatotic or dry eczema is a flaky form that occurs mainly in older age groups as the skin becomes drier through ageing.
Gravitational or stasis eczema develops when people also suffer from varicose veins as reduced blood flow starves skin of nutrients and oxygen.
Contact dermatitis– the most common type of work-related skin disease. It’s split into: irritant contact dermatitis, sensitised skin resulting from frequent contact with everyday substances like detergents and soap; and allergic contact dermatitis, where someone develops a severe allergic reaction.
Seborrhoeic eczema is due to an overgrowth of yeast in oily areas of the skin such as the face, back and chest and scalp, where it may appear as dandruff.
An itchy problem
These types aren’t mutually exclusive; if you have atopic eczema, your skin is naturally dry and susceptible to irritant contact dermatitis. And we also see discoid eczema in people who had atopic eczema as children. Eczema is an ever-changing condition, lurching from bearable to unbearable in a short space of time. During a severe episode, the itching can get as intense as to disrupt sleep, skin may weep, thicken and crack.
Irritation triggers
In addition to soaps and detergents, a variety of environmental factors can ignite a flare-up – the house dust mite, perfumes, rough clothing, animal fur or hair and pollens included. Stress is also a consideration – it can weaken immunity and at anxious times people are more likely to scratch as well. The issue of food allergies is a thorny one – in a minority of children it may be a problem, but it must only be addressed under the supervision of a paediatric dietician.
Dry skin is vulnerable skin. This is why eczema is often worse in winter when there’s less humidity and nourishing sunlight, we wear coarse clothing and crank up the central heating. There’s also been research into the impact of hard water – it’s known to dry the skin so water softeners are often recommended to parents of young eczema sufferers.
What you can do
Dealing with eczema successfully is all about long-term management. Even when it seems to be under control, stay vigilant by following a good skincare regime and shielding your skin from known triggers – for example, by wearing gloves when handling detergents. Here are some other ways to control it:
Sound skincare Many people think the answer to dry skin is to cosset it in moisturiser – but all you get then is dry and greasy skin. Avoid soaps as they contain detergents and instead use emollients – products that contain oil – which work by trapping water in the skin after washing.
Sap stress Minimising stress can make the world of difference. A colleague has a stress-management clinic as part of her dermatology clinic where patients try acupuncture, t’ai chi and meditation and it’s had a marked impact.
Eat heathily A balanced diet is always important – skin does benefit from good nutrition. The essential fatty acid GLA (Gamma-linolenic acid), present in evening primrose oil, has been shown in some studies to improve the moisture in the skin and reduce dryness.
Stop scratching It may provide temporary relief, but it will only make your skin even itchier. Our nerves don’t function under 15 degrees, so if you’re finding the compulsion just too much to bear, cool the skin down, with some frozen peas or an ice pack.
Targeted treatments
If you’ve got mild to moderate eczema, a lifestyle approach plus a weak steroid cream like hydrocortisone will probably be effective. If not, see your GP. If left untreated it can become infected.
Severe cases of eczema are treated with higher potency steroids – although prolonged use can thin the skin – light therapy, and antibiotics if there’s an infection. The biggest breakthrough is the emergence of highly effective non-steroid creams, which don’t have the skin- thinning effect of steroids – and are now being considered as first line treatment.
Call the National Eczema Society on 0800 089 1122 or visit www.eczema.org.
Treat it naturally…
Omega-3 oils – a German study found that they have a significant impact on the severity and appearance of psoriasis.
Manuka honey – a Dubai study found that honey salve benefited eczema and psoriasis sufferers, and ongoing New Zealand research is testing its powers to ease inflammation associated with these conditions.
Vitamin E is thought to support the skin’s immune response. Italian research revealed that 60 per cent of volunteers taking Vitamin E supplements reported a ‘great improvement’ in their atopic eczema.
Evening primrose oil has been found to ease the irritation and redness of eczema in a recent UK study.
Starflower oil is rich in gamma-linolenic acid, good for reducing itching, says a study in the Journal of International Medicine.
Spotlight on psoriasis
‘Psoriasis affects about two percent of the population and we do know it has a genetic element,’ says Dr Mark Goodfield, President of the British Association of Dermatologists (www.bad.org.uk). ‘It’s an “auto-immune” skin condition – the result of faulty messaging from the immune system. The trigger is often a major life stress or an injury to the skin. It’s important not to dismiss it as a simple rash – one study found that over 30 percent of patients also experienced increased anxiety.
‘The condition occurs when the turnover of the outer layer of skin cells goes awry. Normally the process – from formation to shedding – takes around four weeks. In psoriasis, it can be four days. Most cases are plaque psoriasis, characterised by raised patches on the knees, lower back, elbows and scalp.
‘Like eczema, psoriasis cannot be cured, but treatments have improved immensely. Ultraviolet light, tablet treatments and injections (biologics) are effective for severe cases, but they do have side effects. For milder psoriasis, creams and lotions are preferred – vitamin D creams, vitamin A creams and preparations containing tar or a chemical called dithranol. Topical steroid creams can be used, but care is needed in use.
‘There’s evidence that psoriasis can increase heart and blood vessel disease risk. So it’s important to consider factors such as weight control, alcohol and smoking. A healthy lifestyle is an important element in controlling psoriasis.’
Expert: Dr. Anthony Chu is consultant dermatologist at Imperial College Healthcare (www.imperial.nhs.uk) and professor of dermatology at Imperial College London.
Words by: Antonia Kanczula
One comment
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I have had atopic eczema all my life (!’m 28) and most people do not realise the impact it has on the life of the sufferer. Little things can become very difficult when the skin is flared up, inflamed or infected. I am on antibiotics regularly and my life gets so interrupted to the point it makes me feel very down. After seeing a doctor at work, they have fortunately given me flexible working which makes me feel less stressed, but unfortunately not all employers are understanding. People think you’re just itchy but don’t know how uncomfortable and painful it can be. Even though other conditions/illnesses are a lot worse, some eczema sufferers really do suffer in silence and be aware that it can covered by the Disability Discrimination Act if it affetcs you to a large extent. I personally feel diet has a lot to do with it and I am currently seeing a nutritionist, but exercise classes, soothing ‘me time’ and time in the sun abroad really helps me feel better.
Comment by Natasha on 20 January 2010 at 4:22 pm
