Eczema

• What is eczema?
• What causes eczema?
• Can eczema be caused by diet?
• What treatments are available?

What is eczema?

Long standing eczema is often dry and causes thick scaling of the skin (lichenification).

Although it can look unpleasant, eczema is not contagious; you cannot contract eczema by touching someone who has it.

What causes eczema?

• Atopic eczema is the commonest type of eczema. It is a genetic condition; in 70 percent of cases there will be a family history of eczema, hayfever or asthma. Atopic eczema is characterised by dry, itchy skin. It usually begins in infancy and can often affect the whole body, including the head and face. In more than 50 percent of cases the eczema will persist into adult life. Flare-ups can occur in response to environmental allergens such as house dust mites, animal fur, pollens, microbes and pollutants. Emotional stress and anxiety may also cause the eczema to worsen periodically.
• Allergic/Contact eczema is caused by an allergic reaction to a variety of environmental substances. Where the person's body comes into physical contact with certain substances, an allergic reaction will develop causing the skin to itch severely and redden. The commonest allergies include:
  1. Nickel sensitivity involving the skin in contact with earrings, belt buckles and often the hands and face.
  2. Hair products such as dyes and perms affecting the face, neck and ears.
  3. Clothing dyes in socks and shoe leather affecting the feet.

  If your doctor suspects that your eczema is caused by an allergic reaction, he may carry out Patch Testing to test for allergies to a range of known irritants. You may also be referred to a dermatologist for further tests if the cause is proving difficult to identify.

• Irritant/Contact eczema is a chemically induced skin irritation. It most commonly occurs on the hands as a result of repeated exposure to caustic or acidic substances and everyday household detergents.
• Seborrhoeic eczema is a common, chronic disorder characterised by greasy scales overlying red patches or plaques on the skin. The commonest location is the scalp where it may resemble severe dandruff. It may also appear on the face, eyebrows, eyelids or ears and occasionally on the chest, groin or axillae (armpits). The symptoms are usually those of itching or burning of the affected area.
• Varicose eczema develops on the legs secondary to varicose veins and chronic lower leg swelling (oedema). It typically affects the inside of the ankles over a swollen vein. The skin may become darkened (pigmented) as the condition progresses and may be complicated by secondary infection. In severe cases ulcers may form on the skin.
• Discoid eczema is characterised by circular or oval skin lesions that may become crusted or scaly. Lesions most commonly affect the trunk or backs of the limbs. The cause is unknown.

Can eczema be caused by diet?

What treatment is available?

1. Education. One of the most important aspects of management is explanation, education and discussion. Known skin irritants should be avoided and the skin should be kept well moisturised to prevent drying and splitting. When bathing, use warm, not hot, water and limit the use of soaps.
2. Steroids. Treatment may require the use of topical (on skin surface) steroid cream. If the skin is crusted or weeping antibiotics may be required to prevent or treat infection. In severe cases oral (tablet) steroids may be required for short periods.

   Antihistamines may also be used to control the itch.

3. Emollients. Emollient creams provide a lipid (oil) film on the surface of the skin that prevents water loss. They are most effective when applied after bathing when the water content of the skin is greatest.

   Emollients should be reapplied to exposed areas such as hands and face at regular intervals throughout the day and also provide some protection against external irritants.

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