Ditch the Itch
Atopic Eczema is probably one of the commonest forms of eczema. It is an inflammation of the skin which will flare up from time to time. It usually starts in early childhood. There is no cure, but treatment can ease and control the symptoms. About 2 out of 3 children will “grow out” of it by the time they are teens.
The cause is unknown. The skin will feel dry. Some areas become red and inflamed, most commonly near skin creases, e.g. the front of the elbows and wrists and behind the knees, but it can occur anywhere. The skin becomes very itchy and if scratched a lot the skin will become thickened. Sometimes the skin can become blistery and weep and can then become infected. The usual treatment consists of :
- Avoiding known irritants and “triggers”
- Emollients (moisturisers) used daily to prevent inflammation developing
- Topical steroids (steroid creams or ointments) used when the inflammation is marked.
Lots of things are irritants and triggers. Common are soaps, bubble baths, shower gels. They dry out the skin even more. Instead use a soap substitute and a bath or shower emollient. Try not to scratch, keep nails sort. Rub with the fingers rather than scratch with the nails if you really need to relieve an itch. Cotton is the best fabric next to the skin. It is the smoothness of the material so some man-made fibres can be as good. Try to avoid extremes of temperature. After washing clothes make sure they are rinsed well to remove traces of detergent. Biological detergents can be especially problematical as can softeners. Some people have certain foods which act as triggers, usually when there is a severe form of eczema in young children.
Regular use of emollients is the MOST IMPORTANT PART OF DAY TO DAY TREATMENT for eczema. They should be applied frequently; this may be twice a day, or several times a day. As a rule, thicker, greasy ointments work better than thinner creams but to a lot of people are not as acceptable. But if you opt for a cream you will have to apply it more often. Use it liberally. You cannot overdose on emollients as there is no drug to be absorbed into the skin. A common mistake is to stop using the emollient as soon as the skin appears okay, then patches of inflammation appear that would otherwise have been prevented. Some emollients come as bath additives and shower gels. These should be used as well as creams or ointments and not instead of them.
Topical steroids work by reducing the inflammation in the skin and come in varying potency. The greater the potency the more the risk of side effects with continued use. The lowest potency steroid effective is used to clear the flare up. Some people like to use steroids as they quickly dampen down the inflammation, and are less “bothersome” than using emollients regularly, but regular or repeated use of steroids can cause:
- Thinning of the skin, which can eventually cause stretch marks, bruising, discolouration or thin visible spidery blood vessels
- Worsening or triggering of other skin conditions such as acne or rosacea
- In children when the steroid gets into the blood stream there can be an effect on growth
Your GP will be able to advise on how best to use topical steroids.
Occasionally a flare up of eczema will become infected. When this happens, you can get weeping blisters, lumps, crusting and failure to respond to your normal treatment. When severe you may develop a fever and feel unwell. See your GP who will be able to assess and if necessary prescribe an appropriate antibiotic.
In severe cases, your GP will refer you to the hospital to see a Dermatologist who may prescribe different treatments.
There is little evidence that alternative therapies have much to offer, and just because something claims to be natural does not mean that it is without side effects.
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