How can YOU minimise the effects?

ECZEMA

What is Eczema?

Eczema is a common skin condition affecting up to 1 in 5 children and 1in 10 adults. There are many different types of eczema and different names for eczema.  The terms eczema and dermatitis are synonymous and can be used interchangeably.

Eczema presents as red, itchy, flaky, dry patches of skin and can occur on any part of the body. In darker skins, eczema may not show redness, but may cause a change in pigmentation resulting in either lighter or darker patches.

How can Dr Emma help?

Unfortunately there isn’t a cure for eczema and this sometimes leads people to feeling that there is nothing they can do about their condition. Whilst we can’t totally remove the tendency for eczema, there are so many different effective treatment options. Untreated eczema can impact on so many aspects of life – work, school, personal relationships and psychological wellbeing. It is essential that the skin is well controlled to allow sufferers to thrive.

What is Dr Emma’s expertise with Eczema?

Dr Emma is an expert in treating eczema at all ages. She has lectured internationally on the subject of eczema and has been involved in cutting edge research. She understands how stressful, uncomfortable and distressing, even mild cases of eczema can be and works closely with her patients to ensure that eczema no longer interferes with day-to-day life.

What are the different types of Eczema?

Atopic Eczema

Atopic eczema or dermatitis refers to eczema that is due to underlying changes in the skin which means it is more sensitive and likely to become irritated. This type of eczema often goes alongside other conditions like hayfever, asthma and food allergies. Atopic eczema is highly heritable. If one or other parent suffers from eczema, asthma or hayfever, there is a 25% chance their baby could get eczema. If both parents have eczema, asthma or hay fever, then there is a 50% chance of their baby getting eczema.

Seborrheic Eczema

This is a common condition which often presents with a scaly scalp and flaking around the nose and eyebrows. This often comes on in teenage years, although some people will have a lifelong tendency to seborrheic dermatitis. This results from the combination of an overgrowth of a yeast known as Malassezia and a sensitivity of the skin.

Irritant Eczema

Irritant eczema is caused by damage to the skin barrier due to strong chemicals coming into contact with the skin. It is common amongst people who have sensitive skin who have used acids or retinoids which are too strong for their skin. It can also commonly on the hands with excessive washing with harsh soaps, particularly in winter time.

Contact Allergic Dermatitis

This is due to an allergy to a particular substance that is coming into contact with the skin. Commonly this may be nickel, fragrances or preservatives that are used to extend the shelf life of cosmetics.

Whilst each of these subtypes of eczema are slightly different, they all have some common features:

(1) Impairment of the skin barrier – skin dries out and is unable to lock moisture in which is essential for healthy skin functioning.

(2) Cutaneous immune dysfunction – your skin has a very active immune system which is normally carefully balanced to react to protect the body by reacting to harmful stimuli, but staying calm when there is no danger. In eczema, the skin’s immune system becomes overactive – in the case of atopic eczema this is due to genetic changes within the immune system, whereas in contact allergic dermatitis , this is due to a particularly ingredient which comes into contact with the skin. Overactivation of the skin’s immune system results in red itchy patches.

(3) Changes in the microbiome – people with eczema have a change in the balance of bacteria in the skin, and sometimes in the gut as well. Changes in the microbiome in the skin can drive the changes in skin barrier function and result in inflammation (for example in seborrheic dermatitis where Malassezia causes flaking and irritation).

In some cases, Dr Emma may recommend further tests.  These may include:

Skin swabs – to look for infection.

Blood tests – to check immune cells

Allergy tests – this may be for immediate type food allergies, as they can commonly co-exist with eczema. However, the current validated tests for food allergies look for immediate reactions (known as IgE mediated allergies) and apart from in infants, it is rare that food alone is the driver of eczema patches.

Patch testing – this is a specialist test that investigates if any substance coming into contact with the skin could be causing the eczema. Common culprits include nickel, fragrances and preservatives.

What are the treatments for Eczema?

Environment

For some, controlling aspects of your environment can impact on the skin. This includes temperature control, humidification of air, water softening and house dust mite control measures.

Clothing choice

The scatch:itch cycle of eczema can be worsened by synthetic fibres. Dr Emma can recommend a number of garments or devices that can be helpful for eczema sufferers.

Diet and supplements

Unless there is an obvious reaction to a particular food, It is very important you do not restrict your or your child’s diet without help from a professional. Restrictive diets in people with eczema who do not show signs of food allergies have not shown to be helpful and can impact on your nutritional status.

It is important that your diet contains healthy fats such as nuts, seeds, oily fish and avocado to boost skin barrier function. Fibre and minimising processed or fast food can be useful ways of improving gut health and microbiome.

For some, depending on your individual diet, Dr Emma may suggest adding supplements.

Barrier repair

Dr Emma will advise you on how best to repair your skin barrier and which moistuirsers, balms and wash products to use. This may vary according to how active your skin is and the time of the year.

Immune system control

If eczema is very red and angry, medical treatment to calm inflammation will be required. This can be done in a number of different ways:

Steroid creams or tablets

These may be effective for people who have milder or more localised eczema and can usually be used with side effects, as long as they are monitored carefully. Dr Emma can advise you on how much is safe to use. Steroid tablets can be a quick way of treating more widespread eczema, but is not a longer term option.

Topical calcineurin inhibitors

These are non-steroid creams which can be particularly useful for delicate areas like the face.

Light therapy

Phototherapy uses a very specific band of light to help reduce down the inflammation and may be a useful option to help a flare of more widespread eczema. This would involve coming into clinic for treatment 2-3 times per week for 3 months.

Tablets

In more severe and widespread eczema, Dr Emma may advise that tablets are needed. These are often used to calm the skin’s immune system down. There are a number of different options which will be discussed with you if she feels these are necessary.

Injections

Some of the new eczema treatments come as injections. These are generally used for more severe changes, but are excellent options if you have been struggling for a while with severe eczema.

A Word from Dr Emma

“Eczema is an entirely treatable condition, so if you are suffering, make an appointment to discuss your skin concerns now.”