Eczema

Atopic eczema is the most common form of eczema found

Atopic Eczema

The term ‘atopic’ refers to a personal and family tendency to develop eczema, asthma and/or hay fever. While these conditions tend to be hereditary they are not always passed directly from parent to child and may skip a generation.

Atopic eczema is the most common form of eczema. While it can affect people of all ages it is primarily seen in children, affecting 5-15% of UK children by the age of seven. Eczema begins in the first year of life in about 60% of children and within the first five years in 85%.

Most children grow out of atopic eczema as they get older, but it is not possible to say at exactly what age the problem will go away. In approx 65 % of children the eczema has gone by the time they are seven years of age and in approx 74% of children the eczema will have disappeared by 16 years of age. It isn’t possible to tell whether your child will or will not out grow their eczema, although generally speaking those who have the more severe eczema are less likely to grow out of it. However, even children who ‘out grow’ eczema can continue to have ‘sensitive’ skin as adults.

Although we still do not know exactly why atopic eczema develops in some people, research has shown that a combination of genetic and environmental factors play a part.

Atopic eczema can flare up and then calm down for a time, but the skin tends to be dry and itchy even in-between flare ups. It often affects the creases of body joints, such as the backs of the knees or inside the elbows, but in black skins the eczema often affects the front of the knees and elbows. Atopic Eczema can occur in small patches or all over the body.

Spontaneous flare-ups are often the result of triggers. Triggers are not the same for everyone, but there are a number of common ones:

• Soap and detergents
• Skin Infection
• House-dust mites and their droppings 
• Animal dander (fur, hair) and saliva
• Pollens
• Overheating
• Rough clothing

Many people with atopic eczema find that there is a connection between eczema and stress although whether the stress causes the eczema or vice versa is less clear.

Learning what your triggers are can help you to take control of your eczema however it may not always be immediately apparent what has provoked a flare-up.

The chief characteristic of atopic eczema is the ‘itch’ which at times can become almost unbearable leading to sleep loss, frustration, stress and depression. It is crucial to acknowledge that this can affect the whole family, not just the person with eczema.

Although there is currently no known cure for atopic eczema, when well managed it is possible to limit its impact on day to day life.

Contact Dermatitis

Contact eczema, or contact dermatitis as it is more commonly referred to, is the name given to those types of eczema that occur as a result of contact with irritants or allergens in the environment. Contact dermatitis affects 9% of the UK population and is the most common type of work related skin disease (also known as occupational skin disease).

There are two types of contact dermatitis:

Irritant Contact Dermatitis

Irritant contact dermatitis is a reaction to frequent contact with everyday things which irritate the skin, such as soap, detergents, hair cosmetics, bleach, cold wind and raw food. Common sites for irritant contact dermatitis are the hands and face, but the condition can affect other parts of the body. A person who had atopic eczema as a child is at an increased risk of developing irritant contact dermatitis.

Symptoms of irritant contact dermatitis may range from mild dryness and skin redness to the appearance of skin burns. It can be painful, red, fluid-filled and ulcerated. Weak irritants, for example, diluted acids, diluted alkalis, solvents, soaps, detergents, metallic salts, cement, resins and cutting fluids are the commonest cause of irritant contact dermatitis.

Occupations at greatest risk of developing irritant contact dermatitis include: chefs, hairdressers, metal workers, nurses, cleaners and construction workers.

Irritant Hand Eczema (sometimes called hand dermatitis)

There can be a variety of reasons why eczema occurs on the hands. Adults with a history of atopic eczema may find that in later life the condition reappears on their hands as a result of contact with irritants such as detergents, cleaning agents or white spirit. This type of reaction is known as irritant contact eczema and can occur in anyone who regularly uses substances of this kind in their everyday life, as well as those who have a history of atopic eczema.

Allergic Contact Dermatitis

Allergic contact dermatitis is much less common than irritant contact dermatitis. Minute quantities of apparently harmless substances may cause severe allergic contact dermatitis.

Allergic dermatitis is caused by an individual developing a specific allergy to a chemical. For allergy to develop, repeated exposure to the chemical is required over a period of time, usually months or years. Once this has happened, the body’s defence mechanisms learn to recognise the chemical and the individual develops a reaction when the chemical contacts the skin again. The allergy is ‘remembered’ by the body for many years. In medical terms the body has become ‘sensitised’ to a chemical.

The reaction can be immediate or delayed depending on the type of allergen in question. Most frequently seen on the hands, allergic contact dermatitis can cause the skin to become dry, red, split, cracked, weeping, fluid filled and intensely itchy, sore, painful and stinging. The severity will depend upon the allergen and the length of time it is in contact with the skin.

Allergic Hand Eczema (sometimes called Allergic Hand Dermatitis)

Allergic hand dermatitis may occur either on its own or against a background of atopic eczema. The hands are often scaly, dry and itchy and can be accompanied by blistering, soreness or splits in the skin.

Common ‘sensitisers’ include:

• Nickel – found in many jewellery items, studs of jeans, zips and watch straps
• perfumes found in cosmetics and toiletries
• preservatives found in cosmetics, toiletries, topical medicines such as creams, steroids, eye and ear drops. 

Many industrial chemicals also need preservatives:

• phenylene diamine – found in hair dyes is a well known sensitiser
• plants such as primula obconica and chrysanthemums.

If allergic hand eczema is thought to be a possibility then you are likely to be referred to a dermatologist for possible patch testing.

Nickel allergy

Nickel sensitivity is common in the UK, especially in women. Anyone can become allergic to nickel, but more cases begin during the teenage years when girls start to wear cheap metal jewellery. Ear piercing can often start up a nickel allergy.

It is possible, but much less common, to become allergic to nickel later on in life. People who have been in contact with nickel for many years can suddenly become allergic to it for no reason.

We don’t know why some people become allergic to nickel when others don’t. But those with certain jobs are more likely to become sensitive to nickel: these include hairdressing, nursing, catering, cash handling and those handling metals.

Many people notice a red itchy rash under a piece of jewellery, jeans stud or watch strap which can be due to irritation and sweat.

The rash can start in one place or in a number of places on the body at the same time. If the condition carries on for a long time the skin will dry out and become red, scaly and cracked. Normally the rash will appear wherever the nickel is in close contact with the skin, but it is possible for the rash to spread so that later on even areas that haven’t come into contact with the metal become red and itchy.

Once an allergic rash due to nickel has developed on a particular part of the body, it is possible for the rash to spring up again on that site whenever the body comes into contact with nickel, even at a different place on the body.

Gravitational Eczema

This type of eczema is common later in life, particularly in women. If you have poor circulation, have had a blood clot in your legs, have varicose veins or are overweight you are at risk of developing gravitational eczema (also known as varicose or stasis eczema).

Poor circulation means that the blood moves less well up our veins towards the heart. The resulting increase in pressure weakens the vein walls causing fluid to pool in the lower legs making the ankles swell. Blood may then leak through the very small vessels in the legs, causing a dark red or brown patch under the skin. Over a period of time the skin becomes very thin and fragile on the lower legs and can easily break down, leading to an ulcer.

When gravitational eczema is severe the skin can have weeping, crusted areas which can quickly get bigger and become a varicose leg ulcer.

A leg ulcer is a small hole in the skin which can deepen and widen and become very sore. Because of the nature of the wound it can easily become infected and can be difficult to heal especially in those with poor circulation.

Pompholyx Eczema

Also known as dyshidrotic eczema, the key characteristic of this form of eczema is blistering that is restricted to the hands and feet. In particular, the sides of fingers, palms of hands and soles of feet are affected although it can combine with other types of eczema elsewhere on the body. Pompholyx accounts for 5-20% of all cases of hand eczema.

The blisters can break and cause weeping and the skin is very itchy and inflamed. Peeling can occur as the skin dries out. The cause is not known, although factors such as emotional tension, a sensitivity to metal compounds such as nickel, cobalt, chromate, or heat and sweating can aggravate this type of eczema.

Discoid Eczema

Also known as nummular dermatitis, this type of eczema is usually seen in adults with dry skin although it can affect teenagers and young children, but this is rare. It is very distinct with ‘coin shaped’ discs of eczema the size of a fifty pence piece that start off slightly bumpy, usually on the lower legs, trunk or forearms. Within a few days the patches begin to ooze, and can become very itchy, crusted and infected.

Later on, the surface becomes scaly and the centre of the discs clears, leaving the skin dry and flaky. Like most types of eczema the exact cause is not clear, although dry skin is perhaps the most common feature seen in people with this condition. Other factors include the use of soaps and detergents, and previous experience of eczema.

Asteatotic Eczema

Also known as “eczema cracquelée”, this type of eczema almost always affects people over the age of 60. The cause is not known but asteatotic eczema can be linked to a decrease in the oils on the skin surface, low humidity, over cleansing of the skin, hot baths, scrubbing the skin and vigourous towel drying. Pre-existing dryness and roughness of the skin are also linked to this type of eczema.
 

Asteatotic eczema initially appears on the shins with a ‘crazy paving’ appearance. Fissures or grooves can appear which look pink and red, but tend to only affect the superficial layers of the skin. Other areas that can be affected are upper arms, thighs and lower back but it is usually linked to the legs. It can cause a great deal of discomfort including soreness and itching.

Seborrhoeic Eczema

Seborrhoeic eczema in adults

 Adult seborrhoeic eczema usually starts on the scalp as dandruff that can progress to redness, irritation and increased scaling, which becomes seborrhoeic eczema. As the scalp becomes inflamed, the eczema may spread onto the face and neck. Eyebrows, temples, folds at the sides of the nose, and neck are often affected – the area looks red and sheds small white flakes of skin. Seborrhoeic eczema can be particularly bad behind the ears – larger, greasy scales stick to the skin and surrounding hair, making the area look thickly crusted. The ear folds and canal may also be affected, causing irritation inside the ear, which is called ear eczema.

Seborrhoeic eczema often occurs only on the scalp and face, but it can extend to the centres of the chest and back, especially in men. Other areas which can also be affected are the armpits, under the breasts, groin and between the buttocks and genitals.

The cause of seborrhoeic eczema is not entirely clear. However, it has come to light that a yeast called pityrosporum ovale (also known as malassezia furfur) is found on the skin of people with seborrhoeic eczema. At present it is not clear if this yeast is the sole cause or merely a contributing factor to seborrhoeic eczema however it thrives in areas of the body where there are increased numbers of sebaceous glands.

Unfortunately, seborrhoeic eczema does tend to return at intervals, especially when treatment is stopped. With treatment the condition can be successfully controlled in most cases so that the skin and scalp are comfortable much of the time.

Seborrhoeic eczema in children

Childhood seborrhoeic eczema is usually seen in infants under the age of one, seborrhoeic eczema can appear quite suddenly between two and six months after birth. Often the nappy area is affected first, however, it tends to spread fairly rapidly so that the scalp, face, neck, armpits and sometimes even the trunk are soon affected – this may seem rather alarming but don’t worry, it will soon improve!
In the nappy area, the skin looks red, inflamed and flaky – the surface may also feel bumpy due to tiny blisters. The skin scales in this area are small and white, and tend to rub off easily making the skin look shiny. Sometimes it spreads up the body and down the legs, when small round or oval patches are seen, which later join together to form larger red areas.

On the scalp, the scales are larger, greasy and yellowish – they tend to stick to the head making it look crusted. The forehead, temples, eyebrows, back of neck, behind the ears and folds at the sides of the nose are often also affected.

Childhood seborrhoeic eczema is not usually itchy, sore or uncomfortable, so your baby should feed, play and sleep as usual, and hopefully be undisturbed by it.

Web: www.eczema.org