Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy.
Atopic eczema tends to run in families. The main symptom is itch which can be severe enough to interfere with sleep, causing tiredness and irritability. Typically AE goes through phases of being severe, then less severe, and then gets worse again. Sometimes a flare-up can be due to the reasons outlined below, but often no cause can be identified.
What does atopic eczema look like?
Atopic eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases in the joints at the elbows and knees, as well as the wrists and neck
Affected skin is usually red and dry, and scratch marks (accompanied by bleeding) are common.
What makes atopic eczema flare-up?
- Many factors in a person’s environment can make AE worse; these include heat, dust, woollen clothing, pets and irritants such as soaps, detergents and other chemicals.
- Being unwell, for example having a common cold can cause a flare-up.
- Infections with bacteria or viruses can worsen AE. Bacterial infection (usually with a bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment. An infection with the cold sore virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare-up of AE, with weeping small sores.
- Dryness of the skin.
- Teething in babies.
- In some, food allergens may rarely cause a flare up
Regular use of medical moisturisers can help restore the skin’s barrier in children
How can atopic eczema be treated?
‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical, although for more severe eczema some people need to take ‘oral’ medication (by mouth) as well.
‘Complete emollient therapy’ is the mainstay of treatment for all patients with eczema as the most important part of their treatment – this means regular application of a moisturiser (also known as an emollient) and washing with a moisturiser instead of soap (known as a soap substitute).
Moisturisers (emollients): These should be applied several times every day to help the outer layer of your skin function better as a barrier to your environment. The drier your skin, the more frequently you should apply a moisturiser. Many different ones are available, varying in their degree of greasiness, and it is important that you choose one you like to use. The best one to use is the greasiest one you are prepared to apply. Moisturisers containing an antiseptic may be useful if repeated infections are a problem.
Topical steroid creams or ointments: These will usually improve the redness and itching of AE when it is active. They come in different strengths and your doctor will advise you on which type needs to be used, where and for how long.
Antibiotics and antiseptics: If your AE becomes wet, weepy and crusted, it may be infected and a course of antibiotics may be needed. Antiseptics, when applied to the skin alone or as part of a moisturising preparation, can be helpful in stopping the infection.
Topical calcineurin inhibitors: Calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream, may be used when AE is not responding to topical steroids, or in skin sites which are more susceptible to the side effects of steroids, such as the face, eyelids and armpits and groin. The most common side effect is stinging on application but this normally disappears after a few applications. They are associated with an increased risk of skin infections and should not be applied to infected (weeping, crusted) skin.
A maintenance regimen using intermittent calcineurin inhibitors (see below) is useful in patients who have frequent flare-ups of AE.
Antihistamines: Antihistamine tablets can be helpful in some patients
Other treatments: People with severe or widespread atopic eczema not responding to topical treatments may need oral treatments (taken by mouth). These work by dampening down the immune system and are given under the close supervision of a dermatologist.