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Eczema Fact Sheets

Eczema Fact Sheets

WHAT IS ECZEMA?
Eczema is an allergic condition which affects the body’s largest organ – the skin. The skin becomes dry, red and itchy. Eczema can appear anywhere on the body, although it often appears on the face, inner elbows, back of knees, hands and neck. In severe cases, swelling, crusting, blistering, cracking, bleeding and weeping may occur. There is the chance that skin may become infected. 

Eczema is non-infectious and is prevalent in families whose members also have hay fever or asthma. Two-thirds of eczema patients have a family history of an allergic condition. It can be triggered for a variety of reasons including allergic reactions and environmental factors.

Eczema affects a third of all Australians at some time in their life, with atopic eczema being the most common type. It can occur at any age but usually appears in babies up to 12 months old. They usually grow out of the condition by the time they are 6 years old.

 

THE MAIN TYPES OF ECZEMA
Different types of eczema can have different triggers and symptoms. 

Atopic Eczema
This is the most common type of eczema and the number of people with atopic eczema has been rising in recent years. It is extremely itchy, recurring and tends to run in families with asthma, hay fever or food allergies. It usually affects babies, but can also occur in older children and adults. In infants the rash tends to develop on the face, neck ears and torso. In children and adults it is more likely to appear on the hands, elbows, knee and wrist joints, ankles, chest, eyelids, neck and face. Controlling scratching can be a challenge, especially at nighttime. Wearing cotton gloves, or clothing with mitts helps minimise scratching. 

Symptoms include moderate to severe itching; a dry red rash or cracked skin; lesions weeping watery fluid; thickening of the skin; skin infections as the result of infected lesions.

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Contact Dermatitis
This is caused by contact between the skin and some substance. If exposure to the offending substance is avoided, contact dermatitis is preventable. There are two main types of contact dermatitis: irritant and allergic. 

Irritant dermatitis is direct irritation of the skin brought on by repeated irritation from a substance. It can affect different areas of the body and a stinging or burning sensation usually happens within seconds of exposure. If prolonged exposure to a mild irritant occurs, a chronic form of contact dermatitis can occur which can lead to the skin cracking. Examples of irritants are soap, bubble bath, sweat, saliva and even water (“dish pan hands”). 75% of cases of contact dermatitis are of the irritant type. 

Allergic dermatitis is a sensitivity or allergy to a specific substance. It usually affects only the area of skin which came into contact with the trigger and can take anywhere from several hours to 3 days to appear. For example, dermatitis of the earlobes can be caused by earrings containing nickel.

Hand eczema
As the name suggests, this form of eczema is limited to the hands. It comes and goes in cycles and can be related to atopic eczema or it can be caused by repeated wetting, drying or exposure to strong chemicals. Hand eczema can also be caused by an allergy, such as a latex allergy. Certain jobs may aggravate the eczema due to constant hand washing. Examples are nursing, hairdressing and food handling. Stress is also thought to be a trigger for hand eczema.

Seborrhoeic dermatitis
Seborrhoeic dermatitis causes red or flaky skin, usually in areas with hair or skin creases such as the neck, face, around the nose and scalp line. The name seborrhoeic comes from the sebaceous glands which make oil to keep the skin lubricated. It creates a greasier rash than is usual for eczema conditions. Seborrhoeic dermatitis can occur on the scalp and in adults causes dandruff and in babies cradle cap. 

Statis dermatitis
This type of eczema tends to affect older people over fifty, particularly women. You are at risk if you have poor circulation, have had a blood clot in your legs, have varicose veins or are overweight. 

It affects the ankles, calves and feet and often appears as speckled skin which is dry and itchy. The skin irritation is caused due to fluid accumulating under the skin. Statis dermatitis is treated with emollients and steroid creams, and by taking measures to improve circulation. If left untreated, the skin can break down, resulting in an ulcer.

Nummular eczema (often referred to as discoid eczema)
This type of eczema causes round, coin-shaped lesion. It is most common in adults in their 60s and 70s, but can occur less frequently in teens and 20s. It is rare in children. It appears most commonly on the legs, but also on the arms, hands and chest. It may start as one or several lesions and usually recurs around the site of the initial outbreak. New lesions may be weepy and form a crust, while older lesions appear scaly. The patches of eczema often contain tiny bumps and blisters, which may merge together into large patches. The eruptions are intensely itchy but they may also burn or sting. The cause of nummular eczema remains unknown, but some possibilities are the combination of a few irritation factors at once. Often it is worse when the weather is cold and dry and better when it’s warm and humid.

Asteatotic eczema
This type of eczema usually affects people over 60 years and is linked to a decrease in oils on the skins surface, over cleansing, hot baths, low humidity, and vigorous towel drying of the skin. It usually appears on the lower legs where there are fewer oil glands, but can also appear on the upper arms, thighs and lower back. It causes fine cracks in the skin which look pink and red, but tend to only affect the superficial layers of the skin. It causes soreness and itching. 

WAYS TO MANAGE YOUR CHILD'S ECZEMA AT SCHOOL
A child with eczema has added challenges to face. The management of their health needs to be a team effort between parents, teachers and the child. It’s a good idea to meet with a teacher to outline your child’s health issues. Most teachers will be obliging in their efforts to help. Recommendations should be made which will assist in the management of your child’s eczema, reduce flare-ups and minimise any embarrassment or teasing.

Topics to discuss with your child’s school and teacher
• The use of emollients. Provide your child with a container of emollient to keep with them. Put the emollient into a fun container which they like using. They may wish to decorate it themselves. This makes the application of emollient seem less of a medical nature to them and their friends. Younger children may need encouragement from a teacher to apply emollients.
• Explain that your child may need additional time around sports activities to apply emollients, either before swimming or after showering.  
• Arrange for your child to leave the classroom if they are having an itching attack. They may need a quiet place to sit, calm down and apply emollient. Keeping a clean flannel in their schoolbag is a good idea as they can run it under cool water and apply it to the skin to reduce the itch. 
• Children with eczema need to avoid contact with children who have cold sores and shouldn’t share drink bottles. Catching the infection can result in eczema herpeticum which is a serious viral illness. 
• If your child is taking antihistamines which make them drowsy, let their teacher know. Or if they are not sleeping well due to the itch, explain that they may be tired and grumpy in the afternoons. 
• If your child has anaphylactic reactions, ensure all teachers know. Modifications may need to be made in classes such as cooking, or a child may need to be excused from attending certain lessons to avoid contact with the allergen. If the child is using the school canteen, they also need to be aware of the condition and measures may need to be taken when preparing food. 
• If your child’s school uniform is aggravating their condition, some modifications may need to be made. Where possible, they should wear 100% cotton clothes. This includes shirts, dresses, socks and under clothes. 
• If your child is being teased, becoming withdrawn or depressed as a result of their eczema, they may require counselling. Some schools offer this service for free or you may wish to consult with a professional counsellor outside the school system. Teachers need to be made aware if bullying is occurring so they can take action. 
• As itching gets worse with heat and sweat, ask if your child can sit away from sunny windows and heaters. Sitting in the coolest part of the room would be of benefit. 
• Ensure teachers understand that your child may find sporting activities embarrassing and that overheating can provoke symptoms. You may need to get permission for them to leave certain sporting events early if their skin is becoming irritated. It is best to try not to exclude them altogether as exercise is good and it is important that they do not feel isolated from their classmates. 
• Some activities in art and technical classes may need to be avoided such as pottery or those using strong solvents, glues, or chemicals. Supply your child with cotton gloves they can wear to minimise exposure to these irritants. They should also avoid using soaps and detergents on their hands. 
• If going on a school excursion with bunk beds, ensure your child sleeps on the top level as dust mites will shower on to the bed below. 
• School-related stress can aggravate eczema. Measures should be put in place to keep stress to a minimum.
• Each year you should update your school on the progress of your child’s allergies. Let them know of any new allergies, triggers, treatments, medications and dosages. 

AVOIDING ECZEMA TRIGGERS
Triggers vary from person to person, however there are some main culprits. Print out the sheet from the Trigger Tracker link and write down when reactions occur. This will help you work out what may be causing your eczema so you can avoid it in the future. Please note that with some triggers such as food, reactions may not appear immediately and could take up to two days to manifest. Please talk to your doctor about your eczema and the triggers.

Avoiding skin irritants and triggers
Certain internal and external factors may trigger eczema. These include:
• Certain detergents, soaps, shampoos, cleaning products, laundry powders, cosmetics and chemicals
• Fabrics such as wool, nylon and acrylic
• Dust mites, pollens, moulds
• Exposure to tobacco smoke
• Foods, alcohol, preservatives, colourings and chemical food additives
• Pets
• Emotional stress
• Heat, sweat and rapid changes in temperature

Detergents, soaps, cleaning products
It is recommended to avoid using soaps, bubble baths and detergents. Instead use a non-soap cleanser and bath/shower emollient which is kind to sensitive skin. Take short lukewarm baths and showers rather than long hot ones, as they can dry out the skin and cause irritation. 

When washing clothes, it is best to eliminate washing powder/liquid which may cause a reaction. This can be done through the use of Envirodiscs (see the Laundry Care section of The Allergy Shop for more details). If using washing powder/liquid, choose your powder/liquid carefully and rinse clothes well. When buying products, look for those which are fragrance free or for sensitive skin.

For housecleaning and deodorising, a range of chemical free cleaners are now on the market. Choose ones which are natural and scented using essential oils rather than synthetic fragrances. Or you can make you own. 

Clothing
When choosing clothing, it is best to wear either organic cotton, 100% cotton, or bamboo clothing. Cotton and bamboo clothing breathe well and reduce sweating (which can be an irritant). Avoid wearing wool, synthetic materials and tight clothing, as they can make the skin feel itchy and irritated. Unpick labels so they don’t aggravate the skin and wash new clothing before wearing to remove any residual chemicals and to make them softer. 

Tops and sleepsuits with in-built mitts help to control scratching in babies and children (especially during their sleep). Sleepless nights can have adverse health affects for both the child with eczema and their parent/carer. Choosing sleepwear with Natural Silver Soothe removes bacteria overgrowth (see more information about Natural Silver Soothe in the information panel on The Allergy Shop homepage). An overgrowth of bacteria and micro-organisms can lead to allergic reactions and infections. Bamboo clothing also has anti-bacteria properties. 

Dust mites, Pollens, Moulds
House dust mites may be a trigger. They are tiny, can’t be seen with the naked eye and love warm, damp conditions. They feed on mould and skin flakes. Every home has them and they are impossible to remove totally, although they can be reduced significantly. Eczema, asthma and allergic rhinitis (a runny nose) often improves dramatically when allergic individuals take avoidance measures. 

They are mainly found in bedding, mattresses, lounges, other soft furnishing, carpets and clothes. They thrive in undisturbed environments such as where winter clothes are stored. 

Ways to reduce dust mites are: removing carpet and rugs from the home (especially the bedroom), using dust mite covers on mattresses, doonas and pillows, avoiding feather-filled pillows and doonas, frequently washing and changing bed linen, vacuuming regularly (including under the bed, mattresses and lounges), keeping clutter in the house to a minimum, avoid stuffed toys unless they are allergy friendly (see the Anti-allergy toys section of The Allergy Shop for more details). Freezing stuffed toys also helps kill dust mites (put toys in a plastic bag and freeze overnight). 

Dust mites love cushions and curtains, so if possible they should be removed. If you need to use fabric curtains, choose ones which can be washed at 55-60 degrees celsius. When choosing soft furnishings such as a lounge, it is best to choose leather or one with removable, washable covers. 

When vacuuming, HEPA (High Efficiency Particulate Air) filter vacuum cleaners are best as they reduce the allergens put back into the air from the vacuum cleaner. HEPA filters remove 99.97% of particles bigger than 0.3 micrometers in diameter and even a higher percentage of larger particles. HEPA filters  are also used in air purifiers, reducing allergens such as dust, pollen and mould from the air in homes.

Some people are allergic to pollens and moulds. There are two main types of pollens – grass and tree pollens, whereas mould is mostly found in compost heaps, indoor plants and rotting vegetation. Compost heaps should be kept covered. The use of an air purifier will improve air quality in the home by reducing pollutants from house dust mite, pollen, pet dander, tobacco smoke, fumes and gases. Keeping rooms well ventilated helps reduce mould growth.

Food Allergies
Allergies and intolerance to food can be a major factor in people with chronic, persistent atopic eczema. Although food allergens vary from person to person, the most common foods triggers for eczema are: cow’s milk, wheat, fish and shellfish, eggs, soy and nuts. See an allergist for diagnosis. Some hospitals have allergy clinics and can diagnose allergens through skin prick tests, food exclusions diets and the keeping of a food diary. There are also a number of independent companies and therapists who conduct food allergy testing.

Another important diet factor for eczema sufferers is striking the right balance between Omega 6 and Omega 3 essential fatty acids. This is vital in treating eczema. The first sign of essential fatty acid deficiency is eczema and other chronic skin problems. Having these two essential fatty acids in balance reduces the risk of inflammation and aids cellular hydration. A lot of people have too many Omega 6 fatty acids in their body and too little Omega 3s. There should be a ratio of 3:1 (3 times the amount of Omega 6 to Omega 3). With our modern diets and lifestyles, often the ratio is around 16:1 (16 times the amount of Omega 6 to Omega 3). Omega 6 is found in oils such as sunflower oil, safflower oil, corn oil, cottonseed oil and evening primrose oil. Omega 3’s are found in fish and fish oils, canola oil, flax seeds and flaxseed oil, walnuts and walnut oil, dark green leafy vegetables and soyabeans. If you don’t get enough Omega 3’s in your daily diet, supplements can be taken. 

Pets
Cat and dog dander (small scales from animal hair, skin or feathers) along with their saliva and urine can cause an allergic reaction in some people. Special steps need to be taken as pet dander can remain for up to six months after the pet has been removed. 

The best treatment is avoidance, but if this is not possible, the best steps to take are: give pet dander treatments when bathing your pet, shampoo the pet once a week, keep the pet outdoors or only allow it into a few rooms of the house (not the allergy sufferers bedroom), keep the pet off furniture and discourage hugging and kissing of the pet because of allergens found in the saliva and fur.

Whilst the hair of cats and dogs is not considered to be big allergen, it can increase exposure to other allergens by collecting dust, mould and pollens. Comb long-haired pets regularly to remove loose fur. 

Pet litter boxes should be kept away from the air supply of the house and should be avoided by allergic individuals. Clothing should be removed and washed after playing with your pet, and clothing with animal dander should not be kept in the bedroom. Wash your hands, arms and face after playing with your pet. Droppings from other common caged pets such as birds, rabbits, guinea pigs and mice can be the source of bacteria, dust, fungi and mould.

Emotional Stress
Stress in adults:
Prolonged emotional stress can trigger eczema and itching. It is important to find ways to reduce and manage stress levels. However, eczema can cause emotional stress, affecting an individuals self-confidence, social life, work and relationships. Eczema sufferers therefore often find themselves stuck in a vicious cycle. 

To try and break out of this cycle, it is important to exercise regularly, eat a nutritious healthy diet, get enough sleep, create and maintain happy and fulfilling relationships with others, and to take time off to rest and do the things you love. You should also be kind to yourself trying to maintain a positive inner self-dialogue (for example, rather than saying “I look and feel awful and I am embarrassed by my eczema” turn it into a positive statement such as “I am feeling better than yesterday and I am looking forward to seeing my friends”). 

Other methods for de-stressing are: positive visualisation, meditation, yoga, massage, counselling and hypnotherapy. If you are in a relationship or job which is making you unhappy, it is also important to address this issue as it will be causing daily stress. 

Stress in children: Children also experience emotional stress which can have a negative impact on their eczema. Develop a routine to help your child cope with their eczema explaining how foods, certain clothing, emollients and medications help their condition. Explain to them what triggers an outbreak and the importance of avoidance. Let them know that most children outgrow the condition and that over time their eczema should improve. 

Teasing may occur at school, so it is important to have an open dialogue with your child to gauge if this is happening. If it is, you could talk to the school to make them aware of the problem. You could also teach your child ways to talk to their peers about their eczema and answer questions they get asked.

Heat, sweat and rapid changes in temperature
Many people find that heat triggers their eczema. Wearing natural fibres such as 100% cotton, organic cotton and bamboo clothing will keep you cool. Synthetic fabrics can make you hot, sweaty and itchy. If sweat triggers your eczema, try doing exercise which doesn’t makes you sweaty – swimming is a good option. If you do get sweaty exercising, have a shower and moisturise as soon as possible afterwards. 

Also try to avoid going from one extreme temperature to another, such as in winter going from a warm heated room, into the cold outside, back into the warm heated room and so on. 

When showering and bathing, ensure the water is lukewarm rather than hot. And when sleeping, make sure you use the appropriate amount of bed covers so you do not overheat.

ADOPTING A MOISTURISING REGIME TO HELP PREVENT INFLAMMATION
Maintaining hydrated skin is very important in controlling eczema, reducing the itch and avoiding flare-ups. Applying emollients helps relieve the symptoms and is most effective when applied within 3 minutes of patting the skin dry after bathing. The skin doesn’t need to be completely dry, it can still be moist. The quick application helps lock in the moisture. 

Emollients are lotions, creams, ointments and bath/shower oils which stop the skin from becoming dry. You should apply them as often as you need. This will vary from person to person and could be twice a day or several times a day. 

• Use emollients every day when the skin is both good and bad. Maintaining use when the skin is good avoids further flare-ups. 
• Choose an unperfurmed and hypo-allergenic emollient. It may be a bit of trial and error to find one that best suits your skin.
• Bathe with a emulsifying oil (fragrance free) as it will help absorb some of the moisture from the bath. The bath will be greasy, so take care when getting in and out that you don’t slip.
• After bathing babies/children and applying emollient, they may be slippery, so handle with care.

THE USE OF STEROID CREAMS, OINTMENTS, LOTIONS, MEDICATION AND OTHER TREATMENTS
Topical steroid creams, ointments and lotions
Steroid creams and ointments can be bought over the counter or by prescription. They work by reducing inflammation in the skin. Over the counter creams and ointments are for mild cases of eczema, whereas prescription ones are for moderate to severe cases. The greater the strength, the more effective they are at reducing inflammation, but the higher the side-effects associated with long-term use. Topical steroid creams and ointments should be used as per the product instructions until the eczema has completely disappeared. The treatment duration varies from person to person. 

A mild strength steroid might be used first. If the eczema is not disappearing, a stronger topical steroid might then be prescribed. A person may use a combination of different strengths for different areas of the body (the strongest topical steroids should not be used on the delicate skin of the face). Some people with recurrent and chronic eczema, may prefer applying a strong topical steroid from the outset. 

Topical steroids should be used only on the area of skin affected by eczema and the amount of cream/ointment kept to a minimum. The use of emollients should continue when using topical steroids. 

Creams vs Ointments vs Lotions: Creams are good for treating moist or weeping areas of eczema. Ointments are suitable for dry, thickened areas of skin. Ointments are also good for areas which come into contact with water (such as the hands) as an ointment is less likely to wash off. Lotions are good for treating the scalp as application is easier due to the large amount of hair. 

Side-effects of topical steroids: Side-effects can occur with repeated long-term use. Short periods of correct application usually cause no problems or side-effects. External side-effects include thinning of the skin and damage. After repeated use, skin may look “prematurely aged”. Stretch marks may appear, skin may bruise and tear and blood vessels may become enlarged. If high strength topical steroids are used for a long period of time, sufficient steroid may be absorbed through the skin to cause internal problems. These can include adrenal gland suppression, diabetes and raised blood pressure. 

Oral steroids
Taking steroids by mouth is occasionally used to treat a flare of chronic atopic dermatitis which won’t clear using other methods.

Topical calcineurin inhibitors
Topical calcineurin inhibitors are non-steroid topical medications developed to treat mild to moderate eczema. They do not cause skin thinning and can be used anywhere on the body, although due to their expense are usually reserved for use on the delicate areas of the face, eyelids and neck. They are approved for use in patients over 2 years old and should only be used for short-term flares of eczema. The effect of long-term use is not yet known, so they are usually only prescribed if topical steroids haven’t been successful in eczema management. 

Antihistamines
Antihistamines can be effective at reducing itching, scratching and eye allergies. Some brands make you drowsy, so can be good at aiding sleep when nighttime scratching is a problem. Monitor the results and choose the right brand for you or your child. 

Antibiotics
If eczema gets infected during a flare-up, a course of antibiotics may be needed. This will be in addition to usual topical treatments. It is best to discard the topical creams and ointments you were using during the infection and buy new supplies (in case they are contaminated). 

OTHER TREATMENTS
Wet wraps
When other therapies are not effective, wet wraps can often have great results. They re-hydrate and calm the skin, reducing redness and inflammation. Some patients report the feeling of “the itch leaving their body” when the wet bandages are applied. The skin is overdosed with moisture to keep it supple and if topical steroids are used, they are more readily absorbed assisting healing. 

Topical steroids and/or emollients are applied to the skin which is then covered with a layer of warm wet bandaging. Treatment may differ slightly from patient to patient to suit individual needs. An example of application would be soaking in a bath with emollient, moisturising the skin and applying a suitable topical steroid before application of the wet bandages. The bandages are generally soaked in warm water before application and can be applied to any area of the body including the face (get your doctors advice before applying topical steroids to the face). To maintain the moisture in the bandages, keep clothing dry and prevent scratching, dry bandages are then wrapped over the wet ones. 

Wet wraps are usually only used for a few weeks to get severe eczema under control (they can assist with sleeping as the skin is less itchy and moist for longer). The drawbacks of wet wraps are that they are time consuming and may be difficult to apply (especially to a child). However the results can be well worth the effort and patience involved. 

A quick and easy option is to buy ready-made Tubifast Garments for wet and dry wrapping (they can be found in the Wet Wrap Garments category of The Allergy Shop). They are available in long sleeved vests, tights, leggings and socks. They are convenient and simple to apply and can be worn under sleepwear and ordinary clothes. Tubifast garments are suitable for all ages 6 months and over.

Ultraviolet light therapy
This therapy is known to suppress the immune system and reduce inflammatory responses. Your dermatologist will calculate precisely how much UVB light your skin should be exposed to, then it will be administered as you stand in a UVB cabinet for a period of a few seconds to several minutes. Treatment is carefully controlled by a team of health professionals. It is reserved for patients not responding to other treatment methods as described above.

Treating Constipation
If you have constipation in addition to eczema, treat the constipation first and see if your skin improves. If the bowel is not removing waste products efficiently, the skin may suffer as toxins are released into the body. 

Complementary Medicine
Complementary medicine can be successful in treating and improving eczema and is often used in conjunction with other traditional treatments. Let your doctor know if you are planning to start complementary medicine to check it won’t interact with other medications. 

There can be varying results from person to person, so it is important to find what your body best responds to. Ensure that the practitioner is qualified and registered with their professional association. Options include: chinese herbal medicine; kinesiology; acupuncture; hypnotherapy; naturopathy; homeopathy.