Eczema

What is it?

Eczema, or atopic dermatitis, is a common chronic skin condition which causes red, itchy or dry patches of skin. It is a chronic genetic condition that usually develops in childhood and is caused by a combination of poor skin barrier function, exposure to allergens and a malfunctioning immune response. It usually occurs on “flexural” surfaces of the body (creases), such as the back of knees or inside the elbows).

 

Eczema is distinct from other forms of dermatitis (such as contact dermatitis or stasis dermatitis) as well as psoriasis. If unsure, our diagnostic service can help you determine which condition you have.

What causes it?

The exact mechanism leading to an individual developing eczema is not fully understood, though multiple independent factors can contribute to the disease:

 

  1. Water loss from the skin compromises the skin’s function as a barrier, allowing allergen and bacterial penetration. Eczema sufferers have a genetic predisposition to this while the disease process itself further exacerbates water loss through inflammation.

 

  1. Irregular immune response. In normal patients, an exposure to allergens and bacteria triggers an immune response, leading to localised inflammation.In patients with atopic eczema this immune response is sustained due to errors in immune regulation. 

 

  1. Overgrowth of normal skin-bacteria is found on most eczema sufferers. It is not fully understood but believed to be part of what triggers the inflammatory process in the skin.

 

An impaired skin barrier function and allergic inflammation create a vicious cycle leading to worsening disease severity and preventing recovery.

How to treat it?

Eczema is partially caused by genetics and so is currently impossible to fully cure. However, an effective treatment plan can suppress the flaring of the disease and prevent recurrence.

 

  1. Moisturisers and restoring skin barrier function. A cornerstone of treatment is the regular use of moisturisers. This replenishes lost fluid and prevents further water loss. The use of moisturisers is both an effective treatment and preventative measure and should be used religiously, even while (and after) receiving other treatments.

 

  1. Avoiding exposure to allergens. Exposure to allergens (through direct contact or ingestion) can aggregate the disease. It is helpful to try and identify possible triggers by keeping a diary or records of changes to diet, washing powders, skin products etc.  It is also possible to receive an allergen test (patch testing) through either your GP, NHS services or private medical providers.

 

  1. Steroid creams can be used to suppress inflammation, preventing further compromises to the skin barrier function. Long-term use can permanently weaken the skin, so steroids should be used for brief courses to break the cycle of inflammation. Other oral treatments can be used to suppress the body’s immune system, but are only considered in severe cases.