It's estimated 15 million people in the UK are living with eczema and while for some it’s a minor if unsightly irritation, for others it’s an intolerable burden that takes a huge physical and psychological toll. Some people call it eczema, some dermatitis. Whatever the label, the impact on wellbeing can be devastating.
Who is most at risk of eczema?
Anyone of any age. But children are more susceptible; one in five suffer with it compared with one in ten adults. It often runs in families and if one first degree relative has it, there’s a good chance other family members will be affected too. The classic triggers include emotional distress, the strain of caring for a loved one, poor general health and financial pressure.
The good news is many children grow out of it and once they have passed the age of five a sizeable proportion will be clear of eczema. But they can still be left with sensitive skin which means eczema can return later on in life.
Those at the other end of the age-scale are also commonly affected – especially the over sixties. This is because, as the body ages, the make up of the skin changes and it becomes much drier and more susceptible to eczema.
What causes it?
It begins when your skin fails to produce enough fats and oils to keep it healthy. It needs these so the outer, protective barrier can keep moisture in. Without that barrier, moisture escapes and the skin begins to dry out, causing itching that can be so bad it can feel overwhelming, especially for children.
In mild cases, it leaves the skin dry, red, scaly and very itchy. But if it’s severe the skin may start weeping and become crusty. Scratching, which can be hard to resist, may make it bleed. As a result, the skin breaks down more easily, dries out and then reacts more quickly when it’s in contact with soap, detergent, dust and other substances.
“With most people who have eczema there’s a genetic link,” explains Julie Van Onselen, a dermatology nurse specialist. “Atopic eczema is the most common type and we know that runs in families – it’s the same gene that carries asthma and hay fever.”
“Even if you don’t have the gene, you can have eczema that has been set off by environmental triggers.”
Triggers that irritate eczema
Some of the most common culprits for making eczema worse are soaps, shampoos, detergents and bubble bath. “Soap and detergents are real enemies of eczema,” explains Julie Van Onselen. Instead, use soap alternatives or emollients especially for your hands that may have to be washed several times a day.
“We recommend that people with eczema have a daily bath or shower, but you need to use emollients rather than soap,” adds Julie. Emollients are moisturisers that help to reduce the loss of water through the skin and provide a protective covering. Emollients are a vital part of eczema treatment and should be prescribed by a GP for children, older people, and anyone with severe eczema.
Changes in temperature are particularly bad for your eczema, especially going from cold to hot – from outside, for instance, to a centrally heated building in the winter. This is because the change in humidity can aggravate the irritation. “Try not to get too hot or too cold, as this triggers changes to your blood vessels which make your skin itch more,” says Maureen Jenkins, Allergy UK’s Clinical Director. “Sitting near a window that opens can help you keep your temperature even.”
Fabrics like wool or synthetic materials can also make it worse if they’re next to the skin, so stick to materials such as cotton and silk. “Wearing lightweight layers is a good idea,” says Maureen Jenkins. " People with eczema lose a lot of moisture through their skin, so drink plenty of water, and use lots of moisturizer.”
Even house dust mites, pollen, mould and pets – usually thought of as triggers for asthma - can set your eczema off. “Using a very efficient vacuum cleaner, which has a good system for picking up and filtering dust and dirt, and keeps the allergen contained, can help with this,” says Maureen Jenkins.
Don’t forget about food allergies, like peanuts, wheat, eggs and cow’s milk, which can make your skin sore and itchy. “If you think you may be allergic to foods, it’s important to know what you’re allergic to,” explains Maureen Jenkins. “ Ask your GP for a referral to a dermatologist or allergist.
When you need more help
If using emollients isn’t helping to reduce your symptoms your doctor may well prescribe topical steroids – these are steroids that you put on your skin.
“Topical steroids are first-line treatments for eczema flares,” says Julie Van Onselen. So don’t be afraid to use them to control eczema. Generally, they’re prescribed taking into account the age of the person, the severity of the eczema, and the area of the body that’s affected.
“In some cases, you might need two different steroid treatments, a mild to moderate one, for use on your face, and a more potent one for your body.”
Steroids are often prescribed to patients to help treat and control eczema flares. Usually, they are prescribed for short periods to get the eczema under control. It’s important to use steroids as prescribed – don’t stop using them without talking to your doctor first.
If the emollients and steroids aren’t controlling your eczema, talk to your doctor about a referral to a dermatologist. They will have more treatment options to deal with difficult cases of eczema. These include further treatments to apply to your skin, light therapy and drug therapy.