Eczema

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The word 'eczema' comes from Greek words which means 'to boil over', a description which aptly illustrates the irritation and inflammation of the skin which is caused by this condition and is used as a general term to cover a range of skin conditions all of which have similar symptoms but varying causes and treatments.

How does eczema develop?

To fully understand what eczema is we must first understand the make up of healthy skin and how it differs from eczema prone skin. In a person with healthy skin, the skin on our body acts as a protective barrier which shields us from irritations and infections. It is made up of three layers, the first of which is a thin outer layer, the second of which is an elastic middle layer and the third and final of which is a fatty layer which is thicker than the others.

Each of these three layers is packed full of a combination of skin cells, fats and water, all of which help to protect the skin and maintain it's condition. It is these three key components which help to prevent anything harmful from entering the body as well as ensuring that anything damaging is unable to penetrate the skin. The fat and water will also help to retain moisture as well as preserving our body temperature.

Because eczema prone skin does not produce as many fats as healthy skin, water retention and the protective barrier are less effective. This means that the skins layers are not adequately filled with water and gaps will begin to open up between the cells allowing bacteria and other irritants to penetrate the barrier and cause damage to the skin. If this is the case the skin may become highly sensitised to certain everyday substances such as perfumed liquid soap and washing detergent, which will break down the skin more easily causing it to become irritated and inflamed.

Though the exact cause of eczema is unknown, experts believe that abnormalities in the skin barrier as explained above, and impaired immune system functioning are key factors. In addition, previous studies have revealed that individuals with atopic dermatitis commonly have gene defects which result in abnormalities in certain proteins which play a role in the maintenance of the skins barrier.

As well as the above causes, eczema outbreaks can also be triggered by certain substances, environmental allergens, psychological stress or even changes in humidity.

Types of Eczema

As mentioned previously, eczema is a blanket term which is used to cover several similar skin conditions. There are several types of eczema which have varying causes, the two most common being atopic dermatitis and contact dermatitis.

Atopic Dermatitis

This form of eczema usually begins in the first few months of life and results in red, itchy, weeping lesions on parts of the body where the skin creases such as the front of the elbows and behind the knees as well as on the face, scalp and extremities.

According to research, atopic dermatitis is thought to effect up to one in five children and one in 12 adults and possible causes range from rough and dry skin through to food allergies, dust mites, pet allergies and exposure to certain bacteria. This condition is also thought to be largely inherited.

Contact Dermatitis

This form of eczema is most common among adults and occurs on skin which has come into contact with a chemical substance. There are two forms of contact dermatitis, the first of which is allergic contact dermatitis in which the surface of the skin is damaged by frequent contact with damaging substances such as cleaning products, the second of which is irritant contact dermatitis which occurs when the skin comes into contact with something which removes its natural oils resulting in red, dry, cracked and itchy skin.

Discoid Eczema

Named discoid eczema because the patches of inflamed skin appear in 'disc' shapes. The condition can occur at any age but is most common among adults and older adults and is often difficult to treat in comparison to other forms of eczema.

Seborrhoeic Eczema

Malassezia is a form of yeast which is present on the surface of the skin. Though this is present in everyone, individuals who have seborrhoeic eczema have a higher volume of it on their skin and it tends to cause inflammation on areas which are affected by hair growth such as on the eyebrows and scalp.

Varicose Eczema

This form of the condition affects the skin which surround varicose veins in the lower leg and is most common among elderly adults.

Eczema causes

If you are affected by contact dermatitis then you should attempt to identify what is causing the reaction so that you can avoid it in the future. A patch test with a variety of chemicals will easily help you to establish this and your GP will be able to provide you with further information about this procedure.

Similarly, a skin-prick test or a food allergy test may also help atopic eczema sufferers to identify what it is that is causing their reaction.

Additional causes can range from allergic reactions and low immunity through to a family history of eczema or even stress.

What are the symptoms?

Though there are many different forms of eczema the majority of strains are all accompanied by similar symptoms. Milder cases tend to be accompanied by small patches of itchy, irritated and sore skin and more severe cases often see the skin become inflamed, red, weeping, sometimes developing into crusted lesions and usually affecting creases of the body such as behind the knees and at the front of the the elbows most severely.

Individuals with eczema are also more prone to skin fungal and wart infections as well as herpes and in addition to this, much research has indicated that up to half of all babies who are affected by widespread atopic eczema will go on to develop asthma and rhinitis as their eczema begins to improve.

Eczema sufferers may also find they are hypersensitive to certain irritants such as household cleaning chemicals, perfumed bath and body products, airborne pollutants, changes in temperature and humidity and certain foods and fabrics.

On top of the physical symptoms, long suffering or severely affected individuals may begin to experience a psychological impact. A child of school age may find their self-confidence is knocked when their peers are not understanding of the condition, or a teenagers self-esteem may be dealt a blow because they are unhappy with their physical appearance. If left to manifest these psychological factors can result in the development of depression.

Treatment for eczema?

Though it is not yet possible to cure eczema, there are a number of treatments which can effectively relieve the symptoms. Eczema creams are the most common type of treatment and are available in many different forms, each of which will work differently for each person.

• Antihistamines – Sometimes prescribed during flare-ups or for those who scratch and itch their eczema either during the day or subconsciously whilst sleeping.

• Antimicrobial medicines – Chronic eczema can become infected and if this is the case then antimicrobial medicines such as antivirals, antibiotics or antifungals will need to be prescribed in order to control and eradicate the infection.

• Complementary therapies – Some individuals may decide to use complementary therapy such as chinese herbal medicine, ayurvedic medicine, homeopathy or over the counter remedies to treat their symptoms. Though some individuals do find these helpful, currently very little evidence exists to prove their efficacy.

  If you are considering using a herbal remedy then it is always best to consult your GP beforehand to ensure they are safe to use.

• Creams containing pimecromlimus and tacrolimus – Creams containing one of these active ingredients belong to a fairly new class of medicines known as topical immunomodulators, which are not steroids but help to reduce inflammation of the skin and control flare-ups of atopic eczema.

Both ingredients work by preventing the production of inflammatory chemicals in the skins white blood cells.

• Emollients – These are moisturisers which do not contain steroids and can be obtained in either cream, ointment, lotion or gel form. The aim is to keep the skin moist to prevent cracking and itchiness. Creams are a combination of fat and water and are quite light. The creams tend to contain preservatives so occasionally sufferers can become sensitive to them, though this is rare.

  In contrast, ointments do not contain preservatives and can be extremely greasy. They are good at keeping the water in your skin and are also good for thickening skin. Lotions have a higher water and lower fat content than creams meaning they are thinner in consistency than creams and are also less moisturising. Many eczema sufferers find that lotion works best on hairy areas of the body, and also for the day time when it is not comfortable or appropriate to use thick, heavy and greasy creams and ointments which take some time to sink in.

• Steroid creams and ointments – Often referred to as 'topical steroids' these are creams, ointments and lotions which contain steroid drugs. The steroid inside the cream works to reduce any inflammation in the skin as well as soothing and keeping the area moist to prevent flare ups.

• Toctino capsules – A course of medication which is usually prescribed for severe long-term eczema affecting the hands. The capsules contain the active ingredient alitretinoin, a form of medicine known as a retinoid which is derived from vitamin A.

Experts are unsure as to why it works effectively for eczema but it is thought to be related to a combination of alternations in activity of the immune system in the skin and its anti-inflammatory properties.

Nutritional therapy

We have known for some time now that the nutrients in food can help to prevent numerous degenerative diseases and help to keep our body healthy and in optimum condition. What we put into our bodies can really have an effect on our physical health and it is for this reason that there has been increasing interest in the role that diet plays in the development and management of eczema and its symptoms.

Though a good diet will not be able to cure your eczema and you may still need to keep up additional treatments, it can help to reduce some of the symptoms.

Eczema in children

There are three keys ways in which foods trigger eczema symptoms in children:

1. Increased itching, scratching or rubbing - Sometimes eczema will feel more irritated and itchy after certain foods, causing children to scratch or rub vigorously which may lead to skin damage, inflammation or infection. A good way to identify food triggers is to keep a diary of what you feed your child and when their symptoms flare-up. Also look for obvious signs of swelling and redness around the mouth.

2. Immediate hypersensitivity - Occasionally a child will experience an immediate adverse reaction to a certain food. This may come in the form of a significant rash on the body, swelling or redness and can occur between five minutes and two hours after consumption. Other reactions may include vomiting, wheezing, abdominal pain and in some very severe cases can result in anaphylaxis which can cause a loss of consciousness.

3. Delayed hypersensitivity - If symptoms occur between two and twenty-four hours after eating the food this is known as delayed hypersensitivity. The most common symptoms include abdominal pain, diarrhoea and increased itching and they may last for several hours.

Parents wishing to alter their child's diet should not do so without the correct supervision from either a qualified nutritionist or their GP. As children there are certain nutrients and vitamins which are essential for growth and development so a professional nutritionist will be able to ensure you are not removing anything from their diet which is important.

A qualified nutritionist will be able to help parents plan a nutritional program for their child, removing any foods which are known to trigger symptoms whilst ensuring that the diet remains healthy, balanced, and contains all of the necessary vitamins, minerals and food groups.

Often it can be difficult to get a child to eat well, so eliminating what could be some of their favourite foods may mean you may have to deal with some difficult behaviour. A nutritionist will be able to provide you with ideas for substitutes, treats and mealtime ideas to help make the process easier and will be there to provide ongoing support and motivation and also to monitor your child’s progress.

Eczema in adults

Though diet is thought to play less of a role in adult eczema it is still an important factor. Similarly to that of children, adults should look out for foods which may act as triggers and should try to eliminate these form their diets or at least keep consumption to a minimum.

Some adults who are effected quite seriously by eczema try not to consume foods which have been modified or preserved, so as to minimise the consumption of additives which may cause flare-ups. 

With all of this information it can be difficult for adults to know what the right option is for them and what they need to either eliminate or increase in their diet. If this is the case then sufferers may benefit from consulting a qualified nutritionist, who will be able to work with individuals to create a healthy and nutritious diet programme which could significantly improve eczema symptoms.

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All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional. Whilst some people have benefited from nutritional therapy, no claims can be made to treat, cure or heal specific conditions, and we strongly advise individuals with any health problem to seek independent medical advice from their GP before considering nutritional therapy.