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The Evolutionary Perspective
Category Archives: Eczema
Posted: May 11, 2017 at 12:24 pm
Having a little one with eczema is hard enough, but finding a sun cream to protect their vulnerable skin can be a minefield.
As with eczema creams, finding the right sunscreen is a matter of trial and error - as what works with one child, won't work for another.
However, there are some pointers that families can follow to give them a better chance of finding the right one.
As part of Sun Awareness Week, we've been taking a look at the advice to follow.
The National Eczema Society (NES) says parents should consider the same things that you would when choosing an emollient - for example, it is recommended that you avoid fragrance and other ingredients that are commonly associated with sensitisation.
Ingredient labels on products will help you to avoid substances to which you have a known sensitivity, but you should always be careful and make sure that you test any new sunscreen, in advance of going away, by dabbing a test area on the forearm before applying it to the whole body, just in case it causes a reaction or stings.
It is recommended that you do this once a day for five days as sensitisation can take some time to develop. It is also recommended that you patch test creams that you have used in the past since the formulation, or indeed your skin, may have changed.
There are two types of sunscreen:
1. Chemical absorbers, which absorb UV radiation.
2. Mineral-based reflectors (usually titanium dioxide), which reflect UV radiation.
Many people with eczema seem to find that mineral-based sunscreens are less irritating to their skin than chemical absorbers.
The NES does not recommend any one sunscreen product as what suits one person does not necessarily suit another, but it does give a number of suggestions for mineral-based, unfragranced products which 'seem to suit many people with eczema'.
It is recommended that any emollient is applied half an hour before sunscreen.
This is to prevent the sunscreen from becoming diluted by the emollient and to ensure that the sunscreen keeps its protective properties.
If you are using a moisturiser that is greasy or oily, be careful not to overdo the application of the moisturiser as this can cause a frying effect in the sun.
A better solution may be to use a UV sun suit to minimise the need for sun creams.
Practical advice and tips
When it comes to swimming some children's skin can face further irritation.
Dryness of the skin after swimming is likely to occur if the pH of the pool water is raised. Chlorine can also cause dryness, but since it is a bleach, and recent research in eczema has recommended diluted bleach as a way of reducing bacteria on eczematous skin, it is not all bad.
Suggestions for avoiding swimming-related skin problems
Avoid swimming if the eczema is flaring badly.
If swimming indoors, apply your usual emollient cream or, better still, an emollient ointment, before entering the pool. It is a good idea to put on more cream than you usually would, so that it acts as a good barrier to the water.
Apply emollients about half an hour before applying sunscreen this will prevent the sunscreen becoming diluted by the emollient and ensure that the sunscreen keeps its reflective properties and protects your skin. Try not to overdo your emollient when outdoors as it may produce a frying effect in the sun if it hasnt been properly absorbed.
As soon as possible after swimming, shower off using your usual emollient wash/oil/gel. Then apply more leave-on cream than usual. (If the pool showers use chlorinated pool water, it is best to go home and take a shower/bath immediately you get there.)
Continue reading here:
The best sun creams for babies and children with eczema - Manchester Evening News
Posted: May 9, 2017 at 2:59 pm
The team at Newcastle University, in collaboration with scientists at Stiefel, a GSK company, have identified how a key skin barrier protein called filaggrin impacts on other proteins and pathways in the skin, which in turn drive the development of eczema.
This has also lead them to identify potential targets for future drug development which could treat the underlying cause rather than treating the symptoms.
Atopic eczema is one of the commonest skin conditions in the UK, affecting up to 10% of adults and 20% of children in the UK. Its more common in children, often developing before their first birthday and often persists into adulthood with severe itching that has profound effects on well-being and may lead to sleep disturbance.
The research builds on the important discovery by scientists in Dundee which showed that lack of the protein filaggrin in the skin caused an inherited dry skin condition known as ichthyosis vulgaris that is strongly linked to the development of atopic eczema, as well as other allergic diseases such as hayfever and asthma.
Nick Reynolds, Professor of Dermatology at Newcastle University who also sees patients with skin conditions including eczema at Newcastle's Royal Victoria Infirmary, is the lead investigator of the study. He said: We have shown for the first time that loss of the filaggrin protein alone is sufficient to alter key proteins and pathways involved in triggering eczema. This research reinforces the importance of filaggrin deficiency leading to problems with the barrier function in the skin and predisposing someone to eczema.
New skin model
Publishing in the Journal of Allergy and Clinical Immunology (JACI), researchers at Newcastle University, in collaboration with scientists at Stiefel GSK, report on their development of a human model system. In this, the upper layer of skin (epidermis) was modified, using molecular techniques, to become filaggrin-deficient, directly mimicking the situation observed in the skin of patients with atopic eczema.
This model enabled the team to discover proteins and signalling pathways directly down-stream of filaggrin, and most importantly, identified a number of key regulatory mechanisms. These included regulators of inflammatory signalling, cell structure, barrier function and stress response. These pathways were found to map to those networks observed in the skin of people with active eczema.
This mapping provides researchers with new understanding of the mechanisms involved and suggests targets for future drug development.
Nina Goad of the British Association of Dermatologists said: This latest research from Newcastle is crucial as it expands on our knowledge of how filaggrin impacts on other proteins and pathways in the skin, which in turn trigger the disease. This type of research allows scientists to develop treatments that target the actual root cause of the disease, rather than just managing its symptoms. Given the level of suffering eczema causes, this is a pivotal piece of research.
Elias, M., Long, H., Newman, C., Wilson, P., West, A., McGill, P., Wu, K., Donaldson, M. and Reynolds, N. (2017). Proteomic analysis of filaggrin deficiency identifies molecular signatures characteristic of atopic eczema.
This article has been republished frommaterialsprovided byNewcastle University. Note: material may have been edited for length and content. For further information, please contact the cited source.
Posted: at 2:59 pm
For the first time, scientists have pinpointed a bunch of processes that go wrong in the skin for people who have eczema (also known as atopic dermatitis), and it could help us finally figure out how to combat this chronic condition.
Back in 2006, researchers found a strong link between people lacking in a certain skin protein, and the risk of developing eczema. Now scientists have built on those results to show exactly goes wrong, and their results could even take us closer to an eczema cure.
Eczema is a common skin condition affecting up to 20 percent of childrenand 3 percent of adults worldwide. While there's no shortage of creams and lotions than help alleviate the chronic symptoms of eczema, we still haven't found a cure that can clear it up for good.
For the past decade, scientists have known that eczema is associated with a genetic lack of filaggrin (filament aggregating protein) in the skin. This protein helps shape individual skin cells, and plays an important role in our skin's barrier function.
If a person has a genetic mutation that prevents proper filaggrin supply, they can develop skin conditions such as eczema or ichthyosis vulgaris, where skin cells don't shed, and instead pile up in a pattern that looks like fish scales.
But until now, researchers weren't sure how eczema actually develops when filaggrin is lacking.
Now scientists from Newcastle University in the UK in collaboration with GSK Stiefel have tracked down a series of proteins and molecular pathways that lead to this insufferable skin problem.
"We have shown for the first time that loss of the filaggrin protein alone is sufficient to alter key proteins and pathways involved in triggering eczema," says lead researcher Nick Reynolds from Newcastle University.
To track down these mechanisms, the team used a lab-created 3-dimensional living skin equivalent (LSE) model. They altered the top layer of this lab-made 'skin' to become filaggrin-deficient, just like in people who have the genetic mutation.
They found that this deficiency alone could trigger a host of molecular changes in important regulatory mechanisms in the skin. This affected things like cell structure, barrier function, and even how cells got inflamed and responded to stress.
"Notably, for the first time, we have identified 17 proteins that are significantly differentially expressed after [filaggrin removal] in LSE cultures," the team writes in their paper.
The researchers then verified their initial findings by analysing proteins in skin samples from actual humans, comparing the results between participants with eczema and healthy subjects.
They found that several of the proteins they detected were similarly altered in only those with eczema - just like the lab-based model had demonstrated.
While this is just the next piece of the puzzle in terms of a deeper understanding of conditions like eczema, it's a really promising step.
Once scientists know for sure what goes on in the skin if you have the faulty filaggrin gene, they can start looking for drugs that can stop that from happening.
"This type of research allows scientists to develop treatments that target the actual root cause of the disease, rather than just managing its symptoms," Nina Goad from the British Association of Dermatologists said in a press statement.
If you suffer from random bouts of dermatitis, that's a really exciting prospect.
The study was published in the Journal of Allergy and Clinical Immunology.
Posted: at 2:59 pm
Eczema is one of the most common skin conditions, affecting roughly one in 10 adults. Now, new research has suggested that a deficiency in the skin's outer barrier is key to triggering the debilitating problem, leaving scientists one step closer to discovering exactly what it is that triggers eczema and what they can do to prevent it.
Everything you've ever wondered about skin allergies
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The Newcastle University research team created a human model system in their laboratory in order to mimic the skin observed in patients with atopic eczema the most common type. They then used molecular techniques to reduce the levels of filaggrin, the protein which has previously been strongly linked to eczema, within the upper layer of skin (epidermis) of the model.
A number of regulatory mechanisms, such as stress responses, were affected by the changes. Nick Reynolds, Professor of Dermatology at Newcastle University and who works within the Newcastle Hospitals NHS Foundation Trust is the lead investigator of the study. He said:
"We have shown for the first time that loss of the filaggrin protein alone is sufficient to alter key proteins and pathways involved in triggering eczema. This research reinforces the importance of filaggrin deficiency leading to problems with the barrier function in the skin and predisposing someone to eczema."
Other mechanisms affected by altered filaggrin levels included inflammatory signalling, cell structure and barrier function all of which are known to be active in the skin of patients with eczema. Nina Goad of the British Association of Dermatologists said:
"This latest research from Newcastle is crucial as it expands on our knowledge of how filaggrin impacts on other proteins and pathways in the skin, which in turn trigger the disease. This type of research allows scientists to develop treatments that target the actual root cause of the disease, rather than just managing its symptoms. Given the level of suffering eczema causes, this is a pivotal piece of research."
The paper was published in the Journal of Allergy and Clinical Immunology.
Are you giving yourself eczema?
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What causes eczema? - NetDoctor - Netdoctor
Posted: May 7, 2017 at 11:23 pm
Eczema is the term for a group of medical conditions that cause the skin to become irritated and inflamed. Atopic dermatitis, a type of eczema, is known as the itch that rashes. It usually appears on the face, hands, and limbs, and is accompanied by an intense itch.
Atopic dermatitis is the most common type of eczema. It affects approximately 15% of infants and children and 3% of adults in the U.S. Many people outgrow the condition during childhood, although some suffer with it throughout life.
Atopic dermatitis affects the skins barrier functionits ability to keep moisture in and irritants out. It also disturbs the formation of natural skin oils and reduces sweat secretion. As a result, skin loses moisture and can eventually become so dry that it cracks and fissures develop, allowing bacteria and irritants to penetrate the skin and possibly cause infection. While the exact cause of the disease is unknown, the good news is that it can be managed and treated with a good daily skincare regimen.
Eczema is a condition that can be managed with a physicians assistance. Your dermatologist or pediatrician may prescribe medications to help you manage your eczema or atopic dermatitis, but he or she will also tell you that daily moisturizing is your first line of defense against flare-ups and can help reduce itch.
To prevent skins natural moisturizers from being stripped away, try to take only one warm (not hot) bath or shower per day, and limit it to 10 minutes. Avoid soaps and instead, wash with a gentle soap-free and fragrance-free cleanser. After bathing, gently pat away excess water with a soft, absorbent towel and apply moisturizer while skin is still damp, to help seal in moisture.
Hydrating the skin is essential in helping to reestablish skins natural barrier, which keeps moisture in and irritants out. Use moisturizers at least twice a day or even more often if you feel that you need it. Choose a fragrance-free moisturizer thats safe for sensitive skin.
On http://www.easeeczcema.org, youll find helpful resources and information for people who suffer from eczema or atopic dermatitis. Among the suggestions they offer is to wash all new clothes before wearing to remove formaldehyde and other potentially irritating chemicals that are used during production and packing of clothing as these ingredients can irritate skin. Also use mild detergents that are dye-free and fragrance-free, as dyes and fragrances can irritate skin. Also look for Over-the Counter skin protectant with colloidal oatmeal to moisturizer skin and help relieve minor irritation and itching of eczema
The information provided herein is not intended to be medical advice. Nor is it intended to treat the underlying skin disease or condition. The information is provided solely to:
1. Moisturize, soften and smooth dry skin 2. Improve the appearance of the skin 3. Achieve healthier-looking skin
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Eczema - Eucerin Skincare Products
Posted: at 11:23 pm
Chances are, youre here to look for answers and find support.
You might have first noticed an itchy, red patch on your babys cheeks, chin, or chest that she or he scratched until it became even more irritated. Sound familiar? Or maybe you experienced something similar on your own neck, inner elbows, or behind your knees.
Thats probably when you made an appointment with your doctor, who looked at it, talked to you about your symptoms, asked you questions about your family history and the types of products you use on your skin and in your home. Then your doctor told you it was eczema.
So what exactly is eczema? Who can get it and why? And what should you do, now that you or your child has been diagnosed?
Learning more about what kind of eczema you have and what may have triggered it, is the best starting point to treating and managing it, so that your eczema doesnt get in the way of your everyday life.
The good news is youve come to the right place. Were here to help guide you with all of the tools and support youll need every step of the way.
Eczema is very common. And in many cases, its also manageable. In fact, over 30 million Americans have some form of eczema.
Its most common for babies and children to develop eczema on their face (especially the cheeks and chin), but it can appear anywhere on the body and symptoms may be different from one child to the next. More often than not, eczema goes away as a child grows older, though some children will continue to experience eczema into adulthood.
Adults can develop eczema, too, even if they never had it as a child.
The most important thing to remember is that eczema and its symptoms are different for everyone. Your eczema may not look the same on you as it does on another adult, or on your child. It may even appear in different areas of the body at different times.
Eczema is usually itchy. For many people, the itch is usually only mild, or moderate. But in some cases it can become much worse and you might develop extremely inflamed skin. Sometimes the itch gets so bad that people scratch it until it bleeds, which can make your eczema worse. This is called the itch-scratch cycle.
What to look for:
You might have all of these symptoms of eczema or only just a few. You might have some flare ups or your symptoms could go away entirely. But the only way to know if you have eczema for sure, is to visit your doctor so he or she can look at your skin and ask you about your symptoms.
Here is the original post:
Eczema | National Eczema Association
Posted: at 11:23 pm
Reasons for eczema susceptibility uncovered
Atopic eczema is one of the commonest skin conditions in the UK, affecting up to 10% of adults and 20% of children in the UK. It's more common in children, often developing before their first birthday and often persists into adulthood with severe ...
What causes eczema? Scientists blame it on lack of a protein skin barrier
What Causes Eczema? Lack of Protein In Skin May Lead To Painful Inflammatory Condition
Eczema caused by deficiency of protein in skin, confirm scientists
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Reasons for eczema susceptibility uncovered - Science Daily
Posted: May 6, 2017 at 3:13 am
New research shows for the first time that a lack of the key barrier protein filaggrin alone may be responsible for changes in skin proteins and pathways that make people susceptible to eczema. It builds on previous work that shows a lack of the protein is strongly tied to the development of eczema.
Researchers from Newcastle University in the United Kingdom and Stiefel - a GlaxoSmithKline company - report their findings in the Journal of Allergy and Clinical Immunology.
Lead investigator Nick Reynolds, a professor of dermatology at Newcastle University who also works as a skin and eczema specialist in Newcastle's Royal Victoria Infirmary, says that their discovery "reinforces the importance of filaggrin deficiency leading to problems with the barrier function in the skin and predisposing someone to eczema."
He and his colleagues also believe that the study could lead to the development of drugs that target the underlying causes of eczema rather than just alleviate the symptoms.
Eczema is a condition that is usually characterized by dry, itchy, cracked, and rough skin that mainly erupts on the hands, feet, and face, as well as behind the knees and inside the elbows.
It can also present with blisters that weep fluid when scratched. The condition can cause disturbed sleep and may profoundly affect quality of life.
The most common type of eczema is an inflammatory, non-contagious skin condition called atopic dermatitis that affects around 30 percent of people in the United States, most of them children and adolescents.
In this article, the word eczema refers specifically to atopic dermatitis.
The exact causes of eczema are unknown. However, research reveals that it is likely to arise from a combination of genetic and environmental factors and probably involves dysfunction of both the skin barrier and the immune system. People with eczema may also develop asthma and hay fever.
Fast facts about eczema
Learn more about eczema
In their study report, the researchers explain that filaggrin plays a key role in maintaining the barrier that protects the skin and that previous research has already established that a lack of the protein strongly predisposes people to eczema.
However, exactly what happens at the molecular level to link filaggrin deficiency to the development of eczema "remains incompletely understood," they note.
To further investigate the role of filaggrin, the researchers developed a 3-D model of human skin, in which, using molecular tools, they made the epidermis (the outside layer) deficient in filaggrin.
The model closely mimics what happens in the skin of people with eczema.
Using the model, the researchers were able to map the proteins and signaling pathways that lie "downstream" of filaggrin, and thus observe how the absence of the protein altered them.
They identified a number of signaling mechanisms that regulate inflammation, cell structure, stress response, and the function of the skin barrier.
The mapping of these pathways in the model appears to match that seen in people with eczema.
For example, the skin of people with active eczema has high levels of a protein coded by the gene KLK7. The team was able to show - from the model - that upregulation of KLK7 was one of the molecular consequences of filaggrin loss.
"This type of research allows scientists to develop treatments that target the actual root cause of the disease, rather than just managing its symptoms. Given the level of suffering eczema causes, this is a pivotal piece of research."
Nina Goad, British Association of Dermatologists
Learn how friendly skin bacteria keep harmful Staphylococcus aureus in check.
Posted: at 3:13 am
Derived from the Greek language, the word eczema translates to something like to boil. And anyone who has atopic dermatitis the most common form of eczema can probably see why. The symptoms often shows up as red, itchy rashes on your arms and legs, and can sometimes cause open sores or resemble scaly skin.
Although its possible to develop atopic dermatitis for the first time as an adult, the majority of people experience it shortly after they were born, perhaps as young as two months old. Most people outgrow it in their early teens, but it can come back later in life, says Whitney High, MD, an associate professor of dermatology and pathology at the University of Colorado School of Medicine, in Denver. For some people, atopic dermatitis continues through into adulthood and never lets up.
The condition itself is likely hereditary, and usually runs in the same circles as allergic rhinitis and asthma. Families that have one child with eczema often have another child with asthma or even a third child with seasonal rhinitis or hay fever, he says.
To limit your odds of experiencing a flare-up, here are nine things to avoid.
1. Taking a luxurious bath A long soak in the tub might sound fantastic but if you have atopic dermatitis, spending too long in the bathtub can leave your skin feeling itchy and red. The next time you turn on the tap, remember the Goldilocks rule: the water should be not too hot, not too cold, but a lukewarm medium. Ideally, youll also limit your soak to no longer than 15 minutes a day, says Dr. High. We tell people to take good care of their skin by doing gentle bathing and not over-drying the skin, he says.
RELATED: The 7 best lotions for eczema, according to dermatologists
2. Wearing a wool sweater Any kind of abrasive texture, like wool or certain synthetic fibers, might irritate your skin, says Dr. High. A better wardrobe choice: soft, cotton clothing in a looser cut, which wont rub against your skin. You should also wash any new clothing you buy before wearing them some contain dyes that make the fabric appear nicer in the store, but may trigger a flare-up on your skin.
3. Using scented laundry detergents Scented laundry detergents and some dryer sheets can also bother your skin. Choose products that are free of fragrances and dyes; liquid ones tend to leave less irritating residues behind compared to powder versions. We like the all-FREE CLEAR laundry detergent thats specifically designed for people with sensitive skin; the product received a seal of acceptance from the National Eczema Association (NEA), which keeps a list of other helpful products on their website.
RELATED: The best laundry detergents for sensitive skin
4. Washing with anything besides fragrance-free soaps Similar to scented laundry detergents, scented hand soaps, bubble baths, body washes, and lotions can all cause your skin to feel dry and itchy. Use bland soaps, not highly perfumed or scented soaps, says Dr. High.
5. Scratching your skin Atopic dermatitis is sometimes called the itch that rashes. In other words, says Dr. High, some people think you have the itching sensation first, then do all the damage to the skin with the scratching and picking, which leads to the rash. And while its a good idea to reach for a moisturizer at the first sign of a tingle, you should also keep your fingernails trimmed and smooth that way, youll be less likely to puncture the skin if you do end up scratching at it.
6. Getting too hot or cold During the warmer months, the high temperatures (or, the sensation of heat, says Dr. High) can sometimes bother peoples skin. Not only that, but sweating can cause irritation, too. Likewise, the cold, dry weather in winter can also trigger itchiness.
7. Skipping moisturizer To avoid a flare-up, youll have to do more than just avoid certain products. You should also moisturize your skin at least twice a day to prevent it from becoming too dry or cracked, according to the American Academy of Dermatology. Look for mild, fragrance-free lotions Aveeno Eczema Therapy Moisturizing Cream and Cetaphils RestoraDerm Eczema Calming Body Moisturizer are two options or opt for petroleum jelly. Its also smart to try out a new product on a small area of your skin first, on the off chance that it causes your skin to feel itchy and irritated later on.
Although the majority of eczema flare-ups arent caused by a persons diet, there may be occasional cases where atopic dermatitis is exacerbated by food or drinks, says Dr. High. To pinpoint what might be triggering your flare, try keeping track of your daily routine (including meals) in a journal. By looking back at your past entries, you might be able to identify the culprits. For example, if you and your doctor think that milk is causing a flare, you might want to eliminate it from your diet while working with a nutritionist to help shore up your intake with other calcium-rich foods.
8. Letting stress take over Although stress can certainly trigger a flare, Dr. High says that its usually the last factor that doctors consider. But he also notes that all of his patients feel itchier at night, whether they have atopic dermatitis or any other itching skin condition. Its the time of the day when its quiet, says Dr. High. Youre not going to feel itchy when youre going a million miles an hour at your job. You dont have time to plug into all those body sensations.
This article originally appeared on Health.com.
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Prevent an eczema flare-up by avoiding these 8 things - Fox News
Posted: May 4, 2017 at 2:49 pm
Atopic eczema is an inflammation of the skin, which tends to flare up from time to time. It usually starts in early childhood. The severity can range from mild to severe. There is no cure but treatment can usually control or ease symptoms. Moisturisers (emollients) and steroid creams or ointments are the common treatments. About 2 in 3 children with atopic eczema grow out of it by their mid-teens.
Eczema is sometimes called dermatitis which means inflammation of the skin. There are different types of eczema. The most common type is atopic eczema. In this type of eczema there is a typical pattern of skin inflammation which causes the symptoms.
The word atopic describes people with certain allergic tendencies. However, atopic eczema is not just a simple allergic condition. People with atopic eczema have an increased chance of developing other atopic conditions, such as asthma and hay fever.
Typically, inflamed areas of skin tend to flare up from time to time and then tend to settle down. The severity and duration of flare-ups varies from person to person and from time to time in the same person.
Most cases first develop in children under the age of five years. It is unusual to develop atopic eczema for the first time after the age of 20. At the moment, about 1 in 5 schoolchildren have some degree of atopic eczema. However, statistics show that it is becoming more common year on year. In about 2 in 3 cases, by the mid-teenage years, the flare-ups of eczema have either gone completely, or are much less of a problem. However, there is no way of predicting which children will still be affected as adults.
Between 1-5 in 20 adults have atopic eczema.
The cause is not known. The oily (lipid) barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and a tendency towards dry skin. Also, some cells of the immune system release chemicals under the skin surface, which can cause some inflammation. But it is not known why these things occur. Inherited (genetic) factors play a part. Atopic eczema occurs in about 8 in 10 children where both parents have the condition and in about 6 in 10 children where one parent has the condition. The precise genetic cause is not clear (which genes are responsible, what effects they have on the skin, etc). However, recent research suggests that in some people genetic changes hamper the production of a chemical (filaggrin) involved in the defence barrier of the skin.
As mentioned previously, atopic eczema is becoming more common. There is no proven single cause for this but factors which may play a part include:
There may be a combination of factors in someone who is genetically prone to eczema, which causes the drying effect of the skin and the immune system to react and cause inflammation in the skin.
The usual treatment consists of three parts:
Many people with atopic eczema have flare-ups from time to time for no apparent reason. However, some flare-ups may be caused (triggered) or made worse by irritants to the skin, or by other factors. It is commonly advised to:
House dust mite is a tiny insect that occurs in every home. You cannot see it without a microscope. It mainly lives in bedrooms and mattresses as part of the dust. Many people with atopic eczema are allergic to house dust mite. If you are allergic, you have to greatly reduce the numbers of house dust mite for any chance that symptoms may improve.
However, it is impossible to clear house dust mite completely from a home and it is hard work to reduce their number to a level which may be of benefit. It involves regular cleaning and vacuuming with particular attention to your bedroom, mattress and bedclothes.
Therefore, in general, it is not usually advised to do anything about house dust mite - especially if your eczema is mild-to-moderate and can be managed by the usual treatments of emollients and short courses of topical steroids. However, if you have moderate or severe atopic eczema which is difficult to control with the usual treatments, you may wish to consider reducing the number of house dust mites in your home. See separate leaflet called House Dust Mite and Pet Allergy, which gives more details on how to reduce house dust mites.
About 1 in 2 children with atopic eczema have a food allergy which can make symptoms worse. In general, it is young children with severe eczema who may have a food sensitivity as a trigger factor. The most common foods which trigger symptoms in some people include cow's milk, eggs, soya, wheat, fish and nuts.
If you suspect a food is making your child's symptoms worse then see a doctor. You may be asked to keep a diary over 4-6 weeks. The diary aims to record any symptoms and all foods and drink taken. It may help to identify one or more suspect foods. If food allergy is suspected, it should be confirmed by a specialist. They may recommend a diet without this food if the eczema is severe and difficult to control by other means.
Other possible factors which may trigger symptoms, or make symptoms worse, include:
However, some of these may not be avoidable.
See separate leaflet in this series, called Eczema - Triggers and Irritants, for more details.
People with atopic eczema have a tendency for their skin to become dry. Dry skin tends to flare up and become inflamed into patches of eczema. Emollients are lotions, creams, ointments and bath/shower additives which prevent the skin from becoming dry. They oil the skin, keep it supple and moist and help to protect the skin from irritants. This helps to prevent itch and helps to prevent or to reduce the number of eczema flare-ups.
The regular use of emollients is the most important part of the day-to-day treatment for atopic eczema. Your doctor, nurse or pharmacist can advise on the various types and brands available and the ones which may suit you best.
You should apply emollients as often as needed. This may be twice a day, or several times a day if your skin becomes very dry. Some points about emollients include:
Many people with atopic eczema use a range of different emollients. For example, a typical routine for a person with moderately severe atopic eczema might be:
Note: emollients used for eczema tend to be bland and non-perfumed. Occasionally, some people become allergic (sensitised) to an ingredient in an emollient. This can make the skin worse rather than better. If you suspect this, see your doctor for advice. There are many different types of emollients with various ingredients. A switch to a different type will usually sort out this uncommon problem.
Warning: bath additive emollients will coat the bath and make it greasy and slippery. It is best to use a mat and/or grab rails to reduce the risk of slipping. Warn anybody else who may use the bath that it will be slippery.
See separate leaflet called Moisturisers (Emollients) for Eczema for more details.
Topical steroids work by reducing inflammation in the skin. (Steroid medicines that reduce inflammation are sometimes called corticosteroids. They are very different to the anabolic steroids which are used by some bodybuilders and athletes.) Topical steroids are grouped into four categories depending on their strength - mild, moderately potent, potent and very potent. There are various brands and types in each category. For example, hydrocortisone cream 1% is a commonly used steroid cream and is classed as a mild topical steroid. The greater the strength (potency), the more effect it has on reducing inflammation but the greater the risk of side-effects with continued use.
Creams are usually best to treat moist or weeping areas of skin. Ointments are usually best to treat areas of skin which are dry or thickened. Lotions may be useful to treat hairy areas such as the scalp.
As a rule, a course of topical steroid is used when one or more patches of eczema flare up. You should use topical steroids until the flare-up has completely gone and then stop them. In many cases, a course of treatment for 7-14 days is enough to clear a flare-up of eczema. In some cases, a longer course is needed. Many people with atopic eczema require a course of topical steroids every now and then to clear a flare-up. The frequency of flare-ups and the number of times a course of topical steroids is needed can vary greatly from person to person.
It is common practice to use the lowest-strength topical steroid which clears the flare-up. If there is no improvement after 3-7 days, a stronger topical steroid is usually then prescribed. For severe flare-ups a stronger topical steroid may be prescribed from the outset. Sometimes two or more preparations of different strengths are used at the same time. For example, a mild steroid for the face and a stronger steroid for patches of eczema on the thicker skin of the arms or legs.
For adults, a short course (usually three days) of a strong topical steroid may be an option to treat a mild-to-moderate flare-up of eczema. A strong topical steroid often works quicker than a mild one. (This is in contrast to the traditional method of using the lowest strength wherever possible. However, studies have shown that using a high strength for a short period can be more convenient and is thought to be safe.)
Some people have frequent flare-ups of eczema. For example, a flare-up may subside well with topical steroid therapy. But then, within a few weeks, a flare-up returns. In this situation, one option that might help is to apply steroid cream on the usual sites of flare-ups for two days every week. This is often called weekend therapy. This aims to prevent a flare-up from occurring. In the long run, it can mean that the total amount of topical steroid used is less than if each flare-up were treated as and when it occurred. You may wish to discuss this option with your doctor.
Topical steroids are usually applied once a day but this may be increased to twice a day if there is no improvement. Rub a small amount thinly and evenly just on to areas of skin which are inflamed. (This is different to moisturisers (emollients) which should be applied liberally all over.)
To work out how much you should use each dose: squeeze out some cream or ointment from the tube on to the end of an adult finger - from the tip of the finger to the first crease. This is called a fingertip unit. One fingertip unit is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together. Gently rub the cream or ointment into the skin until it has disappeared. Then wash your hands (unless your hands are the treated area).
Note: don't forget you can use emollients as well when you are using a course of topical steroids.
See separate leaflet called Fingertip Units for Topical Steroids for more details.
Short courses of topical steroids (fewer than four weeks) are usually safe and normally cause no problems. Problems may develop if topical steroids are used for long periods, or if short courses of strong topical steroids are repeated often. The concern is mainly if strong topical steroids are used in the long term. Side-effects from mild topical steroids are uncommon.
For more details about side-effects see separate leaflet called Topical Steroids for Eczema for more details.
Most people with eczema will be prescribed emollients to use every day and a topical steroid to use when flare-ups develop. When using the two treatments, apply the emollient first. Wait 10-15 minutes after applying an emollient before applying a topical steroid. That is, the emollient should be allowed to sink in (be absorbed) before a topical steroid is applied. The skin should be moist or slightly tacky but not slippery, when applying the steroid.
Sometimes, one or more patches of eczema become infected during a flare-up. Characteristics of infected eczema include:
If the infection becomes more severe, you may also develop a high temperature (fever) and generally feel unwell. If infected eczema develops then a course of an antibiotic tablet or liquid medicine will usually clear the infection. This is used in addition to usual eczema topical treatments. Sometimes, a topical antibiotic is used if the infection is confined to a small area.
Once the infection is cleared, it is best to throw away all your usual creams, ointments and lotions and obtain fresh new supplies. This is to reduce the risk of applying creams, etc that may have become contaminated with germs (bacteria). Also, if you seem to have repeated bouts of infected eczema, you may be advised to use a topical antiseptic such as chlorhexidine on a regular basis. This is in addition to your usual treatments. The aim is to keep the number of bacteria on your skin to a minimum.
See your doctor if a flare-up of atopic eczema is getting worse or not clearing despite the usual treatments with moisturisers (emollients) and topical steroids. Things which may be considered include:
You may be referred to a skin specialist if a flare-up does not improve with the usual treatments.
Alternative remedies such as herbal medicines are sometimes tried by some people. However, you should be cautious about using them, especially if their labels are not in English and you are not sure what they contain. Some herbal treatments are mixed with steroids and some (particularly Chinese remedies) have been linked to liver damage.
It may be worth breast-feeding a newborn baby for three months or more if several members of the family suffer from allergies such as eczema, hay fever or asthma. There is, however, no evidence to suggest that the mother should avoid any particular foods during pregnancy or breast-feeding.
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