What is eczema?
Eczema is a general term for a group of skin conditions that cause the skin to become dry, red, itchy and inflamed. The term is most often used to refer to atopic dermatitis (atopic means related to hypersensitivity reactions to something in the environment and dermatitis describes inflammation of the skin) .
If you have atopic dermatitis, your skin barrier function (which prevents water loss and protects against allergens and irritants) is impaired or weakened. This makes the skin dry out and it vulnerable to infections by bacteria and viruses.
Eczema is a very common skin condition and is not contagious. It affects 1 in 5 children and 1 in 12 adults in Ireland. There is no cure for eczema, but, in most cases, it is manageable.
Our new What you need to know about eczema booklet has been prepared by people with eczema, their carers, dermatology nurses and consultant dermatologists to help you understand your condition, learn about management and find useful tips for living with eczema.
Atopic eczema usually starts in the first months of life but it may also develop for the first time in adulthood. The main symptom is itch. Scratching in response to itch may cause many of the changes seen on the skin. The itch can be severe enough to interfere with sleep, causing tiredness and irritability. This can have an enormous impact on the whole family. Typically it goes through phases of being severe, then less severe, and then worse again.
Dry and itchy skin
- Caused by a defect in the skin barrier
- Dry skin can be improved by the every day use of emollients
Red, sore and itchy skin
- An eczema flare, caused by:
- Trigger factors
- Viral or bacterial infection
- Skin dryness
Seek urgent medical help if:
- Wet/weepy with yellow crusts, as their eczema may be infected
- Very sore, with red blisters, especially if someone close to you has a cold sore
Causes and Triggers
Atopic eczema can be triggered by lots of things. These may be common, for example soap, detergents, fragrance and temperature changes; or they may be more individual.
- Tobacco smoke, chemicals, weather (hot and humid or cold and dry conditions) air conditioning or overheating.
- Soaps, shampoos, washing powders, cosmetics and toiletries.
- Ingredients such as alcohol, astringents, and fragrances.
- Avoid materials that feel”itchy,” things like wool, etc. Try to wear soft fabrics like cotton or silk which tend to be less irritating. It is also a good idea to wash all new clothes, linens, and towels before using them for the first time. Investing in specialist eczema garments is worthwhile.
House dust mites, moulds, grasses, plant pollens, foods, pets.
If all regular treatment and avoidance of trigger factors fail, diet may be looked at. This is more successful in children under five years of age and should only be done in consultation with a doctor and dietician.
Common foods that provoke allergies are cow’s milk, eggs, chicken, tartrazine (and similar colourings) and nuts.
It has been suggested that people with eczema may be more prone to peanut allergy; therefore it is important to be aware that some over the counter emollients contain groundnut oil (refined peanut oil). It is rarely used in emollients available on prescription.
Do not assume that food is causing eczema flare-ups. Do not exclude food from a child’s diet without full medical consultation.
Emotional stress can be a cause of eczema flare-ups. Patients can have difficulties with anxiety, anger and hostility caused by having eczema. This only adds to the problem. Learning to reduce stress may lessen the frequency and, hopefully, the intensity of the flare-ups. Whilst stress is associated with flares of atopic eczema, it is not yet fully understood.
- Being unwell, for example having a common cold can make eczema flare up.
- Bacterial infection (usually with a bug called staph aureus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment.
- An infection with the cold sore virus herpes simplex can cause a sudden painful widespread (and occasionally dangerous) flare of eczema, with weeping small sores and may need treatment with oral antiviral treatment. This is known as eczema herpeticum and should be treated immediately.
- Teething in babies.
Daily Care Information
This booklet contains information on day-to-day management of eczema, treating symptoms and how and when to apply treatments.
It is important to remember that emollients form the basis of eczema management, but when your eczema flares up, other treatments, such as topical steroids, are needed and are usually prescribed by your healthcare professional.
Topical steroids come in four different strengths:
- Very potent
The strength must be matched to the severity of your eczema and the area of the body affected. You may sometimes be prescribed more than one topical steroid, for example, a mild one for your face and a potent one for your body. They are generally used once or twice a day, as prescribed by your healthcare professional.
Topical steroids have been used to treat eczema for about 50 years. People sometimes worry about the side effects, but when used correctly these are less likely to occur; especially if topical steroids are used for short bursts to treat the eczema flare.
Remember the correct use of topical steroids is the most important thing. It is better to treat your eczema with the correct strength for a short time, rather than use steroids that are too weak for a longer time, or not treat your eczema at all. Ask your pharmacist to explain how to apply topical steroids and how much to apply, you may be asked to use ‘fingertip unit’ (FTU) – information about this is provided with the tube of steroid.
Your eczema symptoms should improve after correct use of topical steroid for 3-5 days, but if they don’t, you should seek advice from your healthcare professional.
Your everyday skin care
Emollients (medical moisturisers) must be used several times a day, even when your skin is clear. You should avoid using soaps and bubble baths as they can dry out the skin. Instead, use a soap substitute and a bath/shower emollient.
Emollients help to:
- Restore the skin barrier
- Reduce the number of eczema flares
- Stop irritants and allergens which can trigger eczema flares
Leave-on moisturisers – lotions (for normal to dry skin), creams and ointments (for dry or very dry skin)
- Apply several times a day and after bathing
- Should be put on in smooth, long, downward strokes in the direction of hair growth. Do not rub in – just let them soak in.
- You may need more than one product
- As we get older our skin loses natural moisturising factors, so heavier moisturiser could be worth trying.
Emollient wash products – bath oils and shower gels
- Cleanse the skin and leave a film of emollient on the skin
- Add bath oil to a warm bath (but not too hot as this can cause irritation) or apply to wet skin.
Treatment For Eczema
Very dry skin needs to be constantly moisturised to protect the skin barrier and prevent further dryness. There are a variety of moisturisers/emollients on the market. A good daily care routine is vital in the management of the condition. (See also Daily Care Routine)
In many cases, emollient therapy on its own is not sufficient. The following are further treatments that your GP or Dermatologist may recommend:
It is very likely that your GP or dermatologist will at some stage prescribe a steroid for eczema treatment. As eczema can vary in intensity, there are different levels of steroid treatments available. If used correctly they are very effective.Topical steroid creams or ointments can settle the redness and itching of eczema when it is active. They come in different strengths (mild, moderately strong, strong and very strong). Your doctor will advise you on which type needs to be used where, and for how long. In general, ointments are preferred to creams. Use of a topical steroid once daily is usually adequate, however, they should not be applied more than twice daily.
Used appropriately topical steroids are very effective and safe to use. However used inappropriately, (too strong or for too long), topical steroids may cause side effects, including thinning of the skin.
Weaker topical steroids are usually prescribed for use on the face, breasts, genitals, eyelids and armpits. Stronger steroids can be used at other sites especially thicker areas such as hands and feet.
Your doctor may recommend an antihistamine which in some patients can be helpful. Those antihistamines that make people sleepy are most useful, and are generally given at night. They have no effect on the inflammation of eczema and are helpful largely as a result of their sedating effects, reducing sleep disruption. They are only effective for short term use. Always follow medical advice on usage.
As the name implies, wet-wrap therapy involves wrapping wet bandages around the affected skin. Bandaging (dressings), cotton bandages or cotton vests/leggings worn on top of creams can help keep creams in the skin and stop the urge to scratch. Sometimes these may be applied as ‘Wet wraps’ which can be useful for short periods.
For some patients the use of medicated paste bandages may be helpful, as they are soothing and provide a physical barrier to scratching. If the skin is infected, appropriate treatment is necessary if dressings are being considered. Your doctor or nurse will advise you regarding the suitability of dressings, and can also advise on the use of special silk garments which can be helpful for some people. For further information on garments contact us directly at the Irish Skin Foundation.
Phototherapy (ultraviolet A or B light therapy) may be used when all other avenues of topical and oral treatments have been exhausted. Phototherapy works by controlling cells in the skin that allow skin cell development. By controlling the rate at which skin cells develop, it is possible to control the scaling and sloughing of skin that is associated with eczema.
This is not the same as using a “sun lamp” which is not recommended for eczema patients.
Oral antibiotics may be used for skin infections that arise at the site of an eczema flare-up. Skin infections are indicated if white or yellow pus oozes from the affected site. Topical antibiotics can also be used when the skin is broken to help prevent infection and to treat mild infections.
Topical Immunosuppressants or Topical Immunomodulators
The term immunomodulator refers to a drug that is able to modulate or alter the immune system in some way. Topical immunomodulators are not steroids and therefore do not have the concerns of topical steroid overuse. They are applied directly to the affected area. In Ireland the drug used is Tacrolimus and comes in 2 strengths. This medication has been studied in both children and adults and has been shown to be effective. However, as it is relatively new, long-term effects have not been established. It must only be used under strict medical guidelines.
Tacrolimus ointment may be used when eczema is not responding to topical steroids or in skin sites which are more susceptible to the side effects of steroids such as the face, eyelids, armpits and groin. These treatments are usually prescribed initially by a dermatologist. Their most common side effect is stinging on application, and this usually disappears after a few applications. The treatments are associated with an increased risk of skin infections and should not be applied to infected (weeping, crusted) skin.
In some very severe cases where eczema is not responding, it may be necessary to consider other forms of treatments. People with severe or widespread atopic eczema not responding to topical treatment may need oral treatments. These work by dampening down the immune system and are given under the close supervision of a health care professional. These can include Cyclosporin and Azathioprine. Oral steroids are sometimes used for a short time if the eczema has flared badly. They work well but should not be used long term because of the risk of side effects.
If you want to try complementary therapies it is important to go to a properly registered practitioner and check that any medication or creams you are given have a list of ingredients. There have been problems with so called “natural” products bought over the internet in recent times. Many very potent steroids have been found in their “natural” format in unlicensed products.
Disclaimer: this article is for general information purpose only. It is not intended as medical advice. Always consult with your Medical Practitioner before embarking on any form of treatment.
Clothing & Wet Wraps
It can be difficult for children or indeed anyone who suffers with eczema to find comfortable clothing, particularly when there has been a flare up of the condition. Clothing can aggravate eczema as skin can be very hot and heat increases itch.
- Avoid harsh synthetic fabrics
- Fabrics that do not let the skin breathe
- Use thin layers rather than one thick layer of clothing
- Use eczema specific clothing (see below)
- Use soft cotton or silk sheets and thin cotton blankets
- Avoid woolen underlies, blankets and plastic mattress protectors
- Use Anti-dust mite covers on beds, pillows etc. if an allergy is suspected
Suggested Eczema Clothing
Itchy Little Monkeys*
Offer a practical solution in the form of the Shruggi™ which protects your child’s skin from the damage of scratching. Made from 100% organic cotton and silk, with the Shruggi™ you can say goodbye to traditional scratch mittens. They also offer a refreshing change for bed-time routines through story books. Introduce your kids to the characters of Max & Mimi, they have itchy skin too so they know what your little ones are going through. Their stories are created with both child & parent in mind – fun for kids & educational for you!
To find out more about them and their products:
Made in the UK but Irish agents are Ovelle in Dundalk: They are available to order via your Pharmacy.
Clinifast garments are a convenient quick and simple way to wet or dry wrap in the treatment of paediatric atopic eczema.
Due to its readymade design, there is no need to cut, tie or pin bandages together, making it easier for parents and carers to apply.
Clinifast garments are made from breathable ‘staysoft’ fabric with two way stretch design. They are comfortable to wear both at night and during the day and they allow complete freedom of movement to encourage a full and active life.
- Complete range of garments including gloves, socks, vests, leggings, tights
- Sizes available from newborn to 14 years
- Newly developed stay soft fabric which is softer, stronger and more resilient to wear and tear
- Fabric content: 86% viscose, 11% nylon, 3% elastane – Latex free
- Suitable for wet and dry wrapping. Available to order via your Pharmacist.
Skinnies have developed a range of Therapeutic Clothing Products that help aid recovery from Eczema & other skin conditions. Garments are completely seamless, utilising technologically advanced yarns that are designed to be anti-irritant.
Skinnies are high quality, robust garments for every day and wear and tear, with a combination of colour, style and comfort, which belies a serious medical purpose.
For further information about the Skinnies range and order information, please go to the website www.skinniesuk.com. A 25% discount is offered to customers who mention the “Irish Skin Foundation”.
DermaSilk® – a unique range of Therapeutic Clothing. DermaSilk Therapeutic Clothing is used in the treatment of various forms of dermatitis, eczema and allergic skin conditions that affect different areas of the body across all age groups.
DermaSilk Therapeutic Clothing is made of a special, knitted medical grade silk which has been stripped of its outer coating and bonded with Microbe Shield technology. It is far superior to cotton because it retains up to 30 % of its own weight in moisture without feeling damp.
- Cotton Comfort UK www.eczemaclothing.com
- Mitex (a Dublin based company for bedding and anti dust-mite products) www.mitexproducts .com
The Irish Skin Foundation does not endorse any particular products, any statement on this page should not be construed as a testimonial.
The UK’s National Eczema Society has developed a new school pack to help teachers and parents with back-to-school season.
New schools packs from the National Eczema Society are now online! You can have a look and/or download it here.
The ISF gratefully acknowledges the National Eczema Society for their work on these resources.
- Always keep fingernails short
- Wear cotton clothing where possible
- Use soap free products for bathing
- Use specially formulated shampoos
- Read the ingredients on cosmetics
- Use a non bio washing powder and do not use fabric conditioner
- Do not use chemical sprays and plug-ins around the home
- Cut down on harsh cleaning products
- Shower immediately after swimming in a chlorinated pool and apply a moisturiser
- Use heavy protective gloves when working with paint or chemicals and wear a mask
- Sore skin and sand don’t mix so be careful with children while on holidays or on a trip to the seaside
- Avoid having anybody smoke in the home, avoid houses where there are smokers
Correct eczema clothing is so important for a good night’s sleep, to avoid irritation, and to help prevent infection. For information on clothing, please contact us directly.
Childhood Eczema Video
You may find “Childhood Eczema: Recent Advances and Patient Perspectives”, presented by Prof. Alan Irvine, useful and helpful in learning more about eczema.