Eczema

What causes atopic eczema?

While the exact cause is not known, certain factors are thought to be important in its development, these include an inherited (genetic) predisposition to have a weakened skin barrier, as well as altered inflammatory and allergy responses. Atopic eczema most frequently begins in infancy but may also develop for the first time in adulthood. It affects approximately 1 in 5 children and 1 in 10 adults in Ireland.

For most children affected, the disease is mild. However, often those who have seemingly outgrown the condition will continue to have life-long sensitive skin and may have recurrences of eczema following long symptom-free spells.

Atopic eczema can run in families and frequently occurs alongside other atopic conditions, including hay fever and asthma.

Although there is no cure for eczema yet, treatment are available to manage the condition.

Symptoms

Symptoms include red, dry, itchy skin, which can sometimes weep, become blistered, crusted and thickened. However, the appearance of eczema and the locations of the body affected can vary greatly depending on the age of the person affected.

The main symptom is an intense itch. Scratching only provides temporary relief, and leads to more itching and scratching (the itch-scratch cycle), which can worsen eczema and make the skin more vulnerable to infection. Scratching in response to itch can cause some of the changes seen on the skin in eczema.

The intense itch is very uncomfortable, can be severe enough to interfere with sleep, and negatively impact on the quality of life of the person affected, as well as his/her family. Some people with more pronounced eczema can also experience social embarrassment due to the visibility of their condition.

Typically atopic eczema goes through phases of being severe, then less severe. During a ‘flare up’, when eczema is very active, symptoms such as redness, dryness and itch worsen, while at other times, symptoms settle.

Eczema triggers

Irritants and allergens
Atopic eczema can be triggered or aggravated by exposure to a number of environmental irritants or allergens. Common irritants include soap, bubble bath, shampoo, laundry detergents, fragrances, clothing that feels ‘itchy’ next to the skin (e.g. wool), changes in temperature, or allergens like animal dander, the house dust mite or pollen, but sometimes no cause can be identified.

Stress
Emotional stress can aggravate eczema. Finding ways 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.

Infection
Atopic skin is more vulnerable to infection and infection is often associated with a worsening of eczema. 

Seek urgent medical advice if skin becomes:

• Wet or weepy, with yellow/brownish crusts
• Very sore, with clusters of painful itchy blisters, particularly if there has been contact with someone who has a cold sore

Managing eczema

The main aim is to improve symptoms and achieve long-term control. In atopic eczema, the skin’s protective barrier is weakened which allows moisture to be lost, and irritants and allergens to pass through the skin more easily. Some common everyday substances e.g. soap, contribute to the weakening of the skin’s barrier and should be avoided.

It is important to remember that on-going (every day), frequent and generous use of 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.

For more detailed information about prescribed medical treatments including: topical steroids and other topical treatments (creams or ointments applied directly to the skin), ultraviolet light therapy (also called phototherapy, delivered in hospital dermatology departments), and systemic medications (medicines that work inside your body), please see our What you need to know about eczema booklet above.

For eczema, the good news is that there is a range of treatment options available, as well as on-going research examining potential new treatments. Treatment depends on the severity and location of eczema, as well as the age of the person affected.

Talk with your doctor to find a treatment regimen that is most appropriate for you.

Everyday eczema skin care

Emollients

Emollients are an essential part of daily care, even when skin is clear. Emollients are moisturizers that are used in two ways – applied directly to the skin as a leave-on moisturizer, and as a soap substitute instead of soap or shower gel.

Used several times a day, emollients help to soothe dry, itchy skin and repair the skin’s barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares.

Soap substitutes/emollient wash products

Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, choose emollient wash products when bathing which leave the skin coated with a protective film afterwards.

Choosing an emollient

Emollients come as lotions, creams and ointments. Finding the right emollient is often a matter of trial and error but the best emollients are ones that you (or your child) prefer to use and will continue to use every day.

Remember, a higher price doesn’t necessarily indicate a better product – ask your healthcare professional for advice.

Some practical tips for emollient therapy

• Establish a good daily skin care routine and try to stick to it.
• Don’t stop moisturising when your skin is clear.
• Emollients tend to be bland and fragrance-free (unperfumed); ask your healthcare professional for advice.
• Apply emollients in a smooth, downward motion, in the direction of the hair growth.
• A child with atopic eczema often requires a minimum of 250g of ‘leave-on’ emollient per week, while an adult may need approximately 500g per week.
• Remember – avoid soap, bubble bath and shower gel!
• Use soap free products for bathing and specially formulated shampoos.
• Bathwater should be a lukewarm temperature; 5 minutes with an emollient bath additive is sufficient.
• After bathing or showering, gently pat skin dry. It is a great time to apply emollient all over when the skin is still ‘slightly humid’.
• Remember to change your tub of emollient at least every six weeks, as it can become contaminated, or use a pump dispenser.

It is very important to establish the right diagnosis, so if you are concerned about your skin, you should always speak with your doctor.

Clothing & wet wraps

Sometimes 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.

Basic tips:

• Avoid harsh synthetic fabrics
• Seams
• Wool
• Fabrics that do not let the skin breathe
• Use thin layers rather than one thick layer of clothing

Bedtime

• Consider using eczema specific clothing (see below)
• Consider using 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

Some suggestions for 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:

Visit: www.itchylittlemonkeys.com
Contact: info@itchylittlemonkeys.com

Clinifast Garments

Made in the UK but Irish agents are Ovelle in Dundalk. Ovelle stock Clinifast garments in adult and children’s sizes, all of which are available to order on their website: Clinifast Range

Free shipping within Ireland on orders over €25.

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

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

Dermasilk

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.

DermaSilk® products are available through Irish supplier, Medearly Healthcare.

Other sites:

• 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. Contact us for further details or guidance about clothing.