Eczema is a form of dermatitis, or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent or recurring skin rashes characterised by redness, itching and dryness, with possible scaling in more advanced stages. It is not a contagious skin condition and cannot be spread from one person to another. It can be hard to resist scratching the skin but doing so can open the skin and lead to infection and bleeding.
There are a number of types of eczema. Atopic dermatitis is the most common type of eczema and often begins in childhood. One in five children in the UK is affected by atopic dermatitis. It is most common in children but can affect people of all ages. Whilst many children grow out of eczema they may have a tendency to dry, sensitive skin in adulthood. It is also possible for the eczema to recur during adulthood and so it is important to maintain a treatment regimen designed to prevent the skin becoming too dry. Other types of eczema include allergic contact dermatitis and irritant contact dermatitis. Recognizing the correct type of eczema is a crucial part of producing an effective treatment plan. At the London Dermatology Centre we are able to offer Patch Testing on site as well as other allergy testing. Eczema can be acute, sub-acute or chronic and a variety of treatments exist that can help to effectively manage the condition.
Eczema treatment can be complex and comprises of a maintenance skin care programme to reduce the incidence of flares as well as treatment for the acute episodes. Topical steroids have been the mainstay of treatment for eczema but have recently been subject to some bad publicity causing public concern about their safety. These preparations have been in existence for over 50 years and so the safety profile and side effects are well known. The Dermatologists at the London Dermatology Centre will discuss with you how to use topical steroid treatments in a totally safe manner which will not harm the skin, as well as discuss the steroid alternative treatments and put this all in perspective for you.
One of the most important features of managing eczema is keeping the skin soft and supple by regular and generous use of emollients. An emollient is a type of moisturiser specifically for softening skin. In eczema the outer layer of skin is disrupted and is more prone to water loss. This causes the skin to dry out easily. The drier the skin becomes the rougher and itchier it will get. The emollient provides an extra barrier to the skin to prevent water loss and also adds moisture to the skin to further prevent the skin from drying out.
Emollients are available as creams, ointments and lotions. Creams are a mixture of fat and water and feel light and cool on the skin. Creams are the most popular form. However, all creams contain preservatives and on the rare occasion people can become sensitised to them. Ointments do not contain preservatives but can be very greasy. Ointments should not be used on weeping eczema, a cream or lotion can be used instead. Lotions are similar to creams but contain more water and less fat. Lotions are not as effective at moisturising the skin but can be useful for hairy areas of the body.
Patients with eczema should use their emollient both for washing and for moisturising even when their skin is clear. Emollient soap substitutes do not foam like regular soaps but are just as effective at cleaning the skin. The emollient also helps to soothe and calm itchy, red skin. For mild to moderate eczema, emollients may be the only treatment you need. There are many different emollients on the market that are available to purchase over the counter at pharmacies but here at the London Dermatology Centre we only stock a select number of trusted emollients.
During periods of active eczema the skin can become very red, itchy, sore, blistered and weepy. This is called a flare up and requires additional treatment on top of emollients to help calm the skin. Without the additional treatment these areas of skin may thicken and become even more itchy. The most common treatment for eczema flare ups are topical steroids. Topical steroids reduce the inflammation in the top layers of skin.
Topical steroids come in several different forms and strengths. They are available as creams, ointments, lotions, scalp applications and in plasters and tapes. There are four different strengths of topical steroid available: mild, moderate, potent and very potent. Depending on your age, the severity of the eczema flare up, where it occurs on your body and any other treatments you use, the doctor will decide which strength of topical steroid you need. In general, mild strength topical steroids are used for the face, genital areas and for babies. The length of time you need to use the topical steroid for also depends on the severity of the flare up and of the strength of the topical steroid you are prescribed.
Topical steroids are used for short periods of time to treat flare ups. Patients should continue to use their emollient for washing and moisturising during the use of the topical steroid. It is important to use emollients all the time to prevent the skin becoming dry and itchy. Your doctor may prescribe you a topical steroid to keep at home in case of a flare up. If you have more severe eczema with frequent flare ups, your doctor may prescribe you topical steroids to apply 2 days a week to the areas where the eczema usually flares up. This is known as ‘weekend therapy’ and is a type of preventative strategy for those people with severe eczema. It can help prevent the almost continuous flare cycle, meaning that in the long run less topical steroid is used than if each flare were treated as it occurs.
Topical steroids are safe and effective when used appropriately and under the supervision of an experienced dermatologist. These preparations have been in existence for over 50 years and so the safety profile and side effects are well known. The chance of side effects occurring is related to the potency of the topical steroid used, the condition of the skin and the age of the patient. If topical steroids are used incorrectly or for long periods of time, it can lead to thinning of the skin, telangiectasia (where small blood vessels widen and become more prominent) and striae (stretch marks). Other potential side effects include perioral dermatitis (spotty rash around the mouth) and increased hair growth.
Topical calcineurin inhibitors (TCIs) are another type of topical treatment for eczema that works to calm the inflammation in the top layers of skin. TCIs are safe steroid-alternative treatments for eczema flare ups. There are two types: Elidel (pimecrolimus) and Protopic (tacrolimus). These creams do not contain steroids and so do not cause the same side effects as steroids. The most common side effect of the TCIs is a warming or burning sensation at the site where the cream is applied. This sensation is not usually a reason to stop using the cream as it typically subsides within a week. These treatments are licensed in the UK for the treatment of eczema in adults and children over the age of two.
Other alternative treatments that are used less frequently for the management of eczema are phototherapy, bandages and immunosuppressants.
For more information regarding the treatment of eczema please contact us on 020 7467 3720.
Content by Dr Sunil Chopra and Rebecca Perris
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