Eczema & Dermatitis

Eczema & Dermatitis FAQs

• What are the different types of Eczema?

  The name ‘eczema’ is given to a group of similar skin conditions which lead to dryness and irritation. There are a number of different forms:

  • Atopic eczema – the most common type; though more common in children, it also affects adults
  • Discoid eczema – occurs in circular patches on the surface of the skin
  • Contact dermatitis – a reaction following contact of the skin with certain substance
  • Varicose eczema – an eczema affecting the lower legs, resulting from poor blood flow
  • Seborrhoeic eczema – characterised by discoloured, scaly patches on the nose, ears or scalp
  • Dyshidrotic eczema – small blisters on the palms
• What causes Eczema?

  Eczema is a chronic skin condition whereby patches of skin become very dry and red- much like a rash. In some cases, and especially for kids, eczema will gradually improve over time. Eczema most frequently affects the knees, elbows, neck, face and hands.

• Is Eczema contagious?

  Eczema is not contagious.

• Is Eczema hereditary?

  People within a family often have similar susceptibilities to some skin conditions, including eczema. Eczema tends to develop concurrently with other hereditary conditions like hay fever and asthma.

• How is Eczema diagnosed?

  A doctor will usually be able to discern whether your skin condition is eczema or another similar condition. If normal eczema treatment does not provide relief, you may be referred to a dermatologist to identify the root cause of the condition. As eczema is often associated with an allergic response, you may be advised to have an allergy test. Common allergens linked to eczema symptoms include mites, fungal spores, pollen and some foods. In the case of food, certain changes may need to be made to the diet.

• Does Eczema worsen with age?

  Twenty percent of British children will develop atopic eczema to some extent. In the majority of cases, eczema will first develop while the child is a baby or toddler, and often in infancy.

  Around half of children with eczema will see significant improvement by the age of eleven, and many will see the condition clear entirely by the time they reach adulthood. In some cases, however, eczema will remain through adulthood, or otherwise appear for the first time when the individual is an adult.

• How can I find an Eczema specialist?

  There is no medical specialty devoted to eczema; it falls under the umbrella of skin conditions, which are covered by dermatologists. A GP will refer you to a dermatologist if your eczema is particularly severe or if regular treatment is ineffective.

  If you need help with a referral you can contact us and we will also be happy to help.

• What will a dermatologist prescribe for Eczema?

  Dermatologists will review your current medication and offer support to ensure that they are being used correctly. Further remedies they might offer include:

  • Topical calcineurin inhibitors – these are ointments that will suppress your immune system, which include tacrolimus and pimecrolimus
  • Topical corticosteroids
  • Wet wraps or bandages
  • Phototherapy – ultraviolet light which will combat further inflammation
  • Immunosuppressants – tablets that work to suppress the immune system, which include ciclosporin, azathioprine and methotrexate
  • Alitretinoin – medicine specifically for adults to treat severe eczema of the hands
  • Psychological support if necessary
• Are Eczema symptoms generally symmetrical?

  Symmetrical symptoms usually indicate atopic eczema or psoriasis. Asymmetrical symptoms are typically due to causes from outside the body, like fungal infections or tinea.

• Is it normal to have dry, flaky skin with Eczema?

  This is normal – dry itchy skin is one of the characteristic symptoms of eczema.

• What factors can trigger Eczema to worsen?

  Many external factors can cause eczema to flare up. Though these will vary depending on the individual, common triggers will include:

  • Allergens such as pollen, animal fur, mites, moulds, peanuts, eggs or soya. Reactions to lactose are very often associated with eczema
  • Environmental factors such as dampness or dry weather
  • Irritants in certain types of shampoo and cleaning products
  • Contact with certain fabrics including wool and synthetics
  • Hormonal changes in women, such as in the days preceding a period or whilst pregnant
  • Stress

  Your GP will counsel you on how to identify eczema triggers and how best to avoid them.

• Is there a cure for Eczema?

  As atopic eczema is a chronic condition, there is no cure. However, medication is effective at combating symptoms, and most children with eczema will find that their condition improves significantly with age.

• What is the difference between creams, ointments, lotions? Which is the best one type use?

  The best emollient is the one you use most often - the most important thing about emollient use is that it is regular (up to four times daily).

  Different emollients can be used depending on your own routine - for example, a cream can be applied easily in the morning as it soaks in more quickly and an ointment can be applied at night as it is more greasy and takes longer to absorb.

  Terminology is important in treating skin conditions, so here are the differences between the types of topical products:

  A solution is a liquid with a base of water or alcohol. They are thin and easy to apply, but can cause further dryness for some people.

  Lotions are slightly thicker than solutions. These can be used for large and/or hairy regions of skin.

  Creams are thicker than lotions. They are used for smaller areas of skin, especially when a region is weeping.

  An ointment is a product with high oil content. They can be greasy, and are used to treat dry and scaly skin.

  For quite hairy parts of the body including the scalp, gels are used, which are more solidified. An alternative for the scalp is a mousse, a foamy product.

• What treatments are there apart from emollients and steroids?

  If your eczema does not respond to normal remedies, you may be prescribed topical treatments like tacrolimus or pimecrolimus. To combat itching, you can take antihistamines. If necessary, dermatologists might recommend more powerful treatments including special bandages to provide relief allow the skin to heal.

• What is the best time to apply my Eczema treatment?

  Emollients, such as Diprobase, Balneum and Cetraben, moisturise the skin and should be applied as often as necessary. This is normally two to four times daily depending on your routine and the severity of your eczema.

  Special care should be taken to moisturise often, especially after washing, this will ensure the skin is protected from drying out. The skin absorbs moisturisers particularly well after washing so using emollients after showering or bathing is always a good idea. Washing the skin with soap, gels, shampoo or even very hot water can strip the skin of moisture and is not recommended.

  Emollients can also be used in bath water and in the shower as a soap substitute.

  Steroid creams, including Hydrocortisone, Betnovate and Eumovate, are applied as a think layer once or twice daily for a course of 7 - 10 days to treat a flare-up (always check the individual product instructions).

  They should be applied in the morning and/or evening, leaving at least 15 minutes between applying your regular emollient and the steroid cream to allow both to absorb separately.

• How much cream/ointment should I apply?

  Emollients can be applied as often as you need them. As a general rule, you should always apply more emollient than you think - people tend to underestimate the amount of moisturiser required.

  Application of steroid creams is measured in Finger Tip Units (FTU) - the amount of cream from the end of the finger to the first crease. Typically, one FTU would cover the equivalent area of skin of one hand.

• What if I forget to apply my Eczema treatment?

  Emollients can be applied as often as required. It is important to keep the skin hydrated so apply frequently and regularly. If you forget an application, apply at the earliest opportunity.

  Thick emollient ointments sometimes block the hair follicles in the skin. This may cause a mild inflammation or infection of the affected hair follicles, which is called folliculitis. Ensure you apply emollients in the direction of hair growth after washing with shampoo to hep to prevent this.

  If you forget to apply your steroid cream, apply the correct dose when you remember, and then carry on as before. If it is nearly time to apply the next dose, skip the current application and apply the next dose at the normal time.

• Should I be worried about side effects?

  The side effects of emollients are limited and minimal.

  Over-the-counter creams and ointments can contain colors and perfumes. It is possible you may be sensitive to, or react to, these ingredients rather than the emollient itself.

  Medical emollients don’t have colours or perfumes and are less likely to cause any irritation or reactions.

  To avoid block pores or causing other problems from frequent emollient application, ensure you are applying in the direction of hair growth.

  Steroid containing medicines applied to the skin are well tolerated and cause minimal effects when used in their short courses as prescribed.

  If used for longer periods, or when short courses are often repeated, there is an increased likelihood of developing side effects including thinning of the skin.

• What does infected Eczema look like?

  Eczema causes skin to dry and break apart, so the risk of bacterial infection increases around the cracks. Excessive scratching or incorrect treatment regimens will further increase this risk. Typical symptoms of infected eczema include:

  • Swelling and soreness
  • Yellow discolourations on the flaked skin
  • White or yellow spots on the affected skin
  • Fluid or pus around the affected area
  • Fever and other flu-like symptoms

  Infections can cause existing symptoms to worsen, and prevent normal medication from being effective. You should consult your GP immediately if you notice that you or your child might have infected eczema.

  Infections are typically treated with antibiotics and by ensuring the skin is clean and protected from further infection. When the infection has cleared, you will be required to switch to brand new creams, so as to prevent further contamination.

• When using an emollient and a steroid, which one do you apply first?

  You should apply the emollient first and allow it be absorbed.

  Absorption usually takes around 10 - 15 minutes. When it is complete, the skin should feel slightly tacky to touch.

  You are then ready to apply a thin layer of steroid cream.

• What is the difference between the different steroid creams?

  Corticosteroid creams vary based on their strength. Mild corticosteroids such as hydrocortisone can be purchased at pharmacies. You will require prescriptions for more potent types such as betamethasone dipropionate. Your GP will prescribe the lowest potency that will effectively combat your symptoms.

• Do eczema scars go away?

  Scarring from eczema is a common problem, as the intense itching can lead to scratching of the skin surface that results in bleeding and cracking. For many, this can lead to feelings of self-consciousness, especially if the scars are highly visible – on the arms, face, neck and legs, for example. The scars can range in colour and size, depending on their severity.

  One of the best ways to prevent scarring is not to scratch. But this can be hard. Try using an anti-itch cream like E45 to reduce some of the intensity. If you already have visible scars, there are various good dermatitis creams available, and you should also aim to moisturise your skin often to keep it smooth and hydrated. Consult with one of our pharmacists here at The Independent Pharmacy to discuss which treatment is likely to be the most effective for your condition, whether you’re looking for relief or to minimise the visible damage and scarring of previous bouts of eczema.

• What should I eat to help get rid of eczema?

  There is no ‘wonder food’ that will totally cure you of the symptoms of dermatitis, but research has shown that certain changes to the diet can have a beneficial effect. Cutting out lactose – as found in cow’s milk – is one of the most common suggestions for eczema sufferers, and it is recommended that you try switching to a vegetable milk alternative to see whether this has any effect on your condition. Others have also suggested experimenting with cutting out foods such as gluten, eggs, soy, nuts, sugar and strong citrus fruits, to see if your condition could be partially related to an intolerance.

  On the other hand, increasing consumption of foods like healthy fats (olive and coconut oils), grains and vegetables have been shown in some to have a positive effect. Essentially, any effort that can be made to follow a good, healthy, balanced diet may all help to improve health generally and relieve symptoms – alongside a good topical treatment to provide additional relief.

• Eczema: how does it start, and what is it caused by?

  Unfortunately, the exact cause of eczema is still unknown. It is generally considered to be the body’s way of overreacting to a certain irritant, which could be why some sufferers find the condition improves after eliminating certain foods from the diet. However, eczema also often runs in families (alongside asthma). It usually starts in areas such as the face, the back of the knees, wrists, hands or feet.

  Atopic eczema is often diagnosed alongside very dry skin, where certain people have trouble retaining their skin’s moisture. For this reason, it’s important to moisturise regularly if you suffer with the condition – using an emollient shower gel is also recommended, as frequent showering under hot water can actually contribute to the drying effect.

• Are there ways to treat eczema naturally?

  Alongside the recommended creams and ointments, there are various other natural remedies that dermatitis sufferers claim help to relieve their symptoms – particularly certain kinds of oils. These include:

  • Cod liver oil
  • Coconut oil
  • Jojoba oil
  • Probiotics
  • Sea spray
  • Shea butter
  • Oatmeal
  • Chamomile
  • Honey
  • Witch hazel

  It’s worth keeping a log to write down the effects of various remedies, to see what works and what doesn’t. Every one's skin is different and may react better to certain treatments that others.

• Eczema and dermatitis: whats the difference?

  To clear up the distinction, dermatitis is a term that refers to skin inflammation (hence the ‘itis’), whereas eczema is a more general term that applies to many types of dermatitis, but not all of them. So for example, atopic dermatitis would be considered a form of eczema, which could also include contact dermatitis, stasis dermatitis and neurodermatitis.

  You can develop dermatitis without having eczema, for example, if your skin comes into contact with lots of stinging nettles and becomes inflamed, you could be said to have temporary dermatitis. Eczema sufferers can be said to be experiencing both.

• Do allergies cause eczema?

  Most of the time when eczema occurs, it’s not the result of an allergy. However, being around things that you are already allergic to can certainly exacerbate the condition considerably, if you are already experiencing eczema symptoms. This is because your body’s immune system is already in overdrive trying to fight off the irritant that’s causing the eczema in the first place.

  Studies have shown that in children, if one or both parents have eczema, asthma or seasonal allergies, then the child is much more likely to be at risk. Indeed, it’s not uncommon for the three of them to occur together.