Eczema

What is Eczema?

Eczema, also known as atopic dermatitis, is a skin condition that causes itchy, irritated and inflamed skin. Eczema is a chronic condition that goes through times of worsening, known as an eczema flare and times of dormancy. There is no permanent cure but there are treatments to control flares as well as preventative measures that can be taken.

About 4 million or 16% of Australians get diagnosed with a form of eczema in their life and even more people with eczema suffer from it without seeking proper diagnosis and treatment.

Symptoms & Types

There are many different types of eczema, each with distinct features. Although they slightly differ, there are some common symptoms for almost all types of eczema. These include intensely itchy skin, dry skin, redness and skin inflammation.

The different types of eczema are:

• Atopic dermatitis - the most common form of eczema
• Contact dermatitis - occurs upon contact or with an allergen such as chemicals or latex
• Status dermatitis - occurs due to poor blood flow and weakened veins leaking fluid into the skin
• Neurodermatitis - causes scaly patches
• Dyshidrotic - causes blistering on the hands and feet
• Nummular - causes round itchy, red spots on the skin
• Seborrheic - occurs where the body produces the most oils

You may have one or more types of eczema. Each type can have its own specific set of triggers and targeted treatments. Because of this, it is important that a medical professional diagnoses and treats your eczema.

What Causes Eczema?

The leading experts believe eczema to be the result of the immune system overreacting when exposed to irritants. When exposed, the immune system mounts an attack on the healthy area of the skin causing inflammation that results in the classic eczema symptoms. The risk of developing eczema is closely linked to genetics and family history of allergic conditions such as hay fever or asthma.

What irritants cause eczema can vary from person to person but there are some common triggers for eczema that should be avoided such as:

• Heat
• Dry air
• Washing powders
• Hand sanitiser
• Detergents
• Perfumes & colognes
• Stress
• Sweat
• Clothing materials
• Animal hair
• Food allergies

Creating your own list of triggers can be useful when making decisions on products, household environments and foods.

Eczema often flares when the skin barrier is damaged and exposed to the elements. This is why dry skin can be a particularly common cause of a flare.

Diagnosis

To diagnose eczema, a doctor will examine the area and take a medical history. There is no specific test or lab result required for diagnosis. 

Your doctor may decide to conduct a patch test to identify some individual causes of contact dermatitis. This involves placing a series of patches onto your back with small amounts of common triggers. If a patch irritates your skin, your eczema is triggered by that substance.

Eczema Treatment

After diagnosis, your doctor may prescribe a treatment based on the severity and type of eczema you have. If a flare is severe enough, your doctor may prescribe multiple therapies to get your flare under control. From there, your doctor can provide medical advice on how to manage sensitive skin and prevent eczema.

Please note that Australian law prevents us from naming specific prescription treatments. After completing an assessment, you will be presented with the treatment options our doctors can prescribe.

Eczema Creams and Ointments

Known as steroid creams, these medicines belong to a group of medicines called corticosteroids. Although being called steroids, they are not the hormonal steroids used for muscle growth. They lower the immune system response in the areas they are applied. Because eczema is caused by an immune system attack on the skin, steroid creams and ointments lower the overreaction of the immune system providing relief.

The creams and ointment vary in potency from mild to very potent. They are prescribed based on the severity of the condition with the most potent only being used if absolutely necessary.

Some of these also contain antibiotics. Typically these are only used in infected eczema to help clear away the bacteria.

Topical steroid treatments should not be used on large areas of skin or for long periods of time. They should only be used when an eczema rash is present and for the shortest possible time.

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Corticosteroid Tablets

In severe cases of eczema, your doctor may prescribe a short course of corticosteroid tablets. Similar to the creams and ointments, these control the overactive immune response causing eczema, allowing the skin to heal. Due to unpleasant side effects, these are only used rarely and should not be used long term unless under direct advice and monitoring by a doctor.

Antihistamines

Antihistamine tablets can provide some symptomatic relief from itching. They work by reducing the amount of histamine released while experiencing an allergic reaction. It is recommended you use non-sedating antihistamines to avoid unnecessary sedation during the day. Sedating antihistamines taken before bed may help more if the itching is worst at night.

Prevention

By implementing strategies to prevent flares from occurring eczema can become much more manageable. Consider the following changes:

• Avoid scratching - Scratching the area causes damage to the skin and increases the risk of skin infections. Keep nails short or wear gloves at night to avoid as much damage as possible.
• Moisturize the skin - Dry skin is one of the most common causes of a flare, keeping the skin moist and healthy can protect the skin and help avoid flares from ever beginning. Make sure that you use fragrance-free moisturizer to avoid any allergies as fragrances are a common trigger.
• Wear loose breathable clothing - tight clothes or clothes with irritating material or material that is too hot for the weather can all result in eczema worsening.
• Avoid fragranced products - Soap or laundry fragrances are often responsible for flares. Test some fragrance-free or mildly fragranced products to see if your condition improves. Once you found the right product for you, avoid changing it if possible.
• Manage stress - Find effective ways to manage stress can help reduce flares and improve your mental health.
• Avoid personal triggers - Keep a diary of what triggers your eczema and do your best to avoid them if possible.

Eczema Frequently Asked Questions

Can you buy steroid creams over the counter?

You can buy mild potency steroid creams over the counter from a pharmacy. The higher potency creams and ointments are prescription only. You can access these medicines by speaking to a doctor online or in person.

What does eczema look like?

Eczema affected skin will typically look inflamed and dry. On lighter skin, it will often cause a red rash to appear while on darker skin it may appear grey or dark brown. You can look at photos of eczema here for more details on each type.

How do you cure eczema?

Unfortunately, there is no cure for eczema. It is a lifelong chronic condition. It most commonly occurs in children, with some adults rarely experiencing the condition after childhood. While there is always the potential for a flare you can drastically improve the number and severity of the eczema flares you experience by effectively managing your risk factors and triggers.

Written by Clinical Pharmacist Tyson Wilkman