Eczema Ultimate Guide

Eczema is the name given to a collection of skin conditions characterised by flare-ups of symptoms that involve areas of the skin becoming dry, sore, and itchy. This can affect the whole body, but in most cases it predominantly affects the hands, inside of elbows, backs of knees and the face. The most common form of eczema is atopic eczema, also known as atopic dermatitis, affecting 1 in 5 children and 1 in 10 adults in the UK^[1]. Flare-ups can occur frequently and eczema is usually a life-long condition, so understanding it in its entirety can make managing eczema easier!

What are the symptoms of eczema?

The full scope of symptoms will vary depending on the type of eczema in question, but typically areas of the skin frequently become cracked, inflamed and itchy. These periods of symptoms are known as flare-ups and can occur up to 2 - 3 times each month. Symptoms of atopic eczema can appear anywhere on the body, but they most commonly appear on the hands, backs of knees, inside elbows, face and scalp. The severity of atopic eczema varies from person to person, with mild flare-ups of atopic eczema involving small areas of dry, itchy skin, whilst more severe cases involve cracked, sore skin across the whole body.

What causes eczema?

It still is not clear what exactly causes eczema, although usually it is usually down to genetics, your environment or both:

• Genetics: There’s plenty of evidence that indicates the skin condition could be hereditary, meaning that if one or both parents have it, their child will be at an increased risk of developing it themselves.
• Environment: Coming into contact with an allergen, irritant or other factors such as the weather can trigger eczema symptoms.

What triggers eczema flare-ups?

Each person with eczema will be impacted differently by the triggers below, so understanding which ones trigger your flare-ups means you know which ones to avoid where possible. Common triggers of eczema include:

• Weather conditions (e.g. cold temperatures or extreme heat)
• Certain materials worn close to the skin (e.g. wool)
• Hormonal changes (e.g. related to the menstrual cycle or pregnancy)
• Strong chemicals in soaps, detergents or disinfectants
• Fragranced products (e.g. perfume or cosmetics)
• Stress
• Sweating
• Food allergies (e.g. lactose, eggs, gluten, or nuts)
• Environmental allergens (e.g. pollen, dust, mould or pet hair)

Is eczema contagious?

Eczema is a non-contagious skin condition, meaning that even if you are experiencing a flare-up or have an active rash, it cannot be spread to another person through skin-to-skin contact.

Is there a cure for eczema?

Currently there is no cure for atopic eczema. Symptoms can be managed and eased through several different forms of treaatment.

How to stop eczema itching?

One of the most common symptoms of eczema is an urge to scratch areas of inflamed skin to relieve itching sensations. This should be avoided as it can make the skin bleed and induce secondary infections. It can also disrupt sleep cycles and affect concentration. Here are several ways to relieve eczema-related itchiness:

• Apply a cool compress to the inflamed area and hold for up to 10 mins
• Use an itch-relieving cream or moisturiser, such as E45 Itch Relief Cream
• Apply emollients in downwards strokes instead of rubbing them into the skin
• Pinch the skin around the affected area
• Keep cool and wear light, loose clothing

In addition to these tips, make sure to keep your nails short to avoid damage to the skin from habitual scratching^[2].

Can skin affected by atopic eczema become infected?

As flare-ups of atopic eczema can involve the top layer of skin (epidermis) becoming cracked and broken, there is a risk of skin becoming infected^[3]. Scratching the skin can also increase the risk of an infection developing. Signs of a bacterial infection can include:

• A yellow crust on the surface of affected areas
• The affected area becoming swollen and sore
• Yellow or white spots appearing on the skin of the affected area
• Fluid seeping from the affected area
• Feeling unwell, hot and shivery

If you think you are experiencing an infection and your usual eczema symptoms are getting worse, contact your GP.

How to sleep well with eczema?

It can be difficult getting to sleep whilst experiencing a flare-up. During the day our bodies produce cortisol, a natural anti-inflammatory substance that soothes itching sensations^[4]. At night our cortisol levels drop, meaning eczema symptoms that may not have been as intense during the day feel a lot more impactful at night. You may need to take extra steps in order to ensure you’re getting enough sleep each night, such as:

• Using cotton bedding, to prevent irritation to the skin
• Washing and moisturising yourself before bed
• Having a window open to avoid getting too hot

What are the other types of eczema?

Eczema is the collective name for a group of conditions affecting the skin, causing it to become dry, inflamed and irritated^[5]. Other than atopic eczema the five other types of eczema are:

• Discoid eczema: also known as nummular or discoid dermatitis, this form of eczema is a chronic skin condition causing distinctive circular patches of eczema. The cause is unknown, but it is hypothesised that it could happen as a result of having very dry skin, which means the skin cannot form a protective barrier against substances. This means substances that may not usually cause harm, can irritate the skin.
• Contact dermatitis: this form of eczema is triggered through contact with certain substances (irritants or allergens), and typically clears when those substances are avoided. The triggers include soaps, detergents, solvents or frequent contact with water.
• Varicose eczema: this type of eczema is a long-term condition affecting the lower legs. It frequently affects those with varicose veins, and is more likely to affect women than men. Varicose eczema is usually caused by intense pressure to the leg veins, including those who are pregnant, older, overweight or those who live sedentary lifestyles.
• Seborrhoeic eczema: this is another common form of eczema that appears in places of the body where there are oil-producing glands. Common triggers include stress, cold weather, certain medications, hormonal changes and harsh chemicals.
• Dyshidrotic eczema: this form of eczema (also known as pompholyx) causes small blisters to form on the hands and feet. The blisters often come and go, lasting 2 - 3 weeks at a time. Triggers for this form of eczema typically include strong chemicals in soaps and detergents, allergies to certain metals, stress and frequent contact with water.

What are the treatments for eczema?

• Topical Corticosteroids: these are anti-inflammatory steroid treatments that ease symptoms of eczema by relieving the itchiness, dryness and soreness of an affected area. They either come as an oil-based ointment like Hydrocortisone Ointment, or as a cream like Hydrocortisone Cream or Eumovate.
• Emollients: these treatments reduce water loss from affected areas by covering the skin with a protective layer, so there’s less chance of it drying out and cracking. Emollients can come in several forms, such as lotions, sprays, creams, ointments and soap substitutes. They also have mild anti-inflammatory properties, so they can also reduce the amount of flare-ups and reduce redness and swelling in the affected area. Doublebase Gel soothes itchiness and treats dry, cracked skin with its active ingredients isopropyl myristate and liquid paraffin. E45 Eczema Repair and E45 Emollient Bath Oil are other effective, topical, moisturising treatments that can ease symptoms. Another microbial emollient that can also serve as a soap substitute as well as a moisturiser is Dermol 500.
• Antihistamines: treatments like Piriteze or Clarityn can ease symptoms of eczema flare-ups by inhibiting histamine in the blood from prompting an allergic reaction, which helps soothe itchiness.

How to prevent eczema flare-ups?

As well as using recommended eczema treatments, there are other ways to reduce the impact of eczema symptoms and prevent flare-ups. You may not need to follow all of these prevention tips, just the ones that you feel are relevant to help manage your specific triggers. These tips include:

• Lifestyle changes: taking steps to stop smoking, minimise stress and getting enough sleep can all help to improve your overall health and immune system, which can lower your risk of experiencing a flare-up.
• Keeping a food diary: by writing down the meals you have each day, you may be able to notice if certain foods are contributing to your flare-ups, and eliminate them from your diet. (Make sure to consult a dermatologist before cutting anything out from your diet)
• Avoid strong, fragranced products: avoid soaps, perfumes, detergents or cleaning products containing harsh chemicals or fragrances as these can aggravate the skin.
• Lukewarm baths: hot water can dry out the skin and cause further irritation, so using lukewarm water can prevent your skin from becoming dehydrated.
• Wear loose clothing: flare-ups can be caused by tight or irritable clothing so by wearing loose, skin-friendly clothing (e.g. cotton), the skin can breathe and flare-ups can be avoided.
• Manage home environment: keeping your home clean can reduce the risk of indoor allergens like dust from triggering flare-ups. Central heating can also cause symptoms by drying out the skin, so try using a humidifier to counter this.
• Keep skin moisturised: applying moisturiser after washing helps your skin retain moisture, reducing the risk of experiencing a flare-up. If moisturisers aren’t enough, try using emollients instead.

How long does it take for an eczema flare-up to clear?

The duration of a flare-up can vary depending on the type of eczema in question, as well as the severity of it. With effective treatments being used, flare-ups can last from 1 - 3 weeks, but it can take longer if symptoms are more severe or if treatments are not being applied correctly^[6].