Eczema

Table of Contents

• What is it and how do I manage it?
• Types of eczema
• Eczema symptoms
• Eczema triggers and factors
• How to manage eczema

Types of eczema

There are a number of different causes and types of eczema, but the most common are:

Atopic eczema (atopic dermatitis)

There is no single known cause for atopic eczema, which is also known as atopic dermatitis. This long-term inflammatory skin condition is often genetic, with around half of cases linked to a specific gene. It can also be caused by your immune system or can be triggered and made worse by factors in our environment like extreme temperatures, soap, detergent, pollen, animal dander, house-dust mites and rough clothing.

Symptoms can be mild, meaning patches of dry skin, occasional itching and maybe some redness. Moderate symptoms include patches of red, dry skin, frequent itching, which can cause the skin to thicken; all of which can result in disrupted sleep. In severe cases, large red areas develop, with dry skin that is always itchy and cracked, which may bleed or ooze. In severe eczema, the effects go beyond the skin; in children it can limit their ability to do everyday activities, affects their quality of life and can make it hard for them to sleep through every night.

Although it can affect any part of your body, atopic eczema is most common on your scalp and between your body creases like knees, elbows and armpits; in infants the face is also a common area that is affected. It usually starts in childhood, with up to 90% of cases in children under five years of age. Although 10-30% of children have atopic eczema, they often grow out of it – as only 2-10% of adults are affected. The condition is more common if you have asthma and/or hayfever.

Contact eczema (contact dermatitis)

Contact eczema, otherwise known as contact dermatitis, occurs when an irritant or allergen causes an inflammatory skin reaction.

Dyshidrotic eczema (pompholyx eczema)

Dyshidrotic eczema, also known as pompholyx eczema, usually affects your hands and feet. While the cause is unknown, it has been linked to contact eczema, stress, heat and sweating.

Symptoms start with an itching, burning, prickly feeling in the soles of your feet and/or palms of the hands. Extremely itchy watery blisters develop on the soles of your feet, palms of your hands and outside of your fingers that then group together to form large, weepy blisters. These can become infected, swollen, red and painful then red and cracked as they dry out. You might find you have blisters for around three to four weeks before they vanish of their own accord. The condition can even affect the skin around your nails, causing swelling. It’s more common in adults under 40 years of age, particularly women. Around half of people with dyshidrotic eczema also have atopic eczema or a family history of this condition.

You might find you only ever have one bout of dyshidrotic eczema in your life, though most people find it is a long-term problem with recurrent bouts.

Discoid eczema (nummular eczema)

Also known as discoid dermatitis or nummular eczema, this condition causes ‘coin-shaped’ (round or oval), extremely itchy, dull red patches on your skin. It’s not known exactly why we get it, but having dry skin seems to be a factor. Discoid eczema develops suddenly, appearing anywhere on your body, but usually on your arms, lower legs and/or trunk. One thing to be aware of is that body washes, moisturisers and other materials that touch the skin can make discoid eczema worse in some people.

This form of eczema can affect anyone at any age but is slightly more common in adults. If you’ve ever had atopic eczema, allergic contact dermatitis or eczema as a child, you are more likely to develop discoid eczema. Chronic alcoholism also increases your chances of developing discoid eczema. Unlike some other types of eczema, discoid eczema does not run in the family.

Seborrhoeic eczema (seborrhoeic dermatitis)

This form of eczema is found in the parts of the skin where there are lots of sebaceous (oily) glands, such as the scalp, face and centre of the chest. Also known as seborrhoeic dermatitis, it’s believed to be caused by an inflammatory reaction to the overgrowth of a yeast that lives normally on the skin called Pityrosporum ovale. There are two types of seborrhoeic eczema: one that affects adults and one that affects infants.

Your skin will be pale red and inflamed with greasy-looking white/yellow scale on top. In the skin folds, like your armpits or groin, your skin may look more glazed and you may not have any scales at all. Where your skin is more exposed, the scaliness is more obvious and yellow. Your skin may be itchy and, in severe cases, can even be painful.

Mild scalp seborrhoeic eczema causes flaking skin and is better known as dandruff. If the condition affects your face, you may develop red, scaly skin around your nose and cheeks. In rare cases, seborrhoeic eczema can spread and become more severe, affecting large parts of the body but is not contagious.

Seborrhoeic eczema can affect people of any age, though in children you probably know it better as ‘cradle cap’. Around 4% of the population have seborrhoeic eczema, with dandruff affecting up to half of all adults. It’s more common in men, particularly those around 30 years old. For women, the peak time of developing the condition it is around 40 years of age. If you have another skin condition called psoriasis, you may find you also have seborrhoeic eczema at the same time.

Varicose eczema (stasis, venous or gravitational eczema)

Varicose eczema is also known as stasis eczema, venous eczema or gravitational eczema. When the valves in our leg veins are weak and don’t work properly, blood doesn’t drain well and pressure in the leg veins builds up. Hot, brown, itchy speckled spots that can blister appear on your lower legs. Your skin can be dry, extremely itchy and even painful. In severe cases, your skin can be scaly, weepy and crusty. You might even find that varicose eczema triggers eczema in other parts of the body. It’s important to treat varicose eczema to stop the skin breaking and forming ulcers on the leg, which can be hard to heal.

The condition is more common if you get varicose veins, are middle-aged or older, female or overweight, have high blood pressure or have had conditions such as cellulitis, phlebitis or deep vein thrombosis in the past. Unlike some other types of eczema, varicose eczema does not run in the family.

Eczema triggers and factors

Eczema triggers can vary from person to person and depend on the type of eczema. Here are some of the most common:

Allergens

Allergens cause a reaction in some people with eczema. This happens after you come into contact with a substance that has previously made you become sensitive to its effects. Common allergens include the house-dust mite, pollen, cosmetics, hair dyes, perfume, plants, medicines and metals such as the nickel and cobalt that you find in jewellery. Allergies often run in families.

How to avoid:

• Try and find out what allergen causes you to react, and avoid this as much as possible
• Wipe surfaces with a damp cloth rather than dusting surfaces (dusting can spread allergens into the air)
• Wear gloves when washing up, if the allergen is in cleansers and detergents
• If you can’t bear to get rid of your pet, try and keep them outside or limit them to one part of the house, vacuum often, regularly wash bedding and soft furnishings. Also try and have a pet-free zone, such as the bedroom, where they are not allowed in at any time
• Don’t dry clothes outdoors when pollen levels are high
• Wear wraparound sunglasses while outside
• Shower and change clothes when you get back inside
• Antihistamines can help ease allergy symptoms.

Clothing

Almost half of people with eczema say clothing can irritate their eczema. This can include fabrics such as wool, silk and synthetic fibres.

How to avoid:

• Wear natural fibres, such as cotton
• Avoid synthetic fibres as these can make you hot, causing itchiness
• Avoid wool as it has coarse, stiff fibres that can irritate the skin
• Get rid of labels and loose threads as these can also cause irritation.

Cleansers

Soaps, detergents and fragrances can cause additional skin irritation for the majority of those with eczema.

How to avoid:

• Wash hands with a soap-free product – use an emollient as a substitute for soap
• Use fragrance-free products
• Wear gloves when doing household tasks, ideally plastic gloves with a cotton liner
• Use ‘ecoballs’ in place of laundry detergent or, if using detergent, do a double rinse cycle to remove any traces of washing powder.

Diet

Around a third of people with eczema say what they eat, and drink is a trigger. Some foods can cause allergic reactions in people with atopic eczema, such as cow’s milk. Other foods can cause contact dermatitis, for example, citrus fruits, raw onions, garlic, tomatoes, peppers and chillies.

How to avoid

• Around 75% of food-related eczema is due to milk, wheat, soya, eggs or peanuts – so consider avoiding these foodstuffs
• Wear gloves when preparing foods that irritate your skin
• In babies, try specialist formula milks.

Stress

Stress is a trigger for 9 out of 10 people with eczema. In response to fear or stress, your body produces cortisol which is released from the adrenal glands as part of the fight-or-flight response. This dampens the immune system and can cause an inflammatory reaction in our skin.

How to avoid:

• Try relaxation techniques like deep breathing, yoga, tai chi or meditation
• Use distraction methods such as baking, knitting or painting – whatever works for you
• Get a good night’s sleep. To help, try having a relaxing bath or shower before bed, avoid electronic devices for an hour or two before bedtime and sleep in a dark, cool room
• Exercise regularly – if sweat triggers your eczema, remove sweaty clothes as soon as possible afterwards and shower
• If you feel you can’t manage your stress, talk to a healthcare professional.

Weather and temperature

Around 70% of people with eczema find the weather or temperature can trigger symptoms. You might find your symptoms are better in the summer than in the winter as central heating can dry out your skin. However, sweating in hot weather can also irritate your skin.

How to avoid:

• Keep your house at a regular temperature to avoid overheating or extremes of temperature (18°C is ideal)
• Use humidifiers to put moisture back into the air or place bowls of water under radiators
• Wear thin layers that you can take off if you feel too hot throughout the day
• If possible, have radiators to heat your house rather than convection heaters.