This article was written by London-based GP – Dr Nirja Joshi
September highlights Eczema Awareness Week, and we hope to shed light on a very common, yet complex condition which can affect anyone from newborns to the elderly. The likelihood is that most people know of someone suffering from eczema, so it is helpful to know a bit more about the different types of eczema and what can be done to help. When eczema is not well controlled, it can severely impact a person’s work, social life, and day to day life.
What is eczema?
Eczema is where skin becomes dry, itchy and inflamed and can affect any area and has the potential to blister and weep. This article covers two of the more prevalent types of eczema, but there are other types such as discoid eczema, eczema herpeticum, contact dermatitis and many more.
This type of eczema is one that people may be more familiar with. It can affect people at any age, but the onset is most common in childhood affecting around 1 in 5 children. The word ‘atopic’ relates generally to a collection of conditions which suggest a tendency towards allergy such as asthma and hayfever (1).
Atopic eczema occurs generally related to environmental allergens such as soaps, detergents, perfumes etc. This type of eczema is more common if a child’s parents also have similar atopic conditions.
Symptoms can affect anywhere on the body, but commonly affect the creases at the elbows and knees and also on the face. As well as chemicals and irritants, factors such as infections and stress can contribute to flare ups. Skin can look dry and inflamed and if the flare up worsens, skin can bleed or weep.
60% of children who have atopic eczema will have symptoms clear by the time they are teenagers (2).
This type of eczema responds best to avoiding triggers, topical treatments (moisturisers and steroid creams) and tablets such as antihistamines to help with itching.
Hand dermatitis (3), otherwise known as hand eczema affects around 1 in 20 people. This condition can be very difficult to manage and also one of the more debilitating types of eczema as we use our hands every day. This became particularly common during Covid as people were washing their hands much more than usual as well as using alcohol gel.
As modelled by patients in Covid, sometimes this problem can be short lived and situation specific, but for others, it can last years.
This is more common in people who have jobs which include ‘wet work’.Skin in hand eczema looks red, inflamed, dry, flaky and can bleed and ooze as well as have a tendency towards infection.
The best way to keep hand eczema under control is to dry your hands thoroughly after washing, and use moisturiser after washing your hands. If you are able to use soaps designed for sensitive skin or moisturising hand washes then this can help, and if you wash your hands frequently at work, you can speak to your occupational health regarding this to help you at work. You may require steroid creams to help during a flare up and antibiotics in case of infection. A good tip is to use thick ointments overnight to allow these to soak in, and sometimes wearing gloves overnight can help to reduce itching and allow the treatment to work. If you have a job where your hands are in contact with irritants, wearing gloves to avoid direct contact can be helpful.
What should I put on my eczema?
Ultimately, this is something to discuss with your healthcare professional. The question we commonly are asked in General Practice is ‘which is the best moisturiser?’ and the answer is, ‘the one which the patient will use!’. Far too often, GPs prescribe moisturisers in large quantities which patients do not like and hence do not use, and hence, their skin will flare up. Moisturisers are very important to help the skin’s barrier to remain protected and help to control and prevent flares. Moisturisers without perfumes are often better for those with skin conditions as perfumes can be irritating to the skin. Moisturisers, or emollients, can be bought over the counter, and GPs are being recommended to not prescribe emollients or soap substitutes. Moisturisers have different textures, and it’s important to see what works for you. Ointments are thicker and these are better for drier skin. Personal preference will certainly play a part in what you choose to use on your skin.
You may be given a steroid cream by your doctor or pharmacist. It is important to remember to apply this thinly to the affected skin, as overuse of steroid creams can cause thinning of skin. Steroid creams can help by reducing inflammation (4).
What other treatments are available?
If you are under the care of a specialist, you may be given other treatments such as UV light treatments, immune modulators or oral steroids (4).
Support with eczema
The National Eczema Society (5) has a helpline for those suffering with eczema 0800 448 0818. It is important to remember that eczema, as well as other skin conditions, do carry a psychosocial impact and if you are suffering with your mental health due to a skin condition, you should seek help from a healthcare professional.
- NHS. Atopic Eczema [Internet]. 2019 [cited 2022 Sep 19]. Available from: https://www.nhs.uk/conditions/atopic-eczema/g
- British Association of Dermatologists. Atopic Eczema [Internet]. 2020 [cited 2022 Sep 19]. Available from: https://www.bad.org.uk/pils/atopic-eczema/
- British Association of Dermatologists. Hand Eczema [Internet]. 2016 [cited 2022 Sep 19]. Available from: https://www.bad.org.uk/pils/eczema-hand/
- National Eczema Society. Information and advice [Internet]. [cited 2022 Sep 19]. Available from: https://eczema.org/information-and-advice/
- National Eczema Society. Eczema Helpline [Internet]. [cited 2022 Sep 19]. Available from: https://eczema.org/helpline/
Eczema was last modified: September 21st, 2022 by