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Eczema & Dermatitis frequently asked questions FAQ

Here are common questions about dermatitis. , Also called eczema, it is an allergic skin disorder that usually appears in babies or very young children, and which may last until the child reaches adolescence. Eczema causes the skin to itch, scale and flake. Here you will find our eczema and dermatitis frequently asked questions. If your question is not answered here, please feel free to contact us.

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1. What is eczema or dermatitis?

Eczema, or dermatitis as it is sometimes called, is a group of skin conditions which can affect all age groups. In the United Kingdom, up to one fifth of all children of school age have eczema, along with about one in twelve of the adult population. The severity of the disease can vary. In mild forms the skin is dry, hot and itchy, whilst in more severe forms the skin can become broken, raw and bleeding. Although it can sometimes look unpleasant, eczema is not contagious. With treatment the inflammation of eczema can be reduced, though the skin will always be sensitive to flare-ups and need extra care. [top of page]

 

2. What causes eczema or dermatitis?

The causes of eczema are many and varied, and depend on the particular type of eczema that a person has. Atopic eczema is thought to be a hereditary condition, being genetically linked. It is proposed that people with atopic eczema are sensitive to allergens in the environment which are harmless to others. In Atopy there is an excessive reaction by the immune system producing inflamed, irritated and sore skin. Associated atopic conditions include asthma and hay fever. Other types of eczema are caused by irritants such as chemicals and detergents, allergens such as nickel, and yeast growths. In later years eczema can be caused by a blood circulatory problems in the legs. The causes of certain types of eczema remain to be explained, though links with environmental factors and stress are being explored. [top of page]


3. Which type of eczema or dermatitis do I have?

There are several different types of eczema, many of which look similar but have very different causes and treatments. The first step in effective treatment of eczema is a correct diagnosis. It is very important to see a general practitioner in the first instance, who may make a referral to a specialist dermatologist for further diagnosis and treatment. [top of page]

 

4. What are the different types of eczema?

 

Atopic eczema

Atopic eczema is the commonest form of eczema and is closely linked with asthma and hay fever. It can affect both children and adults, usually running in families. One of the most common symptoms of atopic eczema is its itchiness (or pruritis), which can be almost unbearable. Other symptoms include overall dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema the skin may crack and weep ( wet eczema). Treatments include emollients to maintain skin hydration and steroids to reduce inflammation.

Allergic contact dermatitis

Develops when the body s immune system reacts against a substance in contact with the skin. The allergic reaction often develops over a period of time through repeated contact with the substance. For example, an allergic reaction may occur to nickel, which is often found in earrings, belt buckles and jeans buttons. Reactions can also occur after contact with other substances such as perfumes and rubber. In order to prevent repeated reactions it is best to prevent contact with anything that you know causes a rash.

Irritant contact dermatitis

This is a type of eczema caused by frequent contact with everyday substances, such as detergents and chemicals, which are irritating to the skin. It most commonly occurs on the hands of adults and can be prevented by avoiding the irritants and keeping the skin moisturised.

Infantile seborrhoeic eczema

A common condition affecting babies under one year old, the exact cause of which is unknown. Also referred to as cradle cap, it usually starts on the scalp or the nappy area and quickly spreads. Although this type of eczema looks unpleasant, it is not sore or itchy and does not cause the baby to feel uncomfortable or unwell. Normally this type of eczema will clear in just a few months, though the use of moisturising creams and bath oils can help to speed this along.

Adult seborrhoeic eczema

Characteristically affects adults between the ages of 20 and 40. It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest. The skin becomes red, inflamed and starts to flake. The condition is believed to be caused by a yeast growth. If the condition becomes infected, treatment with an anti-fungal cream may be necessary.

Varicose eczema

Varicose eczema affects the lower legs of those in their middle to late years, being caused by poor circulation. Commonly the skin around the ankles is affected, becoming speckled, itchy and inflamed. Treatment is with emollients and steroid creams. If left untreated, the skin can break down, resulting in an ulcer.

Discoid eczema

Is usually found in adults and appears suddenly as a few coin shaped areas of red skin, normally on the trunk or lower legs. They become itchy and can weep fluid. Usually discoid eczema is treated with emollients (and steroid creams if necessary). [top of page]


5. Is there a cure for eczema or dermatitis?

There is currently no cure for eczema though research continues to shed new light on the condition. However, there are many ways to minimise the discomfort and distress which eczema can bring, the foundation of which is an effective skin care routine. A wide range of treatments is available, either over the counter at the pharmacy, or on prescription from a doctor. Many complementary therapies are available, which some people find helpful. In addition, there are ways of minimising environmental allergens commonly found in the home. [top of page]

 

6. Will my child grow out of their eczema?

There are no guarantees that a child will grow out of eczema. However, research has shown that 60-70% of children are virtually clear of the condition by the time they reach their mid-teens. [top of page]

 

7. How can I help myself, or my child, to manage eczema?

There are a number of ways to manage eczema, all of which begin with an effective skin care routine. Having access to accurate information is important as this allows the person with eczema, or their carer, to make informed choices when managing the condition. The following are the more commonly used treatments. Further information on any of these can be obtained through the National Eczema Society.

Emollients

Emollients are necessary to reduce water loss from the skin, preventing the dryness normally associated with eczema. By providing a seal or barrier, the skin is less dry, itchy and more comfortable. Emollients are safe to use as often as is necessary and are available in various forms: ointments for very dry skin, creams and lotions for mild to moderate or wet eczema. Some are applied directly to the skin, whilst others are used as soap substitutes or can be added to the bath. The range of emollients available is enormous and it may be necessary to try several before the most suitable one is found. Testing a small amount on the skin first is advisable, as emollients contain substances to which some people are sensitive.

Topical steroids

When eczema is under control only emollients need to be used. However in flare-ups, when the skin becomes inflamed, a steroid cream may be needed. Steroids act by reducing inflammation and are used in most types of eczema. Topical steroids come in four different strengths, mild, moderately potent, potent and very potent. The strength of steroid cream that a doctor prescribes depends on the age of the patient, the severity of the condition and, the size of the area and part of the body to be treated. Topical steroids are applied thinly to the affected area, as directed by the prescribing doctor. Your eczema should be reviewed regularly if topical steroids are being applied. It is important to use only the steroid cream prescribed for yourself and not to lend or borrow (what may be) an unsuitable cream from someone else. Many people have concerns regarding the use of topical steroids and their side-effects. As long as steroids are used appropriately and as directed by your doctor, the likelihood of side effects is very rare. Reported side-effects have been largely due to the use of very potent steroid preparations over long periods of time.

WARNING: Steroids carry many possible side effects.

Oral steroids

are sometimes prescribed in very severe cases and usually under the direction of a consultant dermatologist, when topical steroids have been found to be ineffective. These can have possible side-effects and the doctor should ensure close monitoring when prescribed.

WARNING: Steroids carry many possible side effects.

Topical Immunomodulators


These are new drugs available for use in the treatment of atopic eczema:

  • Tacrolimus ointment (Protopic „¢) is an ointment applied to the skin. It is not a steroid.
  • Tacrolimus modulates or changes the immune system in some way.
  • Tacrolimus ointment is licensed in the UK for patients aged 2 years and over with atopic eczema.
  • Tacrolimus ointment 0.1% and 0.03% can be used for the treatment of moderate to severe atopic eczema that is unresponsive to conventional therapy.
  • The ointment is available on prescription only from dermatologists and doctors who have experience in the treatment of atopic eczema.
  • Pimecrolimus cream (Elidel „¢) is a cream applied to the skin. It is not a steroid.
  • Pimecrolimus cream works on the same principles as Tacrolimus, but is probably weaker.
  • Pimecrolimus cream has been specially developed to treat and manage mild to moderate atopic eczema.
  • Pimecrolimus cream is licensed in the UK for patients aged 2 years and over with atopic eczema.
  • Pimecrolimus cream 1% can be used at the first signs of flare or for established eczema.
  • Pimecrolimus cream is available on prescription only from dermatologists or GP s experienced in treating people with atopic eczema.

Other dermatitis treatments

Your doctor may discuss are anti-histamines to reduce inflammation and wet wrap bandaging to soothe dry itchy skin. Ultra Violet light treatment and stronger medication may be considered for very severe eczema or for problematic conditions.

Source: National Eczema Foundation.

NOTE: Narrow Band UVB is becoming increasingly popular for Eczema and Dermatitis sufferers as it has less side effects than the often dangerous drugs and steroids traditionally used. [top of page]


8. Is there anything else that I can do for my eczema?

As well as using emollients and steroids there are several other ways which may help to reduce the severity of atopic eczema. It should be stressed, however, that what works for one person, will not always work for another. Eczema is a highly individual condition, which is why it is so difficult to find a "cure-all".

Reducing the itch

For children in particular, the itchiness of eczema can be very distressing. There are many methods of reducing the itchiness of the skin and minimising the damage from scratching. Cotton clothing and bedding keep the skin cool and allow it to breathe, whereas synthetic fabrics and wool can irritate. The use of a non-biological washing powder and avoidance of fabric softeners, can also help to reduce the itchiness of the skin. Children s nails should be kept short. During the day, distraction is often the best way of reducing the amount of scratching. At night-time, cotton mittens over children s hands can be helpful in reducing damage to the skin occurring during sleep.

Reducing the effect of the house dust mite

It is thought that people who have atopic eczema may be affected by allergens in the droppings of the house dust mite. This mite thrives in warm and moist environments and unfortunately likes to live in bedding, mattresses, curtains and carpets. It is believed that reducing the amount of house dust mites in the home may improve the condition of the skin. This can be achieved in a number of ways, from effective and regular vacuuming, to damp dusting and airing of bedding. [top of page]


9. Can changing my diet help my eczema or dermatitis?

The role of diet in the management of eczema has not been ascertained. Generally changes in diet are only considered in severe cases, when conventional treatments are failing. Dietary changes can be quite helpful in babies and young children, though the effects on older children and adults are less conclusive. When considering altering the diet of a baby or child it is important to seek advice from a dietician, or a nutritional therapist, in order to ensure that the child continues to receive adequate nutrients. Sometimes it can be useful to keep an accurate diary of foods eaten and the condition of the eczema and, when weaning babies, to do so very slowly observing for skin reactions. This is a large and complex topic. [top of page]

 

10. Are there any other treatments for eczema or dermatitis?

Many people prefer to explore the use of complementary therapies in addition, or as an alternative, to conventional treatments. Complementary therapists offer a holistic approach which is usually based upon the individual s needs. Evening primrose oil is now commonly used and other treatments such as aromatherapy, relaxation and homeopathy are readily available. Chinese herbal treatments may be used, but should only be tried after consultation with your doctor or dermatologist.

Though many people have found the use of complementary therapies helpful, there has only been limited scientific evaluation of complementary treatments and so it is important to consider the following:

It is essential to let your doctor know if you are starting another course of treatment, since interactions can occur between certain medications. Conventional treatments should not be stopped suddenly, without consulting your doctor.

Ensure that the practitioner is properly qualified and registered with the appropriate regulatory body.

Remember that a treatment which is described as natural or herbal is not guaranteed to be safe.

What works for one person will often not work for another. [top of page]


11. Eczema and dermatitis in schools, a guide for teachers

 

Introduction

One person in ten has eczema at some time in their life, usually during childhood and the majority of these children will attend mainstream schools. It is therefore very likely that in every school there will be a number of children who have eczema in varying degrees of severity.

In the majority of cases eczema can be managed well within the school environment. By making use of the following information and guidelines most children should be able to lead and active and fulfilling school life.

What is Eczema?

Eczema is a skin condition which can result in dry, inflamed and sometimes weeping or infected skin. There is no cure - only different ways of managing the condition.

The main type is atopic eczema, which is usually inherited, and often allied to asthma and hay fever.

Important facts

Eczema is a highly individual condition which may differ from child to child and also within the same child from time to time. It can appear anywhere on the body though it is commonly seen on the backs of the knees, elbows, wrists, ankle and neck. Some children who are severely affected may have eczema which covers the whole body and face.

Eczema is a dry skin condition which needs regular moisturising. Dry skin will itch and this leads to scratching which will damage the skin and cause bleeding. Dry skin can also crack and fissure making movement difficult. Sometimes it hurts even to smile because the skin cracks open; and fingers may be too sore to hold a pencil. Soreness and stiff limbs can make children miserable and moody.

A hot, itchy skin is the predominant symptom. The greater the itch, the greater is the desire to scratch. This can cause pain and bleeding, but the need to scratch remains. For some children this itch is almost constant and it may be unreasonable to expect a child always to resist the need to scratch in the classroom.

Constant itching and scratching, with sleepless nights, is often the pattern for a child with eczema. Children may be late for school, may have difficulty concentrating during lessons and may fall behind with work. Some children who are severely affected may also have periods of absence.

Eczema is not contagious, but children with eczema can be the butt of cruel teasing. Even very small children can he made to feel rejected - some children may not want to hold their hands for example.

Eczema often improves as the child grows older, although it can reappear at any time (for example, in adolescence and at times of stress). The condition fluctuates and can move in its own cycles - some children are worse than others in spite of excellent care.

High risk factors

Children with eczema are more susceptible to some infections. It is essential to prevent contact between a child with eczema and a child or adult with any of the following infections:

- Cold sores (herpes simplex) as this can lead to a very serious viral illness (eczema herpeticum).
- Impetigo (a contagious pustular skin disease) as this can lead to the development of infected eczema which may need antibiotics to clear it.

General Management of Dermatitis


The relationship between schools and parents

The National Eczema Society can give general guidelines for managing eczema but every child is different, so eczema may vary from one individual to another. Contact between school and parents is therefore essential to the effective management of the condition and the comfort of the child.

Many parents find it helpful to discuss their child s condition and treatments with their child's teacher at the beginning of the school year. It is important to remember that eczema can change quite dramatically in a short period of time and a continuous dialogue is therefore vital.

Basic treatment

The following treatments may be necessary during the school day to keep a child's eczema under control. All children should be using emollients though the frequency with which they apply them may differ. Other treatments mentioned are more likely to be used in children with more severe eczema.

Emollients

These keep dry skin moisturised and lubricated and are essential to minimise itchiness. Ideally, a pot of cream (emollient) should be kept at school. Younger children may like to keep their emollients in a brightly coloured pot which they have decorated themselves.

Emollients are safe for the child or teacher to use in accordance with general instructions from the parents, and with the following guidelines:

Use frequently, especially when the skin feels dry and itchy.
Apply with clean hands - it is very easy for children with eczema to develop infected skin and pots of cream or ointment are an ideal breeding ground for bacteria.

Gently apply a thin even layer, taking care not to rub the skin too hard as this can set off itching.

Use the dot method for thick preparations. From a small amount on a clean spoon, apply small pinches where required, starting from the top downwards. Smooth in gently.

Each child with eczema should have a separate supply of emollient, to avoid cross-infection.

Topical Steroids

Topical steroids are steroids applied to the skin and act to reduce inflammation. In the majority of children eczema can be controlled by the use of emollients alone but some children may need topical steroids if their eczema is troublesome.

It is unlikely that children will need to have topical steroids applied during the school day. Most topical steroids are applied once or twice a day and this is usually done morning and evening. However, in the unlikely event that they have to be used during school they should be as directed by the parent or a health professional. Topical steroids should always be applied thinly to the skin on inflamed areas only.

Those who are applying the steroid should wash their hands both before and after the application.

Antihistamines

Some children may take anti-histamines at night to help them sleep and this can result in a residual drowsiness the following morning. Children are unlikely to need to take them during the day.

Antibiotics

Children with eczema may sometimes need a course of antibiotics even in the absence of mild infection and may have to bring tablets to school.

Bandaging

Children with severe eczema may have special "wet wrap" bandages, or bandages impregnated with a soothing, but messy, paste. These will be applied at home but may need tidying at school. They will undoubtedly draw more attention to a child with eczema as they will show under clothes. Children wearing bandages may need additional support from teachers and other school staff to help them to deal with comments from other children who may not understand why the child is wearing them.

Practical Guidelines

There are certain factors in a school environment which may make eczema worse or which may make a child with eczema feel more comfortable. These factors will differ for each individual child and it is very useful for teachers if parents can give details of situations to avoid and also of methods which are effective helping a child to calm down or to stop scratching.

Aggravating factors for dermatitis


A child's atopic eczema may be made worse by:

  • woollen clothing, ordinary soap, laundry powders, chemicals, metals;
  • pollen, dust, certain foods, colourings and preservatives, pets
  • worry over family problems, schoolwork or the physical discomfort of eczema and its effects on lifestyle and appearance.
  • cold weather, heat and sweating.


The Classroom

Eczema can be a difficult condition to handle in the classroom. The child with severe eczema may have periods of frenzied itching and scratching once or twice a day, breaking their concentration and that of other pupils. Implications will vary for different age groups. The following guidelines may be useful.

Scratching

It is impossible for a child not to scratch. Saying 'Don't scratch!' to a child will probably create guilt, make the child feel unbearably uncomfortable or promote a feeling of resentment. Encourage rubbing or pinching which may bring some relief without damaging the skin.

To avoid disrupting a large class, or occupying staff time unduly, it may be advisable for the child to leave the classroom to calm down. Some emollient cream, a glass of water and a cooling damp flannel may all help, though there may also be times where there is nothing to be done but to let the child scratch. The child and their parents will know the best ways of dealing with these moments.

Distraction and talk can sometimes calm an itchy child, together with the acknowledgement that the child may be in genuine distress rather than attention seeking. For a younger child, reading a book, a change of activity, or a special job, can all work as distraction from an itch.

Seating

It is best if children with eczema can be seated well away from sunny windows and radiators, as itching increases with overheating. A cotton pillowcase, piece of cotton material or folded towel to sit on helps to minimise the irritation from plastic seats.

Irritants

Some children can be sensitive to dusty conditions or animal fur. Children with eczema may need to keep away from guinea pigs, hamsters or rabbits; in extreme cases they may not even be able to share a classroom with any pet. Sitting or playing on a carpet may also aggravate eczema.

Soaps, detergents, washing-up liquids and paints can all be irritant to the hands. Children may wish to bring their own special soap, or emollient washing cream, and plastic or cotton gloves.

Uniform

Children with eczema are usually most comfortable in cotton clothing, particularly next to the skin. As it is not always easy to find non-irritant fabrics which match school uniform colours exactly, it is helpful if schools can be flexible in this respect.

School meals

Diet is sometimes an important factor in the management of eczema. Some children may find that certain foods may make their eczema worse and a small number of children may also have severe anaphylactic reactions to foods. Parents should make these details known to staff.

Flexibility will be needed for children with known food allergies- for instance, permission to bring orange juice if they have a milk allergy. There may also be times when children receive food unexpectedly, for example at Christmas, and care needs to be taken at these times too.

Sports

Children with eczema should be encouraged to participate as fully as possible in sporting activities, though sometimes stiff, sore or infected skin may prevent this. Children with eczema can take part in swimming but may need additional time to apply emollients before and after they swim.

Taking part in sports can be particularly distressing for children with eczema, as areas of skin which they have been able to hide may be exposed to their classmates when they are wearing shorts and T-shirt or a swimming costume. Children may need help to overcome feelings of embarrassment or anger and to deal with comments from other children.

School Activities

There are several school activities which could cause problems for children with eczema. The following list is not inclusive but will give some idea of areas which may require extra vigilance.

- Art and Pottery. Paint and glue may irritate eczema on the hands as may the clay and water used in pottery. Children can wear gloves for art but may have to miss out on pottery.

- Craft, Design & Technology. Children may experience problems with metals, chemicals, plastics and oils. Gloves may be needed and an emollient can be applied before and after the lesson.

- Home Economics. Children with food allergies should avoid contact with the food in question and those who find some foods such as oranges and onions irritating should avoid contact.

- School trips, Work and Residential experience. Extra care may need to be taken in circumstances that are not a part of usual school routine. Care needs to be taken when allocating children to work experience placements. [top of page]

Source: National Eczema Society.

 

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