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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