What is eczema?
Eczema (Dermatitis) is a dry skin condition that varies across individuals and comes in many different forms. It is a common condition affecting 8% of adults but more prolific in children, affecting approximately 20% of schoolchildren. The symptoms can have an enormous impact on quality of life and also increase the risk of allergies developing.
Are there different types of eczema?
There are many types of eczema. Eczema is a genetic condition resulting from the interaction between a number of genes and environmental factors. In most cases there will be a family history of either eczema or one of the other ‘atopic’ conditions i.e asthma or hay fever. Eczema can be broadly divided into ‘allergic’ or ‘atopic’ eczema, where the eczema is associated with allergies or ‘non-allergic’ or ‘non-atopic’ where it isn’t.
What causes eczema?
It is well recognised that allergies can play a significant role in the worsening of eczema, especially in children and identification and exclusion of food or environmental allergens can help improve eczema and reduce the need for conventional treatments such as steroid creams.
The presence of eczema in children also represents a significant risk factor for severe food allergies and recent international guidelines now recommend screening of children with eczema for food allergies, such as peanut allergy, which affects almost 1 in 50 children.
Where on the body do people tend to get eczema?
Eczema can affect anywhere on the body although in infants, it is more common on the face. As children get older, it more commonly effects creases whilst in teenagers, wrists, hands and ankles are common sites.
What are the signs and symptoms of eczema?
Symptoms can range from mild to severe as follows:
- Mild: dry, scaly, red and itchy
- Severe: weeping, crusting and bleeding
In both cases the skin can be itchy and scratching causes the skin to split and bleed leaving it open to infection.
What is the cause of eczema?
The underlying cause of eczema is skin barrier dysfunction, where the top layer of skin cells does not stick as tightly together as it should, to provide the protective layer to keep moisture in and germs out. This is usually the result of genetically programme problems such as a lack of filaggrin, one of the key elements in keeping the integrity of the skin barrier.
Having eczema in early infancy, predisposes to food allergy – the worst the eczema and the earlier it starts, then the higher the risk. If an infant has food allergies, these may contribute to worsening the eczema (for example if the infant is egg allergic and the mother has egg in her diet whilst she is breast feeding). However, food allergies are not the underlying cause of the eczema. As a result, management of eczema in infants requires a dual approach – identify the allergies but also ensure the management of the eczema is optimised.
How is eczema identified and diagnosed?
Eczema is a clinical diagnosis, based on the appearance of the skin and how it has responded to treatment. An experienced allergist will take your detailed clinical history and if there is a suspicion of allergies, as a result of the eczema, or if allergies are thought to be contributing, then they may conduct a sequence of tests such as skin prick testing, specific IgE blood testing, atopy patch testing* or provocation challenges to identify causative allergens. They can also advise of the management of eczema, including the use of topical creams, systemic treatments as well as non-steroid base anti-inflammatory creams (calcineurin inhibitors). They can also advise on more novel treatments and access to current research studies. Our team can also advise guide difficult decisions around introduction of allergenic foods such as egg and peanut into the infant diet, which, if correctly timed can significantly reduce the risk of food allergy developing.
* In adults, patch testing is used to identify triggers for contact dermatitis, and this testing is performed by dermatologists. If we suspect you have a contact dermatitis caused by chemicals, for example in make up or beauty care products we will refer you on to an expert in performing this testing.
Is eczema treatable or curable?
As a genetic disease. Eczema isn’t curable but can usually be successfully managed until it is naturally outgrown. The more severe is and earlier the eczema starts, the more likely that it is to be persistent. Eczema without associated allergies tends to be associated with earlier resolution than eczema with associated allergies.
What treatments are available for eczema?
There are broadly two components to treatment – emollients to help with the dryness of eczema and anti-inflammatory creams and ointments to calm down the inflammatory components. These include topical steroids and where appropriate, non-steroid anti-inflammatory creams such as calcineurin inhibitors. Newer anti-inflammatory creams that work by a different method are also emerging. In eczema resistant to topical treatments, there are a range of oral or injectable medications that may be useful although these are rarely required except for the most severe cases. There can also be value in dietary or environmental manipulation to help reduce the impact of triggers such as allergens, in select cases.
How do eczema treatments work?
Emollients help reduce water loss across the skin and thus help to keep the skin hydrated. Topical anti-inflammatory creams and ointments help reduce the inflammation (sore and angry) component of the eczema. The two types of treatment need to be used together in the correct way for maximum effect.
Do eczema treatments have side effects?
Topical treatment is usually very safe although excessive use of strong topical steroids, especially for extended periods without a break on areas where the skin is more delicate (such as the face) does have a risk of skin thinning. It is thus of the utmost importance that you have a clear plan to treat the eczema safely. Under treatment of eczema is also common and this can lead to unsightly thickening and depigmenting of the skin, as well as the unpleasant impact of active eczema on day to day life. The ideal, is safe and effective management.
How much does eczema treatment cost privately?
This will depend on severity and complexity but most cases can be well controlled within one ot two visits although this will sometimes be supplemented by the involvement of our specialist eczema nurse to train parents in eczema management, ensuring the correct and safe use of topical treatments and effective home management of flare ups.
What are the benefits of getting eczema treatment privately?
Treatments are broadly the same in both he NHS and private sector with a key advantage to private treatment being rapid access to a specialist.
Professor Adam Fox
Date reviewed: March 2021
Adam Fox is a Professor of Paediatric Allergy with over 20 years experience in both the NHS and private sector. Professor Fox is Commercial Medical Director at Guy’s & St Thomas’ Hospitals NHS Foundation Trust and Professor of Paediatric Allergy at King’s College London and the founding Director of the KCL Allergy Academy, a postgraduate educational programme, which was a finalist at the BMJ Awards in 2018.
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