27—MAY—2021 00:00 GMT
E
czema also known as Atopic Dermatitis (allergic skin irritation) is a common condition seen in the UK. Often in the first few years of life.
The most common presentation of it is dry skin that can be itchy and at times painful. The affected skin can be red or darker than surrounding skin (depending on the individual's skin colour).
Underpinning the disease is skin barrier and immune response dysfunction. These have been found to have a genetic basis and give rise to increased water loss through the skin, as well as predispose the skin to infection (1).
Eczema (aka atopic eczema).
Image from Healthline.
Many people have a history of atopic diseases (allergy related diseases) in their family.
There has been some (inverse) link demonstrated between exposure to a variety of different antigens and rates of Eczema (2). This is commonly known as the hygiene hypothesis (a thought that the lack of exposure to antigens/foreign substances leads to defects in immune tolerance).
The mainstay of treatment is around avoidance of triggering factors (food, stress, environment) and maintaining skin hydration with the use of emollients/moisturisers. This reduces the chance of an abnormal immune response and in the latter case provides an effective barrier between the skin and the outside environment. Antibiotics can also be used if it is thought there is a superadded infection this can commonly present as weeping skin, honey coloured crusting and the skin not improving with emollient alone (3).
Applying emollient onto the skin.
Image from MedicalNewsToday
If after the use of emollients the symptoms are still not being controlled then a steroid cream can be used to reduce the symptoms and control the immune response. After this point often if the patient's skin is not responding to treatment despite having tried several different emollients, stronger topical steroids and ensuring ample application it is time to gain advice from a specialist.
References
1. S, S. and G, G., 1995. Objective assessment of the skin of children affected by atopic dermatitis: a study of pH, capacitance and TEWL in eczematous and clinically uninvolved skin. [online] PubMed. Available at: <https://pubmed.ncbi.nlm.nih.gov/8651017/> [Accessed 27 May 2021].
2. Flohr, C., 2011. Atopic dermatitis and the hygiene hypothesis revisited. [online] Available at: <https://pubmed.ncbi.nlm.nih.gov/21576944/> [Accessed 27 May 2021].
3. Weston, W., 2021. UpToDate. [online] Uptodate.com. Available at: <https://www.uptodate.com/contents/treatment-of-atopic-dermatitis-eczema?search=atopic%20dermatitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1> [Accessed 27 May 2021].