Atopic eczema
Updated: 03.08.2023
Created: 29.12.2023
Approved by: General Practitioner, Dr Binita Parmar
Atopic eczema is a chronic and recurring skin inflammation that results in rashes, itching, and dryness of the skin. Eczema can come and go and can appear on various parts of the body regardless of age. Atopic eczema has a strong hereditary factor. Eczema is also associated with skin infections as the skin's natural defence against bacteria is impaired.
Atopic diseases
Atopic eczema is often associated with other atopic diseases. Food allergies and atopic eczema usually occur first and typically start in early childhood. This can be followed by asthma and then allergic rhinitis. The term commonly used to describe how these diseases are interconnected is "the atopic march." It is believed that the association is related to a compromised skin barrier, which allows allergens and other substances to penetrate the body more easily and come into contact with the immune system.
It has a hereditary component, where a strong genetic risk factor for developing atopic eczema is a mutation in the gene encoding an important skin barrier protein called filaggrin. However, filaggrin mutation is not necessary or sufficient to develop the disease.
Symptoms
Atopic eczema is characterised by dry and itchy skin, with rashes particularly appearing in the "flexures," such as the back of the knees and inside the elbows. The rash consists of dry red or pink patches of skin, with occasional weeping, blisters or areas of swollen skin during a flare up.
In infants, eczema is often found as small oozing blisters on the cheeks and scalp. It can also occur on the back of the arms, shins and in the diaper area.
In young children, eczema is often drier and frequently becomes scratched. The changes are often symmetrically present on the body, arms, and legs, and frequently in the areas of the groin, knees, ankles, elbows, and wrists.
In adults, the skin is generally dry and itchy and often thickened in certain areas due to scratching. Symmetrical eczema changes can be found on the upper body, around the elbow and knee creases and face, particularly around the eyes.
In general, there is a higher susceptibility to bacterial infections in eczema-affected skin due to the weakened barrier function of the skin.
Causes
The exact cause of atopic eczema is unknown, but it is considered a multifactorial condition, typically resulting from a combination of genetic and environmental factors. The presence of atopic diseases in the mother, father, or both increases the likelihood of a child developing atopic eczema. In some cases, particularly in infants with severe eczema, certain foods such as milk, eggs, soy, wheat, and nuts can worsen the condition. Avoiding specific types of food during pregnancy or breastfeeding, as well as the timing of introducing solid foods, has not been shown to have a definitive impact on the risk of developing atopic eczema.
Treatment
General measures
If triggering factors can be identified and removed, that is always the first step. However, for most people, there are no simple factors that cause the disease, so the focus is on relieving symptoms, preventing skin damage, and managing complications. Sun exposure can also be beneficial, and vacations in sunny areas or light therapy can have a positive effect.
Certain foods and nutrients may worsen atopic eczema. If you suspect that certain foods aggravate your child's eczema, you should try to identify the specific triggers in collaboration with a doctor.
Indoor environments should not be excessively dry, especially during winter. Sweating, for example, due to wearing excessively warm clothing, can also worsen eczema. Avoid carpets and other dust-collecting surfaces, and do not keep pets where there is an obvious allergy. No one should smoke in a home where someone has atopic eczema. Clothes should be washed with a non biological washing powder.
Moisturising
It is crucial to keep the skin moisturised and prevent it from drying out. Use moisturising creams regularly, especially after bathing or showering. Reduce the frequency of bathing, particularly with very hot water. Soap can dry out the skin, so avoid using soap on areas affected by eczema. Soap with a pH below 5.5 is preferable. Oil baths should be used frequently, ideally on a daily basis.
Medication
In children with mild symptoms, moisturising treatment alone may be sufficient. However, for more severe symptoms, the use of steroid creams or ointments or immunomodulatory treatments (which dial down your immune system) is necessary. It is crucial to use these medications correctly to achieve the best effect.
