What is eczema?
Eczema is a collective term describing various skin disorders characterised by itchy skin. The most common forms are atopic eczema, contact eczema, seborrhoeic eczema and nappy rash. Atopic means “different”, which in this context means that the skin is “different”, and is used to describe hereditary allergic eczema.
Eczema may be chronic, i.e. long-lasting or acute, and in the majority of cases there is a cycle, with improvement in the summer and exacerbation in the winter. The chronic form is characterised by an itchy rash. As a result of scratching, areas of thickened, easily cracked skin are formed. Acute eczema is characterised by red, swollen and itchy skin, possibly with fluid-filled blisters.
In eczema the body’s defence against infection is weakened, and mild infections arise due to infection - including fungal infection.
Who gets eczema?
Atopical eczema predominantly affects small children. Approximately 15% of Norwegian children are believed to be affected by eczema. The disease often begins when the child is a few months old and resolves in 60 % of sufferers before they reach the age of four. It may, in contrast, have a later onset, in the teenage years or as an adult. Contact eczema is rare in small children, but there is an increase in the occurrence in school-age children. Ear piercings, piercings elsewhere and use of base metal against the skin have led to a significant increase in contact allergy to nickel. Sebborhoeic eczema is a relatively common occurrence. The eczema may already occur in early infancy, but is most common in adults.
What are the symptoms of eczema?
Atopic eczema causes itchy, dry skin.
Contact eczema which has just arisen or flared up again, causes red and swollen skin with small and large blisters and oozing sores in areas exposed to direct contact with the causative agent. In chronic contact eczema the skin is dry and cracked. Severe itching is common. In its early stages the eczema is limited to that part of the skin which has been in contact with the agent to which you have reacted, but can later spread to other skin areas.
In infantile sebborhoeic eczema, a normal finding is oily and red skin with oily scabs on the forehead, scalp, face and skin folds in the neck and abdomen. In adults it takes the form of red, thickened, flaking skin in central areas of the face, scalp, behind the ears and on the chest.
Nappy rash takes the form of red, smooth or weeping skin in the nappy area.
The cause of eczema:
The cause of atopic eczema is unknown. Allergies are significant for some forms of eczema – but never in isolation. It is an illness which is subject to inherited and environmental factors. The presence of atopic illnesses (asthma, eczema or hay fever) in other family members is a normal finding. In 20-30% of patients, an allergy can be identified which has some significance for the eczema.
The underlying causes of seborrhoeic eczema are not a result of hypersensitivity but a disease response in the sebaceous glands and may perhaps be due to special yeasts normally present on the skin. Individuals with oily skin and high sebum production are predisposed.
Contact eczema occurs when the skin reacts to agents with which it comes into contact. The condition may be both allergic and non-allergic. The non-allergic reaction is due to direct contact with skin-irritants such as cleaning agents, water and disinfectants. The allergic reaction is triggered by allergy-provoking agents such as nickel, chrome, latex, formaldehyde and perfume. The cause of nappy rash is irritation from urine and faeces.
Treatment of eczema:
The most important facet in the treatment of eczema is good hygiene, systematic use of creams and ointments, preventing dry skin, avoiding itching, reducing irritants and avoiding known food triggers. Exposures to sunlight and salt baths have a good effect on mild and moderate eczema. Cortisone cream is however necessary in the majority of cases. Such use is safe where the correct preparation is used in the right part of the body at the right intervals. Consult your doctor for advice on how this should be done.
Generally speaking one should use the right strength of preparation for the right length of time. By choosing preparations that are too weak, proper control of the eczema will not be achieved. A poor treatment response often results in the entire cortisone treatment being discarded. The result is often a worsening of the eczema. In flare-ups of eczema in a child with a history of eczema, treatment may be commenced using group 2 or 3 steroids. When the condition is under control, less frequent application can be employed (every 2-3 days). When the eczema has healed the cream should still be applied 1-2 times a week in order to ensure the best possible result. Thorough moisturizing morning and evening - and always after a shower or bath - are recommended. Where cortisone cream is used one should wait for a few minutes before applying the moisturising skin to the skin.
Eczema creams not containing cortisone (Elidel®, Protopic®) can be good alternatives, and should be tried in chronic eczema. The advantage in using these products is that they do not affect the thickness of the skin – even with long-term use, and they can have an extremely positive effect on the eczema. In skin infections it is important that the actual infection is treated before these agents are employed.
Medical phototherapy or climate therapy can be effective. In some individuals however the condition may worsen, possibly due to irritation of the skin by sweat. It is also demanding in terms of time and resources and is rarely relevant in children of compulsory school age.
A good treatment result is dependent on the patient being well-informed about the treatment. Eczema can be a severely troublesome illness, but early initiation of treatment will, in most cases, result in good control of the illness. The condition commonly resolves spontaneously - 80% of sufferers being free of the disease by the age of 18. There are reasons to believe that good eczema treatment improves the prognosis.
Potentially exacerbating factors:
Stiff and tight clothing, coarse wool products, polyester, clothing containing strong dyes, moisture, stress, infections, foodstuffs, chlorinated water, tobacco smoke, perfume, allergies, alkaline soaps, degreasant chemicals and heat. The child is usually the best judge of which textiles itch!
Prevention of eczema:
Some studies suggest that symptoms of atopic dermatitis can be triggered in some individuals where the child received breast-milk during the first six months of life. Nonetheless, breastfeeding is still healthy. The mother should also avoid eating foods to which she is intolerant during pregnancy, even though the effects of such intolerance on the child are uncertain.
How to get help:
In milder cases of episodic eczema in children, advice and guidance from the health centre can be sufficient. In more severe cases, contact your GP who may refer you on to a specialist. Free Hospital Choice Norway should make it possible to make an informed choice. Relevant information about treatment locations can be obtained via this website and a free telephone number (800 41 004). Free Hospital Choice Norway also provides information about the right to use the hospital of your own choice. See www.sykehusvalg.no