Your Eczema Questions Answered By Dr. Niki Ralph

Your Eczema Questions Answered By Dr. Niki Ralph

WHAT IS ECZEMA?

Eczema (also known as dermatitis) is a common, non-contagious, dry skin condition which affects 1 in 5 children in Ireland, and 1 in 12 adults. Mild cases may present as dry, scaly skin with some erythema (redness) and pruritus (itching). Sufferers of severe eczema may note fissuring (cracks) of the skin, bleeding and crusting with significant pruritus. 

Atopic dermatitis is a genetic condition based on the interaction between a number of genes and environmental factors. Many people will have a family history of either eczema or one of the other ‘atopic’ conditions Eg: Hay fever (allergic rhinitis) or Asthma.

WHAT CAUSES ECZEMA?

In eczema sufferers the skin produces less fat and oil than normal skin and is therefore less able to retain water, so the skin’s protective barrier is compromised. Gaps open up between the skin cells because they are not sufficiently plumped up with water and moisture is lost from deeper layers of the skin. This allows potential allergens such as bacteria or irritants to pass through more readily.
Everyday substances such as Soap, bubble bath and washing-up liquid, will remove oil from anyone’s skin, but if you have eczema your skin breaks down more easily, quickly becoming irritated, fissured and inflamed.
Because it is prone to drying out and is easily damaged, skin with eczema is more liable to become erythematous (red) and inflamed if in contact with substances that are known to irritate or cause an allergic reaction.

WHAT’S THE BEST WAY TO TREAT ECZEMA?

 Take a short daily bath - under 10 minutes - in lukewarm water using a fragrance-free emollient.
 Pat the skin dry as opposed to harsh rubbing.
 Apply any prescribed topical therapies to affected areas (inflamed, red areas), followed by a fragrance-free moisturiser all over the body.
 Sleep in a cool room – a hot room may encourage scratching during sleep.
 Dress babies in baby grows with built-in mitts and older children in cotton gloves.
 Use wraps/bandages under pyjamas or Babygro’s if necessary.
 Wear cotton clothing, removing any irritating labels/tags and avoid the skin coming into contact with rough seams etc.
 layer clothes to avoid a child becoming too hot.
 Sleep in a cool room.
 Avoid known triggers such as grasses, animals, house dust mite, food or sand pits.

WHAT WOULD YOUR TOP TIPS BE FOR MUMS WORRIED ABOUT ECZEMA IN THEIR KIDS?

Educate yourself by reading up about the condition and how to manage it. There are many good medical websites you can use. Try The Irish Skin Foundation which has a section specifically on eczema, the British Association of Dermatologists website has patient information leaflets. The National Eczema Society is also a good resource. 

Parents should also check in with their GP to get a diagnosis, talk about treatment and ascertain if a visit to the dermatologist is necessary. Fortunately around 65% of children will be clear of eczema by aged 7 and 74% by aged 16 years. 

One cautionary word; there is a lot of information on the internet about diet and eczema. It is thought that in about 30% of children with eczema, food may be one of the causes but a much smaller group than this (less than 10%) will have food as their main or only trigger. This means that only a small number of children will be helped by changes in their diet.

WHAT DESCRIBES A GOOD EMOLLIENT FOR YOU?

The most effective emollient is the one that is used most frequently! 

1) Creams contain a mixture of water/fat. They feel lighter and cool on the skin. Many people with eczema prefer creams for day time use. Creams however, contain preservatives and people can become sensitive to them, although this is not common. 

2) Ointments do not contain preservatives and are very effective at holding water in the skin. However they are usually very greasy and for some, cosmetically unacceptable and impractical under clothing in the daytime. You might prefer to use these at night, however if a child is having a flare of their eczema this would be my preferred choice of emollient. 

3) Lotions contain more water and less fat than creams and are not very effective at moisturizing the skin. They may be helpful for a dry scalp.

HAVE YOU TRIALED LIPIKAR WITH YOUR PATIENTS? WHAT RESULTS DID YOU SEE ON THE SKIN AND IN GENERAL WELL-BEING?

I have tried Lipikar with many patients, family members and myself. Cosmetically it is very acceptable as it is easy to apply and sinks into the skin quickly so you can dress immediately afterwards. I’ve found it to be great for teenagers in particular. They are a challenging group to manage as they may have had eczema all of their life and really don’t want to have to take up time throughout the day applying greasy emollients. They report that they can still feel the emollient on their skin that evening, having applied it many hours earlier.

Another challenging group are toddlers and young children who develop eczema, as they are often resistant to a time-consuming routine. I have trialed Lipikar in this group and parents report it is easier to apply than some other emollients and less of a challenge to use when there’s resistance.

ARE NATURAL PRODUCTS AND NATURAL REMEDIES FOR ECZEMA BETTER?

Many people would like to use “natural” products on their skin, however many products which claim to be “natural” contain preservatives and soaps which would exacerbate eczema.  Plus some natural substances such as Tea Tree oil and lavender oil may sensitize patients’ skin as they are potential allergens. I advise patients to use ointments like paraffin gel which don’t contain preservatives and are tried and tested.

WHAT MYTHS SURROUND ECZEMA TREATMENT?

Myth 1: Sunbeds can help alleviate eczema. 

While UV radiation works for dermatitis and skin often improves over the summer months, you should never use sunbeds. Controlled phototherapy in a hospital based setting is a common treatment for dermatitis, but this is a highly regulated therapy administered by dermatology nurse specialists, overseen by consultant dermatologists and the machines themselves are regulated by the departmental physicist. Unfortunately sunbeds are not regulated and we have no idea what UV radiation a person is getting when they use one. Sunbed use is linked with skin cancer development so you shouldn’t use one for any reason. 

Myth 2: Eczema can be cured simply with a change of diet. 

It is rare that diet alone is the trigger for eczema. In around 30% of children with eczema, food may be one of the causes, but a much smaller group than this (less than 10%) will have food as their main or only trigger. It is rarely gluten sensitivity, as a very small amount of children have coeliac disease. It may be possibly due to dairy intolerances, but this is in the minority of infants and exclusion diets should only be undertaken with medical supervision under the care of a dermatologist/immunologist and dietician as children have significantly higher nutritional needs in infancy. 

Myth 3: Only use natural products

So called “natural” products often contain soaps, preservatives and natural substances like tea tree oil and lavender that may actually exacerbate the problem. 

Myth 4: Only bathe your child once a week and use almond oil as an emollient. 

This is something I have heard from health professionals and parents alike. Bathing every day with a good emollient is important in the treatment of eczema. Using almond oil regularly is not advised in a child with moderate to severe eczema as it can potentially sensitize the child to nuts when used regularly on large areas of inflamed or fissured skin.

WHAT ARE THE LATEST IRISH STATISTICS ON ECZEMA AND HOW DOES IRELAND COMPARE OR DIFFER TO OTHER COUNTRIES?

Atopic eczema and Atopic dermatitis affects approximately 1 in 5 children and 1 in 12 adults in Ireland. Approx. 65% will be clear of eczema by aged 7 years and this goes up to 74% by the teenage years (16), however many of these affected individuals will still have dry skin for the remainder of their life. 

Worldwide studies have been performed on eczema prevalence and the figures range from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalence of atopic eczema symptoms are reported in Australasia and Northern Europe, and lower prevalence reported in Eastern and Central Europe and Asia. US figures show that more than 10% of children have eczema; however this ranges from 18-21% in individual states, which is not dissimilar to Ireland. Also 10.2% of adults have eczema showing similar findings from Irish studies

Children who do not have dry skin in their birth country may present with eczema when they move to another country due to a change of climate.

ARE THERE ANY CHANGES IN HOW ECZEMA IS PERCEIVED?

Historically treatments were much more limited and patients may have been told that nothing can be done to alleviate the condition. Many myths are passed from generation to generation and through the internet. However there are now many options for treatment including a wide variety of emollients, bath oils, topical steroids, topical steroid sparing agents, systemic oral medications, phototherapy etc. When looking for education on the internet, make sure you go to approved medical sites.

HAVE YOU SEEN ANY NOTABLE TRENDS AROUND ECZEMA IN RECENT YEARS?

There are now more clothing options for children to wrap their hands and body and prevent them from scratching.

IS THERE A PARTICULAR DEMOGRAPHIC WHO ARE AFFECTED THE MOST AND WHY?

Children are the most commonly affected (1 in 5 in Ireland). Trans-epidermal water loss begins shortly after birth, so it’s worth noting that our skin needs emollient applied almost immediately and bathing with bath oil is very important from birth. 

The incidence of elderly atopic dermatitis continues to increase in line with the ageing of our population as a whole. The prevalence of AD in the elderly population in industrial countries is now approx. 1-3%. Males are also slightly more affected than females (2:1 ratio). Essentially with each decade of life our skin becomes drier due immuno-senescence, barrier dysfunction in the skin and gut, disturbances of sweat gland function and age-related sex hormone changes.

WHO ARE THE MOST PROACTIVE DEMOGRAPHIC IN DEALING WITH ECZEMA AND WHO ARE THE WORST?

The best at dealing with it are parents who want what is best for their child. Teenagers are probably the worst across the board for managing any chronic conditions. They are the least likely to take medication or apply emollients or prescribed topical therapies on a regular basis. There is a struggle for independence at this age and often they no longer want take their parents advice or help.