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Thursday, 24 June 2021
IF I had to make a list of the most misspelled medical words, eczema would feature prominently alongside such gems as prostate (not prostrate) and diarrhoea.
Of course, there are some ridiculous medical words even more difficult to spell but these are far less commonplace.
Eczema originates from Greek words meaning “to boil out” and probably referred originally to all sorts of skin conditions that fall under different umbrellas these days.
Nevertheless, the word eczema is even today a bit of an umbrella term and the dermatopathologists, the ones in the know, think the term should be replaced.
The truth is that eczema has many different types and subtypes and these vary wildly.
The term dermatitis is sometimes used interchangeably with eczema to describe inflammation of the skin but all sorts of other conditions can inflame the skin.
Eczema is set apart by characteristic processes on a cellular level in what is known as a “spongiotic” pattern.
Spongiosis occurs when tissue fluid gets in between the cells at the surface of the skin and generally causes a bit of chaos in the normally watertight barrier that the skin provides.
Broadly speaking, the definition of eczema we tend to use is an inflammatory condition of the skin characterized by redness and itchiness along with scaly or crusty patches.
The most common form is atopic eczema. “Atopic” refers to a phenomenon in which a person is more sensitive to allergens and so people with eczema will commonly also suffer from hay fever and asthma.
Atopic eczema is most common in children, with around one in five in the UK affected by it and one in 12 adults.
Typically, it causes red, itchy patches on the hands, behind the knees and on the inside of the elbows. It can also affect the face and scalp but can pop up elsewhere.
As with so many medical conditions, there is no one cause but a multitude of probable factors, including family history, stress, sensitivity to certain foods and environmental triggers and allergens, among others. It can also range from the very mild to the very severe and can be really quite debilitating for some.
There are many different types of eczema aside from the atopic kind, although there may be a certain element of overlap.
Discoid eczema occurs when circular scaly patches appear on the trunk and limbs.
Contact dermatitis is something we have been seeing a lot more of recently due to the pandemic and the resultant increase in hand washing and use of alcohol gels.
This will typically occur on the hands or the areas which have been in contact with an irritant or allergen most.
There is another type called pompholyx eczema, which also tends to affect the hands and can show up in multiple small white blisters across the palms and up the fingers.
Eczema, as a rule, will get better as one moves from childhood into adulthood. However, it cannot be “cured”.
The key to managing and treating it is in topical creams and ointments as well as avoiding the triggers.
Fundamentally, the more we wash our hands and skin, the more prone our skin is to damage. That is not for one minute to say we should not be washing our hands, particularly in the current climate.
However, each time we do, we are washing away the natural oily layer that protects us while also exerting an abrasive pressure across the skin.
Once the top layer is broken, moisture escapes and dries out the underlying tissue. This can give rise to dry, itchy skin and make matters worse for people who are prone to eczema.
Therefore, before anything else, for someone who is prone to eczema, or even just dry skin, it is vitally important that one uses a proper emollient cream or ointment daily, even if there are no current symptoms.
This will replace that oily layer and keep the moisture in and the skin underneath nice and healthy. There are so many products out there but you don’t need to go for the expensive ones. Just something as greasy as possible.
Here lies a bit of a balance between practicality and greasiness but, whatever you use, go mad and put loads on.
Remember to pat skin dry rather than rubbing it, use a pump dispenser if you can to avoid contaminating your tub of cream and smooth the cream or ointment on in the direction of the hairs.
For eczema that is flaring, one might then need to apply a thin steroid cream for a week or two. You can purchase milder steroid creams over the counter and this should be your first step.
If this is not working, however, you may need to consult your doctor to see if it’s worth trying a stronger one.
In general though, the tendency is for people to skip straight to the steroids, ignoring the basics that actually might be more effective.
Part of that will also be avoiding triggers as mentioned above. Shower gels, soaps and shampoos are notorious for irritating skin and so if you suffer from eczema, consider switching these out for soap substitutes.
Again, it’s worth speaking to your pharmacist to see what is available. Make-up is another big culprit for eczema of the face and people who wear gloves a lot may find that sweat build-up also causes flares of their skin here too.
Scratching itchy skin is not helpful even if it feels great. In doing so, you will be reversing the healing process and prolonging the discomfort so try to avoid this and consider using an antihistamine bought over the counter.
For babies, you can avoid this by ensuring their nails are regularly trimmed. You can even get anti-scratch mittens.
But bear in mind that while eczema is very common in babies, the majority of the time it will gradually get better.
Although unsightly for the parent, as long as the eczema is not bothering the baby, you may not need to rush for all sorts of treatments; emollient creams may be all that is needed as steroids can thin the skin if used over and over and it’s best to avoid in babies if possible.
Of course for a minority, eczema is a nightmare and, despite all of the above measures, it may require more heavy duty treatments.
If it becomes widespread and severe, specialists may consider immunosuppressing topical creams or even more powerful immunosuppressant medications.
So the next time you get that dry itchy feeling, think about the basics first, double check whether there might be anything triggering it (new pets, new detergents, even stress) and go wild with some emollient cream.
If in doubt, check the NHS website or speak to a pharmacist for some guidance as a next step.
12 April 2021
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