ECZEMA - Full extract 

Eczema or dermatitis is an inflammatory condition of the skin. Areas of eczema can sometimes be weeping and sore. More often the skin is itchy and dry. It is usually a recurrent condition and can be very distressing, especially in young children. 

There are varying forms of eczema. Childhood eczema often has an atopic or allergic basis and tends to start in early infancy. It does tend to run in certain families and can be associated with both asthma and hayfever. It typically affects the face and the trunk, as well as the skin creases on the fronts of the elbows and the backs of the knees. Fortunately, childhood eczema tends to clear as children grow older but it can continue into adulthood. 

Another form of eczema is contact dermatitis. Because of a specific underlying allergy the skin becomes acutely inflamed when brought into contact with certain substances. A common form of contact dermatitis occurs in response to nickel jewellery like ear-rings; the skin around the earlobes can become extremely reddened and itchy. A similar eruption can occur on the hands in response to certain detergents, or in the scalp after using a particular shampoo. Working with soil or cement can produce a similar eruption in the hands, especially if gloves are not used. With contact dermatitis, steering clear of substances that irritate the skin is most important. However, occasional use of cortisone creams or ointments may be required. 

Although there is no cure for eczema, the symptoms can usually be well controlled.

General measures.  Avoid aggravating factors like soaps, detergents and perfumed cosmetics. It is also important to keep woollen materials away from direct skin contact; they can often cause skin irritation. 

Instead of soaps try substitutes like Ego QV or Hamilton's Body wash. As a community we all probably wash and bathe to excess. This can lead to the loss of skin oils and cause skin dryness. If the skin does happen to be quite dry, there are some excellent bath oils and emollients to put moisture back into it and make it less likely to become inflamed. They can be useful in people of all ages, especially the elderly where skin dryness is a frequent cause of recurrent itching and irritation. 

Topical cortisone treatments.  There has been a steady improvement in the treatment of eczema over the last two decades, largely because of the use of cortisone creams and ointments. They are very effective and safe, as long as they are used under medical supervision. Strengths vary from the mild 1% hydrocortisone up to the stronger preparations like Diprosone and Betnovate, with a whole range in between. The aim is to get the best relief of symptoms with the minimum amount of cortisone. Usually treatment is commenced with a stronger preparation for a week or two, and then scaled down to a milder maintenance preparation if this is required. It should be remembered that stronger cortisone preparations can thin the skin if used for long periods. This is especially so on areas such as the face, where milder preparations are always preferred. 

Creams and ointments have different applications. Creams rub in well and are best for moist weeping skin or on exposed areas like the hands and face. Ointments look like thick gel and are quite greasy. Because they do not rub in they tend to retain more moisture and are especially useful on areas where the skin is very dry. 

Additional treatments.   Sometimes a 10% urea cream like Calmurid can be useful to soften areas of dry, roughened skin and improve the absorption of other topical treatments. It is unusual to be able to identify a specific food that is causing or aggravating eczema. However, if a certain food is suspected, this should be discussed with your doctor in case further testing or dietary exclusion is required. 

Sometimes eczema can be made considerably worse by the presence of a secondary bacterial infection. When this is the case, the addition of oral antibiotics usually brings about a prompt improvement. Stress can also aggravate eczema and may require specific treatment. When eczema does not respond to the usual treatments, referral to a dermatologist can be very helpful.  

Health Tip:
* Avoid using creams and ointments that have not been specifically prescribed for you. Preparations prescribed for one condition may make another condition worse.

* When topical cortisone preparations are used a regular review by your doctor is necessary.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001