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Atopic eczema

What is atopic eczema?

Eczema refers to a red, scaly, itchy, sometimes weeping skin condition. Atopy refers to an allergic condition that tends to run in families and includes problems such as asthma, hay fever, atopic eczema and skin sensitivities. However, anyone can become allergic.

Atopic eczema is common and affects about 5 per cent of the population. It is not contagious. No particular cause has been found.

What are the symptoms?

In mild cases the skin is slightly red, scaly and itchy and covers small areas. In infants it usually starts on the face and scalp; in severe cases it can cover large areas, is very itchy and starts to weep and become crusted. The children may be very irritable and uncomfortable.

What ages are affected?

Eczema usually starts in infants from any age. It tends to improve from 1 to 2 years, but the rash may persist in certain areas, such as the flexures of the elbows and knees, the face and neck, and the fingers and toes. It tends to be coarse, dry and itchy at this stage. Many children have outgrown it by late childhood, most by puberty, but a few have it all their lives.

What are the risks?

It is not a dangerous disease, but infection can occur from scratching, especially if the skin is raw. Contact with herpes simplex (cold sores) can produce nasty reactions. Patients have a tendency to develop asthma and other 'atopies' later.

What things appear to aggravate eczema?

  • sand, especially sand pits
  • dust
  • soaps and detergents
  • rough and woollen clothes
  • scratching and rubbing
  • frequent washing with soap, especially in winter
  • drying preparations such as calamine lotion
  • extremes of temperature, especially cold weather with low humidity
  • stress and emotional upsets
  • teething
  • certain foods (which parents may identify)

Note: The relationship of diet to eczema is controversial and uncertain. It may be worthwhile avoiding certain suspect foods for a 3 week trial-these include cows milk, fish, eggs, wheat, oranges and peanuts.

What about skin tests and injections?

The value of allergy testing is doubtful, and 'desensitisation' injections may make the eczema worse.

What is the treatment?

Self-help

  • Avoid soap and perfumed products-use a bland bath oil in the bath and aqueous cream for the skin.
  • Older children and adults should have short, tepid showers.
  • Avoid rubbing and scratching-use gauze bandages with hand splints for infants.
  • Avoid sudden changes of temperature, especially those that cause sweating.
  • Wear light, soft, loose clothes such as cotton clothing, which should be worn next to the skin.
  • Avoid dusty conditions.

Medical help

Your doctor, who should be consulted if you are concerned, may prescribe antihistamine medicine for the allergy and sedation, special moisturising creams and lotions, antibiotics for infection (if present) and milder dilute corticosteroid creams, which can be very effective.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia

 

North East Valley Division General Practice, Victoria, Australia, Disclaimer 
Level 1, Pathology Building, Repatriation Campus, A&RMC, Heidelberg West VIC 3081. .. map
Phone: 03 9496 4333, Fax: 03 9496 4349,  Email: nevdgp@nevdgp.org.au
Please note: NEVDGP does not provide an on-line consultation

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