Eczema

Eczema, or atopic dermatitis, is a skin condition that can start very early in life. It causes unpleasant outbreaks with symptoms such as rashes, itching, blisters, scales and crusts, but fortunately these can be prevented and treated: find out how.

What is eczema?

Eczema is a non-contagious skin infection that leads to inflammation, rashes and itching. Although also known as atopic dermatitis, eczema refers to other conditions too, such as contact dermatitis and occupational dermatitis. Eczema is characterized by blisters, scales, and dry, crusty skin. The chronic form can cause the skin to thicken and become extremely dry. In some instances, the skin can even change colour and become lighter or darker than the rest of the body. Scratching the affected areas may cause the skin to become further infected.

Types of eczema

There are several types of eczema, and the main ones are listed below.

Atopic dermatitis (or atopic eczema)

Eczema is the most common skin condition and affects about one in five North American children. Many babies develop atopic dermatitis in their first year of life, and 90% of children with eczema will show signs before the age of five. Eczema is an inherited condition often associated with allergies (such as hay fever) and asthma. Although usually harmless, eczema is still unpleasant for the affected person and their family. Children who can’t resist the unbearable urge to scratch are drawn into a vicious cycle of itch-scratch-inflammation-itch. This process can lead to infection.

As children age, atopic dermatitis will appear on different parts of the body. For instance, babies under one year will often have red patches on their scalp and face, particularly on the cheeks and forehead. Older children tend to get eczema in the inner creases of their knees and elbows. For some children, symptoms disappear on their own by the age of two. However, one out of two children with eczema will continue to get it into adulthood, but their symptoms will generally be different and more mild.

As with asthma and allergies, atopic dermatitis is increasingly common in children, although the reason for this is still unknown. While doctors aren’t sure what causes eczema, contact with certain allergens is known to cause flare-ups. Dust mites, pollen, animal hair and certain foods are frequently reported as allergens, and stress and chemical irritants are known to trigger outbreaks.

Treatment for atopic dermatitis attempts to:

  • stop symptoms from getting worse
  • relieve dry skin
  • reduce inflammation and itching
  • prevent or get rid of infection

Contact dermatitis (or contact eczema)

Contact dermatitis is caused when the skin comes into contact with certain substances: some plants (poison ivy), preservatives, cosmetics (soap and perfume), industrial products and some medications. Contact dermatitis is characterized by redness and itching. Vesicles (blisters) may form if the outbreak is caused by an allergic reaction. The blisters will form a crust before eventually disappearing. Cold compresses with water or an aluminum acetate solution (DermburoTM) can be applied to reduce the swelling, provide relief and dry out the blisters.

Occupational dermatitis

Contact dermatitis caused by substances in the workplace is called occupational dermatitis. People get this type of eczema most often on their hands, although, depending on their job, they may also get it on their forearms, arms or eyelids. More than one product may be the culprit, and even prolonged contact with water can cause the condition. Affected people tend to notice that their symptoms improve during the holidays. The people most at risk are those with certain construction jobs (from tiles, cement, insulation, plastics, glue, paint), hairdressers (from dyes, perm products, perfumes, scissors), health care staff (from antiseptics, disinfectants, medications, latex), and agricultural workers (from fertilizers, pesticides, plants).

It’s important to avoid contact with the irritating substance and protect the affected area as much as possible. While a protective barrier cream helps in some cases, in others gloves are a better  solution. Cotton gloves are best, as rubber gloves can cause allergic contact dermatitis. Gloves should be changed as often as needed, since prolonged exposure to moisture can also trigger the condition. Applying moisturizing cream after work often relieves dry and itchy skin. If your symptoms are more severe, your doctor may prescribe a corticosteroid-based cream to control the inflammation.

How to avoid the triggers of atopic dermatitis

You can take the steps below to prevent or reduce the severity of eczema outbreaks:

  • Choose cotton fabrics over wool and synthetic materials.
  •  Try several detergents until you find the least irritating option, which should be fragrance- and phosphate-free.
  • Remove soap residue from fabrics by rinsing them thoroughly.
  • Stay away from liquid or sheet fabric softeners.
  • Don’t overheat your home.
  • Avoid exposure to allergens such as pollen and animal hair.
  • Protect against contact with dust mites by covering mattresses and pillows with dust-mite covers.
  • Avoid scratching (keep children’s nails short and have them wear mittens or light gloves to bed).
  • Don’t give allergy-causing foods to children with atopic dermatitis.

Tips and advice

The following skin care recommendations can help reduce the frequency and severity of eczema outbreaks:

  • Take short (5- to 10-minute) lukewarm baths or showers.
  • Use a mild, fragrance-free soap or soap-free liquid cleanser such as CetaphilTM or DoveTM.
  • Pat—do not rub—yourself dry so that the moisture stays on your skin. After bathing, immediately use a pH-balanced, fragrance-free body moisturizer to help retain the skin’s natural moisture.
  • Very dry skin can be hydrated by applying cold, moist compresses (or by wrapping a child in a wet towel) before applying moisturizer.
  • Do not apply oil, as this stays on the surface of the skin and does not moisturize it.
  • Moisturizing twice a day is best; in cold or dry weather, moisturize more frequently. 

Ask your pharmacist to help you choose the best emollient (cream or lotion) for your needs.

Eczema treatment

Eczema outbreaks can be controlled with corticosteroid-based creams. These creams must be prescribed by a doctor, who will choose the class of corticosteroid based on the size and location of the affected area(s). The potency of these preparations varies depending on the active ingredient. While these products should be used with care, don’t be afraid to use them, as they are generally safe when applied as directed by a health care professional, and they are effective in reducing the rashes, swelling and itching from atopic dermatitis. Once the eczema outbreak has subsided, you may need to keep applying the cortisone a few times a week to prevent another flare-up. Check with your pharmacist.

Another class of drugs (ProtopicTM and ElidelTM) can be used either instead of corticosteroid-based creams or as maintenance treatment to prevent new outbreaks. Topical antibiotics are sometimes required if scratching leads to infection. An oral antihistamine may be prescribed to reduce itching.

There are effective treatments for eczema. Talk to your pharmacist, who will help you choose the best one for your situation. For more severe inflammation, you may need to see your doctor.

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