The most common type is atopic eczema which mainly affects children. The condition is most common in children, affecting one in five, but also affects many adults throughout their lives - one in 12 adults have eczema in the UK
‘Atopic’ means you have a genetic tendency to develop allergic diseases such as asthma, hay fever and eczema. If one of your parents is affected by eczema there is a 60 per centchance you will develop it too when exposed to irritants or allergens and the risk is 80 per cent if both parents have the condition.
Common allergen triggers include pet fur, dust mites, pollen and some foods, including cow's milk. Irritants include soap, detergents and cold, dry weather. Stress and hormonal changes in women may also bring on eczema, including pre-menstrual flares which affect 30 per cent of women with eczema.
People with eczema have an ineffective skin barrier layer which doesn't produce enough fats and oils and is less able to retain water to keep it moisturised. The skin dries, gaps appear between the skin cells and allow irritants and bacteria to pass through.
Dry, itchy, cracked, sore and inflamed skin are typical symptoms. Atopic eczema can appear as a few patches or it can be widespread. It most commonly affects the insides of elbows, backs of knees, hands, and in children the face and scalp.
Weepy, oozing skin, yellow crusts and a high temperature are signs of an infection and usually caused by breaking the skin by scratching. In between flare-ups, the skin can be much improved and the itching will die down.
Atopic eczema may be diagnosed if you’ve had an itchy skin condition in the last year, as well as three or more of the following: affected skin creases; asthma or hay fever (or if a parent suffers from hayfever); had dry skin in the last year; symptoms started before age two; patches of red, irritated skin, especially on hands (adults) or face (children).
Other types of eczema include contact dermatitis. This type of eczema is caused by a reaction to soap, chemicals, raw food and cosmetics, and seborrhoeic eczema and in this case patches of red, scaly, dry skin appear on your scalp, eyebrows, temples, behind ears and sides of nose.
Who gets it?
About 80 per cent of eczema cases develop before age five and for the majority there is a family history of allergic disease.
Around 15 to 20 per of children have atopic eczema compared to two to 10 per cent of adults.
Adults who have contact dermatitis tend to be people with occupational exposure to allergens, including chefs, hairdressers, nurses and cleaners.
Emollients (medical moisturisers) are the main treatment for eczema. These cover your skin with a protective film to trap water, relieve itchiness and soothe soreness. They help repair the skin’s barrier layer, which prevents irritants and allergens getting underneath. They should be applied at least twice daily, including between flare-ups.
They come in several forms. Ointments are the heaviest, containing the most oil, and are good for thickened areas or overnight use. Creams are a mixture of oils and water, but won’t leave your skin greasy. The most effective contain humectants (e.g. urea, glycerine), which trap lots of moisture. Lotions contain more water and are used for milder eczema. There are also emollient gels and sprays, plus bath and shower oils.
Topical steroids (corticosteroids) may be needed for inflamed eczema. You can buy the weakest type (1% hydrocortisone) from pharmacies, but stronger ones need to be prescribed to be used for short periods to control flare-ups.
Antibiotic creams or tablets are prescribed to treat infected skin.
The newest treatments for severe eczema are immunomodulators, creams which act on your immune system to control it. These include pimecrolimus and tacrolimus. Immune system suppressant tablets can also be prescribed, including azathioprine and ciclosporin.