Eczema

Unfortunately, there is no single cause of eczema. It is a common misconception that eczema is due to an allergy to food or a skin care product. The truth is that eczema is a complex, multifactorial, genetic and environmentally-determined condition.

Although people with eczema may have other allergies, the condition itself is not always driven by allergies; rather it is the result of a defective ‘skin barrier’ together with an ‘over-active immune system’.

An ‘impaired skin barrier’ can be likened to having a poor-quality brick wall, due to faulty cement. Due to inherited abnormalities of skin proteins and natural oils, the skin becomes porous and allows loss of water (moisture) from between skin cells. Unfortunately, simply increasing water intake will not rectify this.

In addition to dehydration, the impaired skin barrier allows irritants to enter the skin too easily – irritants such as dust, bacteria, viruses, fungi, animal dander and clothing fibres. The combination of these factors results in an already hyper-sensitive immune system, to produce inflammation in the skin.

Inflamed skin is usually itchy; while for some people this itch is only mild, for other it may be severe, even excruciating. Sometimes the intensity of itch is so bad that patients scratch until they bleed – leading to skin infection, more inflammation and worsening of the eczema. This cycle is known as the ‘itch-scratch cycle’ and it can drive patients crazy.

There are a number of internal and environmental triggers that contribute to eczema ‘flares’; these include:

• Stress
• Illness e.g. a cold, cough or other infections
• Diet – in certain people, some foods such as dairy, wheat, eggs, nuts, seafood and food additives can trigger eczema (more common in children)
• Skin infections e.g. bacteria such as Staphylococcus aureus (‘Golden Staph’) and viruses such as Herpes simplex (cold sore virus)
• Tobacco smoke
• Common chemicals e.g. chlorine, dishwashing liquids, laundry detergents, shampoos and body soaps, perfumes and fragrances
• Certain fabrics e.g. woollen or synthetic fibres
• Weather e.g. hot/humid climates, cold/dry seasons, air conditioned or over-heated rooms
• Airborne allergens: including house dust mite, moulds, grasses, plant pollens and animal dander

Unfortunately, there is no ‘cure’ for eczema – at least not yet! Nevertheless, with good skin care, and evidence-based medical treatment, eczema can be very well managed. Our Dermatologists are the most qualified doctors in this field, and are constantly undertaking further research and education to improve the therapies available.

In order to optimise your skin barrier, it is important to adhere to the following general measures:

• Keep showers and baths short and lukewarm: hot water can aggravate your eczema, increase itch and worsens skin dryness.
• Always use soap-free cleansers and minimalist shampoos/conditioners
• Avoid over-heating and over-drying the skin: avoid wearing too many layers, using electric blankets or heavy doonas, turning up heaters or cranking air-conditioners as all these behaviours will dry your skin out and aggravate eczema.
• Apply medicated creams immediately afters showers and baths, as they will be absorbed better by the skin.
• Apply moisturiser every day (even twice a day) to help improve the skin barrier, reduce inflammation and soothe itchy skin.

Treatment options vary depending on the severity of your eczema; topical corticosteroids form the mainstay of mild to moderate eczema. When used under medical guidance, these creams and ointments are extremely safe. Topical steroids (corticosteroids) come in various strengths – you will be prescribed the most appropriate strength for your condition, and location on the body.

Your dermatologist may use a combination of appropriate steroid or non-steroid creams, and possibly ultraviolet radiation therapy (phototherapy.) Ultraviolet B (UVB) exposure in our state-of-the-art phototherapy cabinets, is a medicare-rebatable service that does not incur any out-of-pocket expense.

Dilute bleach baths are often recommended to both treat and prevent skin infections, but in some cases oral antibiotics may be required. We recommend only the safest, most effective moisturisers (emollients), which have been proven to benefit eczema-prone skin.
Oral or injection anti-inflammatory medication to treat eczema, may be prescribed for patients with severe eczema whose condition cannot be managed by creams and phototherapy alone. Oral corticosteroids (prednisolone) are rarely prescribed for eczema, due to a number of short-term and long-term side effects.

At Southern Dermatology, we use the latest and most effective treatment options for atopic dermatitis – including newer ‘biologic’ agents.