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Eczema (baby and infant)

Eczema (baby and infant)

 

Class
Skin
Description
Eczema is a form of dermatitis, a condition where areas of the skin become inflamed, itchy and red. The most common form of eczema is called atopic eczema which tends to run in families who have a history of other allergic conditions such as hayfever and asthma.

About 5% to 15% of children in the UK will be affected by atopic eczema by the age of seven. In most, the condition normally disappears by aged 5 years, but in some, particularly those with more severe forms of eczema, it will continue into adult life.

Another common type of eczema is irritant contact dermatitis, where the skin becomes inflamed because of direct contact with a substance that irritates the skin. The hands are particularly vulnerable as these are the areas of the body that are most likely to come into contact with irritant substances. If repeated exposure to the irritant occurs, a person may develop allergic contact dermatitis. In this case, future contact with only very small amounts of the irritant will be sufficient to trigger an allergic skin reaction.

Seborrhoeic eczema in adults usually affects the scalp, but may spread to the face, neck, eyebrows, behind the ears, sides of the nose, chest and back. Other areas which can be affected are the skin folds in the armpits and groin, under the breasts, and between the buttocks and genitals.
Causes
Atopic eczema is not an infectious or contagious condition. Instead, it appears that there is a genetic reason for being highly sensitive to substances in the environment that trigger an allergic reaction, causing the skin to become red and inflamed. A large number of substances or allergens can trigger the allergic reaction, but the most common are house dust mite, animal fur, soaps, detergents, over-heating and stress.

In atopic eczema, it appears that the skin does not produce as much fats and oils as normal skin. Therefore it is less Eczema-Skinable to retain water and less able to act as a protective barrier. Soaps and detergents can make the condition worse by removing natural oils from the skin. The skin becomes dry, loses its suppleness and cracks. It no longer provides an effective barrier against irritant substances and so quickly becomes red and inflamed. Cracking of the skin also allows bacteria to enter, causing an infection.

Anything that irritates the skin can cause contact dermatitis, but the most common causes are detergents, biological washing powders, cement dust, engine oils, nickel in jewellery, latex in household gloves and sap from plants.

The exact cause of seborrhoeic eczema is also not fully understood. It is not an allergic reaction, an infection or caused by poor hygiene. It is possibly related to overactive sebaceous glands in the skin which produce an excess of an oil called sebum. The excess sebum causes old skin cells to stick together instead of drying up and falling off as they would do normally. In some cases, a type of fungus called Malassezia (previously called Pityrosporum) is thought to be involved.
Symptoms
In its mildest form, atopic eczema appears as itchy, dry skin. In more severe cases, the skin becomes very red and intensively itchy. Scratching of the skin, in an attempt to relieve the itch, makes the condition worse. The skin becomes more swollen, it may crack, weep, bleed and blisters may form. Eventually the skin may become infected. Constant scratching of the skin causes it to become scaly and cracked. Symptoms may suddenly flare up after long periods of being under control. In babies, symptoms often appear on the face, scalp, arms, legs and body. In older children and adults they tend to appear in the skin creases, behind the knees, on the neck, wrists and in front of the elbows.

The signs of irritation and redness are similar in contact dermatitis except that they tend to be localised to the area where the irritant has been in contact with the skin, for example around the neck if a nickel necklace has been worn.

Seborrhoeic eczema usually first appears on the scalp as dandruff, initially seen as small white, transparent flakes that get larger then turn to greasy, yellow, scaly, crusted skin patches that stick to the scalp and hair as the condition progresses. It is usually also accompanied by itching and inflammation of the scalp. As the condition continues to develop, it may spread behind the ears, to the face, and to skin folds around the body. The skin looks red, inflamed and flaky. The skin scales rub off easily, making the skin look shiny.
Treatment
Atopic eczema
There is no known cure for atopic eczema, but regular treatments can be effective at managing the condition. The main treatments are emollients and topical steroids, which are applied directly to the skin.

Emollients are mixtures of oils, fats and water which keep the skin moisturised and prevent it from cracking. They are available in the form of lotions, creams, ointments, soap substitutes and bath oils. Used regularly, emollients will help prevent atopic eczema.

Topical steroids are anti-inflammatory medicines, which are used to bring eczema under control quickly. They help reduce the inflammation and so ease the redness and itchiness of the skin. There are a number of topical steroids available in different strengths in the form of creams, ointments and lotions. They should be used for short periods of time in the lowest strength that will control symptoms.

Pimecrolimus and tacrolimus are known as immunomodulators as they help reduce the immune response that leads to inflammation. Topical pimecrolimus is recommended for moderate to severe atopic eczema in adults and children over 2 years of age. Topical tacrolimus is recommended for mild or moderate atopic eczema in adults and children over 2 years of age. They are used when topical steroids have failed to control symptoms or there is a risk of side effects from using topical steroids; for example, thinning of the skin if topical steroids are used for long periods on the face and neck.

Other treatments include antihistamines, which help control the itching. Antihistamines are best taken orally, as antihistamine creams may make symptoms worse.

Antibiotics, taken orally or applied directly to the skin, may be used to treat eczema that has become infected. Other treatments include wet wrapping with bandages and light treatment.

Contact dermatitis
Prevention is the best way of controlling contact dermatitis. When working with materials that are likely to cause irritation protective clothing should be worn or barrier creams should be applied to avoid the materials coming into contact with the skin. If symptoms do appear, mild topical steroid creams will help.

Seborrhoeic eczema
Over-the-counter dandruff shampoos are the mainstay of treatment for most people with seborrhoeic eczema of the scalp. Shampoos containing a mild detergent used twice per week will help rid the scalp of scale, but will not cure it. Similarly, shampoos containing salicylic acid or sulphur can be used to dislodge clumps of flakes. Selenium sulphide reduces sebum production, will make the hair less greasy and dandruff less likely to form into clumps. Antifungal agents such as pyrithione zinc, coal tar and ketoconazole all exert an antifungal effect against the Malassezia fungus causing the dandruff. Ketoconazole also has an anti-inflammatory action which will help reduce the redness and irritation often associated with dandruff.

A mild topical steroid cream or scalp lotion may be used if the skin is inflamed and itchy. In more severe conditions, a stronger topical steroid or an oral anti-fungal medicine may need to be prescribed by a doctor.
When to consult your pharmacist
Your pharmacist will be able to give advice on atopic eczema, contact dermatitis and seborrhoeic eczema and their treatment. There is a wide variety of emollients available to help moisturise the skin, and the pharmacist will be able to recommend a product that is suitable for you or your child and will describe how to use it. Mild topical steroids containing up to 1% hydrocortisone may also be obtained from your local pharmacy without a prescription, and are suitable to use if symptoms flare up. If your pharmacist thinks that your symptoms are too severe to be managed by over the counter medicines then you will be advised to see your doctor.

All preparations for the treatment of dandruff or seborrhoeic eczema of the scalp are available from your local pharmacy without the need for a prescription. Your pharmacist will recommend a product that is best for you. If the pharmacist considers that you have a condition other than dandruff, for example psoriasis of the scalp, or if your scalp has become infected, you will be advised to see your doctor.

Let your pharmacist know if you think that any of the products you have been using to treat eczema or dermatitis, whether prescribed by your doctor or bought over the counter, are not working. Creams, ointments and lotions contain a large number of different ingredients and it is possible that some of these ingredients are making your symptoms worse. Your pharmacist will be able to identify which of the ingredients may be causing the problem and will advise you to change to an alternative.
When to consult your doctor
Seek help if you suspect you have eczema but have not yet been diagnosed. Any worsening of symptoms needs attention. Consult your doctor if the skin is weeping and fails to heal or if an infection is suspected. Eczema in the very young, the elderly and people with diabetes needs special attention.
Useful Tips
  • Avoid wool and synthetic fabrics - 100 per cent cotton bedding and clothing are more comfortable against the skin
  • Over-heating can make eczema worse - layer clothes and bedding so that the temperature can be adjusted
  • Use non-biological washing products as biological washing products contain enzymes, which may make skin problems worse
  • In allergic contact dermatitis, try to avoid the substance to which you are allergic
  • Special sprays, vacuum cleaners or filters and bedding systems may control irritation caused by house dust mite droppings. Regular damp dusting and washing of bedding at high temperatures can help to keep level of house dust mites down


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