Eczema

Table of Contents

1. An Introduction To Eczema
2. The Different Types of Eczema and Dermatitis
3. Skin Conditions That Can Resemble Eczema
4. How To Effectively Treat Eczema And Improve Symptoms
5. The Eczema Blacklist: Ingredients To Avoid If You Have Eczema
6. Debunked - Myths & Misconceptions Around Eczema
7. Conclusion
8. References

An Introduction To Eczema

Eczema, also known as atopic dermatitis, is a common skin condition characterized by dry, itchy patches of skin. While the terms 'eczema' and 'dermatitis' are often used interchangeably, dermatitis is a broader term that encompasses various types of skin inflammation, including but not limited to eczema.

Eczema is not contagious, but it can significantly affect a person's quality of life, causing discomfort, sleep disturbances, and even psychological distress. Symptoms can flare up sometimes for just a few days, or persist over long periods of time, and the areas of the skin affected can also change.

The exact cause of eczema is not known, but it is believed to be a combination of genetic and environmental factors. People with a family history of eczema, asthma, or hay fever are more likely to develop the condition, and identifying triggers is a big part of managing the condition. These can include certain soaps, detergents and weather conditions, as well as stress and hormonal changes.

Although there is no specific cure for eczema, there are a wide range of treatments available to manage symptoms and help prevent future flare-ups. These can include prescription medications, over-the-counter treatments and also lifestyle changes. Not everyone will react the same way to a specific treatment, so it may take time to find the right one.

The Different Types of Eczema and Dermatitis

Atopic Dermatitis (commonly known atopic eczema or simply eczema)

This is the most common form of dermatitis [1], often seen in infants and children. It’s estimated to affect 12-15% of all school-age children, often starting within the first year of a child's life [2]. It’s characterized by itchy, inflamed skin and typically runs in families with a history of allergies or asthma. For many it is localized to small regions, for instance the hands, but skin can become inflamed all over the body, causing great discomfort. Some will naturally grow out of it before adulthood, but many adults still suffer from atopic eczema, some even develop it for the first time as an adult.

Contact Dermatitis

As the name implies, this type of dermatitis is caused by contact with allergens or irritants, such as certain soaps, cosmetics or plants. This usually happens within a day of exposure to the substance, and tends to clear up once the cause is determined and avoided.

Dyshidrotic Eczema

Also known as pompholyx eczema, this type is characterized by small, itchy blisters on the hands and feet. It’s thought to be related to seasonal allergies such as hay fever, and can also be linked to stress. It typically clears up within a matter of weeks.

Nummular Eczema

Also known as discoid eczema, this causes coin-shaped spots to appear on the skin, with nummular coming from the latin word for coin. These areas can be very itchy and cause significant discomfort, potentially leading to secondary infections from scratching.

Source: www.drugwatch.com

Seborrheic Dermatitis

This is another common form of eczema that causes scaly patches and red skin that can be sore. It often affects oily areas of the body, like the face, sides of the nose, eyebrows, ears, eyelids, and chest, as well as the scalp. We have a separate, detailed article on seborrheic dermatitis including symptoms, causes and treatments.

Stasis Dermatitis

Also known as gravitational eczema or varicose eczema, this is a skin condition that occurs due to poor blood circulation, typically in the lower extremities. It is characterized by inflammation, swelling, itching, and sometimes ulceration of the skin [3].

Source: www.nationaleczema.org

Asteatotic Eczema

This type of eczema, also known as eczema craquelé or xerotic eczema, is characterized by dry, cracked skin, often made worse during winter when the air is dryer.

Skin Conditions That Can Resemble Eczema

Polymorphous light eruption (PMLE) vs Eczema

PMLE is a skin condition that can lead to itchy, burning rashes, bumps, blisters or hives as a result of sun exposure. It’s more common in women and those who live in northern latitudes. It typically resolves on its own without treatment, but in more severe cases, treatments may be prescribed such as topical steroids to manage symptoms.

Eczema can also lead to itchy rashes, but is not directly caused by exposure to the sun and is far more common. Treatment usually involves identifying triggers as well as moisturising the affected areas.

Psoriasis vs Eczema

Both of these skin conditions can lead to red, itchy patches but there are some important differences. Psoriasis occurs when the body makes new skin cells too fast, resulting in scaly patches, whereas eczema can be caused by a wide range of factors including stress, weather and allergies, resulting in red and inflamed areas of the skin. Treatments can be similar, with both conditions often responding well to topical steroids.

Source: www.clevelandclinic.org

Scabies vs Eczema

There are a number of significant differences between scabies and eczema, though both can result in itchy and inflamed areas of the skin. Scabies is caused by an infestation of mites that can also lead to blisters, and it’s contagious unlike eczema. It can be difficult to differentiate between the two, but itching tends to be worse overnight for those with scabies. It’s important to consult with your GP or dermatologist for an accurate diagnosis as treatment will differ.

Ringworm vs Eczema

Unlike eczema, ringworm is a fungal condition that leads to itchy, red, scaly patches that have a defined edge, typically in the shape of a ring, giving it the name. Treatment requires fungal medication, unlike eczema that can be treated with over-the-counter medications or topical steroids.

How To Effectively Treat Eczema And Improve Symptoms

Although there is no cure for eczema, there are numerous treatments that can help to reduce symptoms and prevent further flare-ups. Popular treatments include moisturizers (emollients) and topical steroids that can be prescribed by your GP.

There are a number of self care tips that are important to follow as well:

• Try not to scratch. Eczema can be very itchy and resisting the urge to scratch is never easy, but doing so can damage the skin and result in further breakouts of eczema, as well as increasing the likelihood of getting an infection.
• Determine possible triggers. Eczema can be caused by external factors such as heat, certain fabrics, skin care ingredients or stress. Try to avoid or minimise these once triggers have been established.
• Moisturise after a shower/bath. The best time to apply an emollient or moisturizer is just after having a lukewarm shower to lock in the moisture.

Natural Treatments For Eczema

Colloidal Oatmeal. A number of studies have shown this ingredient to be effective and reducing inflammation and itchiness associated with eczema [4,5].

Glycerin. Glycerin is a gentle humectant meaning it helps to attract and retain moisture in the skin.

Hyaluronic Acid. Like glycerin, this is a powerful humectant that also helps to attract and retain moisture in the skin.

Niacinamide. A type of vitamin B3, this is a popular ingredient in skincare products that has been shown to be effective at improving symptoms in patients with eczema in numerous studies [6, 7].

Shea Butter. Shea butter is generally considered beneficial for eczema due to its moisturizing and anti-inflammatory properties. One study found that a dermacosmetic containing shea butter, among other ingredients, was beneficial for hairdressers suffering from hand eczema [8], while another noted the emollient properties can improve the hydration state of the skin [9].

Terpenoids. Also known as isoprenoids, these are a large and diverse class of naturally occurring organic chemicals. A 2022 study found that these compounds exhibit a range of cosmeceutical benefits such as skin whitening, moisturizing, photoprotection, anti-aging, anti-wrinkle, anti-melanogenic, and antioxidant activities [10], suggesting they may be beneficial for skin conditions such as eczema.

Prescription-Only Treatments For Eczema

Antihistamines. Antihistamines have been shown to improve symptoms of eczema in some individuals [11], blocking histamine receptors that are involved in allergic reactions.

Immunomodulatory Drugs. These medicines alter your immune system in different ways to help treat a wide range of conditions, including eczema. A number of studies have shown some immunomodulatory drugs to be effective [12, 13] at reducing eczema symptoms.

Phototherapy. Also known as light therapy, this involves the exposure of affected areas to light to improve symptoms. A 2021 study showed a significant improvement in over 79% of cases after undergoing NB-EVB phototherapy with minimal side effects [14]. Uncontrolled studies have also shown an improvement in eczema [15].

Tacrolimus. This type of medicine is used for various conditions including eczema and works by reducing the activity of your body’s immune system. It has been shown to be effective in multiple studies [16, 17].

Topical Calcineurin Inhibitors. These types of drugs may be used as an alternative to corticosteroids and have been shown to significantly relieve itching associated with eczema [18]. In addition to this, they can be used as a proactive treatment to prevent symptoms from reoccurring [19].

Topical Corticosteroids. These are some of the most popular treatments for eczema and can be prescribed by your GP to be applied directly to the skin, often reducing symptoms in just a few days [20]. There are different types that will be prescribed based on the severity of the areas affected, and they work by reducing inflammation, itching and lichenification, the thickening of skin [21]. Long term side effects can include skin thinning [22] but this will be discussed with your GP.

The Eczema Blacklist: Ingredients To Avoid If You Have Eczema

It’s equally important to avoid certain skincare ingredients as it is to apply the right ones when treating eczema. Here is a list of some popular ingredients that may worsen symptoms in individuals with eczema.

Cocamidopropyl Betaine. This is a surfactant found in some cosmetic products that can potentially cause skin irritation or allergic reactions.

Essential Oils. Some essential oils can have beneficial properties, with one study showing that thyme and lavender had positive effects on the symptoms of eczema [23], however they can cause allergic reactions in individuals with eczema or sensitive skin [24] so are best avoided.

Ethanol. Also known as ethyl alcohol, this is a common skincare ingredient that may cause skin irritation or dryness.

Fragrances. Fragrances are ubiquitous in many products, including cosmetics, personal care items, and household goods, but are one of the most common causes of contact allergic reactions that can lead to or worsen eczema [25].

Lanolin. Often touted for its beneficial moisturizing properties, a study in 2022 found it to be a significant cause of allergic contact dermatitis [26].

Methylchloroisothiazolinone (MCI) and Methylisothiazolinone (MI). These are preservatives commonly used in cosmetics that have been associated with allergic reactions including allergic contact dermatitis [27].

It’s important to note that this is not an exhaustive list, and that the quantity of each ingredient and composition of each product should also be taken into account.

Debunked - Myths & Misconceptions Around Eczema

Eczema Is Contagious

Not true. Eczema is a chronic skin condition and you cannot catch it from someone else.

Eczema Is Caused By Allergies

This statement has some truth to it, but isn’t always the case. Allergies can sometimes cause flare-ups and worsen the condition, but they aren’t always the cause.

Showers Are Bad For Eczema

Although taking hot showers can cause the skin to dry out and worsen symptoms, a lukewarm shower helps to remove harmful bacteria and potential irritants [28].

Children Will Outgrow Eczema

Sometimes eczema will go away on its own, but for others it can be a lifelong condition that requires regular treatment to ease symptoms and prevent flare-ups.

Conclusion

In conclusion, eczema is a chronic inflammatory skin condition that affects a significant portion of the population. It presents with symptoms such as redness, itching, and dryness, which can significantly impact the quality of life of those affected if left untreated. The exact cause of eczema remains unknown, but it is believed to involve a combination of genetic and environmental factors, with common triggers including stress, weather and allergies.

Various treatments are available to manage eczema, including topical corticosteroids, emollients, and immunosuppressive agents. However, the effectiveness of these treatments can vary among individuals, and some may experience side effects. Lifestyle changes, and avoidance of known triggers, often provide significant improvements in symptoms

Living with eczema can be challenging, but with the right treatment and management strategies, individuals with this condition can lead comfortable and fulfilling lives. It’s important for individuals with eczema to work closely with their healthcare providers to identify the most appropriate treatment plan for their specific needs.

References

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[2] Ridd, M. and Purdy, S. (2009). Exacerbation of atopic eczema in children. BMJ, 339(aug25 1), pp.b2997–b2997. doi:https://doi.org/10.1136/bmj.b2997.

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[4] Sobhan, M., Hojati, M., Vafaie, S.-Y., Ahmadimoghaddam, D., Mohammadi, Y. and Mehrpooya, M. (2020). The Efficacy of Colloidal Oatmeal Cream 1% as Add-on Therapy in the Management of Chronic Irritant Hand Eczema: A Double-Blind Study. Clinical, Cosmetic and Investigational Dermatology, [online] 13, pp.241–251. doi:https://doi.org/10.2147/CCID.S246021.

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[6] Licari, Amelia, Alessia Marseglia, Fabio Agostinis, Massimo Milani and Gian Luigi Marseglia. “Barrier Repair Therapy in Atopic Eczema:Effects of Isoleucine, Rhamnosoft,Ceramides and Niacinamide Facial and BodyCreams on Clinical, Itch and Staphylococcusaureus Skin Colonization: A ProspectiveAssessor-Blinded Study.” (2016).

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[8] Seité, S., Guénaëlle Le Dantec, Ann’Laure Demessant and Kérob, D. (2023). Survey of Hand Issues Encountered by Hairdressers and Hairdresser Related Professionals: From Epidemiological Data to Clinical Observational Survey Results. Clinical, Cosmetic and Investigational Dermatology, [online] Volume 16, pp.111–117. doi:https://doi.org/10.2147/ccid.s385681.

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[12] Kim, K., Kim, M., Rhee, E., Lee, M.-H., Hyeon Jong Yang, Park, S. and Hwan Soo Kim (2023). Efficacy and Safety of Low-Dose Cyclosporine Relative to Immunomodulatory Drugs Used in Atopic Dermatitis: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, [online] 12(4), pp.1390–1390. doi:https://doi.org/10.3390/jcm12041390.

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[14] Ali, S., Mohsin, S., ., Z., Ashraf, B., & Nadeem, M.A. (2021). To Determine the Efficacy and Safety of Narrow Band UVB (NB-UVB) in Chronic Hand Eczema (CHE). Pakistan Journal of Medical and Health Sciences.

[15] Richer, V., AlObaida, S., Kharazmi, P., Lee, T.K., Kalia, S. and Lui, H. (2019). Old is gold? Retrospective evaluation of efficacy and safety of topical psoralen–ultraviolet A phototherapy for palmoplantar psoriasis and dermatitis. British Journal of Dermatology, 181(2), pp.417–418. doi:https://doi.org/10.1111/bjd.18012.

[16] Matsutani, M., Imai, Y., Inoue, Y., Nakatani-Kusakabe, M., Natsuaki, M., Yamanishi, K. and Kanazawa, N. (2021). Effectiveness and safety of tacrolimus ointment combined with dupilumab for patients with atopic dermatitis in real-world clinical practice. The Journal of Dermatology, [online] 48(10), pp.1564–1568. doi:https://doi.org/10.1111/1346-8138.16039.

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[18] Gutfreund, K., Bienias, W., Szewczyk, A. and Kaszuba, A. (2013). Topical calcineurin inhibitors in dermatology. Part I: Properties, method and effectiveness of drug use. Advances in Dermatology and Allergology, 3, pp.165–169. doi:https://doi.org/10.5114/pdia.2013.35619.

[19] Lynde, C.W., Bergman, J., Fiorillo, L., Guenther, L., Keddy-Grant, J., Landells, I., Marcoux, D., Ramien, M. and Rehmus, W. (2019). Clinical Insights About Topical Treatment of Mild-to-Moderate Pediatric and Adult Atopic Dermatitis. Journal of Cutaneous Medicine and Surgery, [online] 23(3_suppl), pp.3S13S. doi:https://doi.org/10.1177/1203475419843108.

[20] NHS (2019). Treatment - Atopic eczema. [online] NHS. Available at: https://www.nhs.uk/conditions/atopic-eczema/treatment/.

[21] Chalmers, J.R., Axon, E., Harvey, J., Santer, M., Ridd, M.J., Lawton, S., Langan, S.M., Roberts, A., Ahmed, A., Muller, I., Long, C.M., Panda, S.P., Chernyshov, P.V., Carter, B., Williams, H.C., & Thomas, K.S. (2019). Different strategies for using topical corticosteroids in people with eczema. Cochrane Database of Systematic Reviews.

[22] Lax, S.J., Harvey, J., Axon, E., Howells, L., Santer, M., Ridd, M.J., Lawton, S., Langan, S., Roberts, A., Ahmed, A., Muller, I., Ming, L.C., Panda, S., Chernyshov, P., Carter, B., Williams, H.C., Thomas, K.S. and Chalmers, J.R. (2022). Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systematic Reviews, 2022(3). doi:https://doi.org/10.1002/14651858.cd013356.pub2.

[23] Karacam, M., & Kaya, D.A. (2020). The effect of some essential oils on pathogenes that cause eczema.

[24] Fettig, J., Taylor, J. and Sood, A. (2014). Post-Surgical Allergic Contact Dermatitis to Compound Tincture of Benzoin and Association With Reactions to Fragrances and Essential Oils. Dermatitis, 25(4), pp.211–212. doi:https://doi.org/10.1097/der.0000000000000057.

[25] Johansen, J.D. (2003). Fragrance Contact Allergy. American Journal of Clinical Dermatology, 4(11), pp.789–798. doi:https://doi.org/10.2165/00128071-200304110-00006.

[26] Silverberg, J.I., Patel, N., Warshaw, E.M., DeKoven, J.G., Atwater, A.R., Belsito, D.V., Dunnick, C.A., Houle, M.-C., Reeder, M.J., Maibach, H.I., Zug, K.A., Taylor, J.S., Sasseville, D., Fransway, A.F., DeLeo, V.A., Pratt, M.D., Fowler, J.F. and Zirwas, M.J. (2022). Lanolin Allergic Reactions: North American Contact Dermatitis Group Experience, 2001 to 2018. Dermatitis: Contact, Atopic, Occupational, Drug, [online] 33(3), pp.193–199. doi:https://doi.org/10.1097/DER.0000000000000871.

[27] Atkar, R. and Todd, P. (2016). Four cases of allergic contact dermatitis caused by methylchloroisothiazolinone/methylisothiazolinone in ironing water. Contact Dermatitis, 75(5), pp.316–317. doi:https://doi.org/10.1111/cod.12552.

[28] www.aad.org. (n.d.). Managing eczema in summertime. [online] Available at: https://www.aad.org/public/diseases/eczema/insider/eczema-summertime.