Eczema (also known as dermatitis) refers to a diverse group of skin disorders characterised by dry, red and itchy skin, which may also ooze fluid and develop crusts. Over time, skin can become thickened and the lines in skin creases more obvious from continued irritation, rubbing and scratching. There are a number of eczema subtypes, some of which are caused by factors within the body and others caused by triggers from outside the body. Below is information on the most common eczema subtypes:
This is the most common form of eczema, affecting up to 20% of children. Eczema tends to develop during infancy and early childhood and for many people the symptoms improve with age, though not everyone is that fortunate. Eczema sufferers commonly have related ‘atopic’ disorders: asthma and hay fever. These conditions often run in families, if a child has eczema, they may have a parent or other close family member suffering from asthma, eczema and/or hay fever. Often individuals find that their skin is very sensitive to materials such as wool, soaps and perfumes and avoiding these products can improve symptoms.
There has been much recent research into atopic eczema, which has led to new treatment options. We now know that two very important factors in atopic eczema are:
- Skin barrier dysfunction: people with atopic eczema lack the normal waterproof skin barrier. This means water can escape, leading to dry skin, and microbes and other immune system stimulants can get in.
- Inflammation: the body’s immune system is activated and the immune system chemical messengers lead to inflammation, which is seen in the skin as redness and itchiness.
At The Skin Hospital
- Emollients (non-perfumed moisturising creams and ointments) help improve the skin barrier and prevent dryness. These should be used generously and frequently.
- Steroid creams or ointments are effective in reducing inflammation. There are some concerns about the use of steroid creams amongst the general public. The risks and benefits of any treatment should be discussed, but steroid creams and ointments used as prescribed under the supervision of a dermatologist are generally very safe.
- Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are often used on sensitive areas such as the face, where long-term use of high-strength steroid creams may not be appropriate.
- For more widespread or severe eczema, tablets such as methotrexate, ciclosporin and azathioprine can be used to dampen down the immune system. Possible side-effects must be balanced against the potential benefit.
- New treatments are currently being developed for the treatment of eczema. We undertake t clinical trials at The Skin Hospital. If you are interested in learning more about clinical trials or would like to be considered for a trial, please contact us for information about any eczema trials currently recruiting patients.
Our experts with special interests in eczema include:
- A/Professor Pablo Fernandez-Penas. Professor Fernandez-Penas leads the chronic eczema clinic, together with a clinical nurse educator with a special interest in eczema (Westmead).
- Dr Kate Dunlop (Darlinghurst)
- Dr Monisha Gupta (Darlinghurst)
- Dr Hanna Kuchel (Darlinghurst)
- Dr Penny Alexander (Darlinghurst)
For further information on atopic eczema, please see the following links:
Authors: Dr Charlotte Thomas & Dr Sarvjit Sohal, last updated 21 September 2015
Contact eczema- irritant and allergic contact eczema.
These types of eczema occur when a stimulus from outside the body causes the skin to become irritated and inflamed. A common cause of contact eczema is occupational exposure, for example, healthcare workers washing their hands frequently with soaps and beauticians and hairdressers working with chemicals in products such as nail polish and hair dyes. However, exposure can occur in any part of life. Contact dermatitis can affect any parts of the body, but the hands and face (due to us touching our face and the frequent use of cosmetic products on the face) are commonly affected areas.
Irritant contact dermatitis is caused by substances such as detergents, acids and alkalis, that have the potential to irritate anyone's skin. Irritant contact dermatitis is more common and more severe in those who have frequent contact with high concentrations of the product in question and also in those who have, or have previously suffered from atopic eczema (link to atopic eczema).
Allergic contact dermatitis is caused by a material (allergen) that contacts the skin and causes an allergic reaction in only susceptible (allergic) individuals. Materials that cause allergic contact dermatitis include substances such as nickel (found in some jewellery), plants, rubber and chemicals in dyes. Even contact with tiny amounts of the allergen can give rise to reactions. There is normally a time lag of hours between the contact with the material and development of the skin reaction. Some people have a condition where exposure to sunlight is needed to trigger the reaction (photoallergy).
At The Skin Hospital
The most important tool in diagnosing contact eczema is a careful history; the dermatologist may ask very specific questions about the skin condition. Keeping a diary of when the symptoms are better and worse can be very helpful in discovering the trigger. The two type of contact eczema (allergic and irritant) can be distinguished by patch testing (link to patch testing from intranet). Patch testinginvolves placing a grid like pattern on your back, in which a selection of thousands of potential culprit materials can be applied to your skin and the skin reactions evaluated by your dermatologist a few days later. You can be tested against standard culprit agents and even your own cosmetic products.
- Avoid triggers. Once problem materials have been identified, avoiding these triggers is the most important part of managing the condition.
- General measures: avoiding soaps (replace with gentle soap-free wash products) and other irritants.
- Topical treatments:
- Regular and generous use of plain/non-perfumed moisturising creams and ointments is helpful.
- Steroid creams & ointments are used to dampen down inflamed areas during a flare.
- Systemic treatments:
- In some severe cases, tablets that dampen down the immune system may be required.
Patch testing is carried out by the following dermatologists at The Skin Hospital:
- Dr Eddie Lobel (Darlinghurst)
- Dr Sarvjit Sohal (Darlinghurst and Westmead)
- Dr Joe Konya (Westmead)
Further information on contact eczema (dermatitis) can be found via the following links:
Further useful information from trusted sources on eczema in general can be found at: