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Dermatology
Eczema
Eczema, or atopic dermatitis, is a chronic, recurring disease. This means that the disease is always present, even though flares may come and go. Skin with eczema is different from normal skin because it can't hold as much water in its top layer.
The symptoms of eczema include dry, inflamed skin and intense itching. Times when the skin becomes inflamed, very itchy and red are called "flares" (or exacerbations). Many people who do not have eczema think of it as 'just a rash', but for millions of children and their parents or caregivers, it is a frustrating, persistent condition that can make their lives miserable.
At times, eczema can be so mild that it may not even be noticeable. Eczema is not contagious, which means that it cannot be passed from person to person. Many children with eczema feel embarrassed by the look of their skin, the constant itching, and the ongoing, sometimes involuntary scratching. Eczema is clearly not life-threatening, but it certainly can be life-affecting.
Where Do Eczema Symptoms Appear? Eczema tends to repeatedly affect the same areas of the body when it flares, but the affected areas may vary with the age of the person. - In small children, eczema usually appears on the face, elbows, or knees, and possibly on other areas of the body
- In older children and adults, the rash tends to appear more behind the knees, inside the elbows, on the sides of the neck, and on the wrists, ankles, hands and face
What Causes the Skin to Flare? The cause of eczema is not fully understood but we know, for instance, that eczema can be triggered by: - Dog or cat hair, dust-mites, moulds and certain foods (milk, wheat, peanuts)
- Chemical irritants in cosmetics, moisturisers, air fresheners, cleaning products and certain detergents
- Extremes in temperature and humidity (such as cold dry conditions during winter)
- Certain types of clothing (such as wool)
- Stress
When these trigger factors get into the lower layers of skin with eczema, the immune system misreads them as threats and then sends immune cells to fight them. This overreaction of the immune system causes an eczema flare.
Flares are unpredictable, so the best way to control eczema is to look after your skin, even when it is not flaring. Good skin care is an essential first step.
Available Treatments and Possible Side EffectsOnly a doctor can tell for sure if you have eczema and recommend an appropriate treatment program. Avoiding triggers alone may not be enough to prevent a flare. There is no cure for eczema, but there are many products that can relieve or stop the itch, reduce the redness, make your skin look healthy again and help control your eczema to minimise its impact on your life.
MoisturisersThe first step in caring for skin is the daily use of moisturisers. Applying moisturisers regularly can help prevent the skin from drying out and can be enough to control some mild cases of eczema.
Topical SteroidsCorticosteroid ("steroid") creams and ointments can quickly help to calm the redness and itching of inflamed skin, particularly for severe flares. Most must be prescribed by a doctor. Steroids can quickly reduce the signs of eczema; however, they are not intended for long-term use (more than a couple of weeks). When steroids are used for long periods of time, side effects such as skin thinning can become apparent. Be aware that even mild steroids should not be used for an extended period of time on a child's skin.
Patients with atopic dermatitis often have large numbers of bacteria on their skin, particularly Staph. aureus which is not normally found on the skin. The presence of these bacteria may provoke the symptoms of dermatitis.
A combination of a mild potency corticosteroid, hydrocortisone acetate, and the antibiotic fusidic acid can reduce inflammation while fusidic acid eliminates Staph. aureus which may prevent provocation and/or worsening of dermatitis.
Non-Steroid Medications Known as Topical Calcineurin Inhibitors Non-steroid medications help to calm the redness and itching of inflamed skin and can also provide long-term disease control.
During a flare, these treatments can take longer to resolve immediate symptoms than steroids, but they can be used from the very first feeling of a flare and over a long period, giving you more flare-free time and better eczema control.
Anti-Itch TreatmentsAntihistamines may also be prescribed to help reduce the itching associated with an eczema flare, although they do not reduce the swelling or redness. Some of these might also cause drowsiness. This makes it easier to sleep through the night, but any drug with a sedative effect should be avoided during the day.
AntibioticsInfection is more likely to take place in skin affected by eczema. If this should occur, antibiotics are prescribed to treat the infected skin. They can kill the bacteria that are causing the infection. Overuse of antibiotics can lead to their loss of effectiveness, as the bacteria become resistant to the drugs. You can prevent this by treating your eczema at the first signs or symptoms, which reduces the risk of a skin infection and helps to avoid the use of antibiotics altogether.
Treatment Options Ask your doctor or pharmacist about the two treatment options available from Adcock Ingram which control the flare in mild to moderate eczema and mild to moderately severe atopic dermatitis where Staph. aureus is suspected as a contributing factor.
REFERENCE:
Novartis Data on File. Further information available on request. ZA.09.DER.064 11/2009 Exp. 12/2011
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