ATOPIC ECZEMA

Atopic eczema is the most common form of eczema and is often closely linked with asthma and hay fever. It can affect both children and adults, usually running in families. Atopic eczema is thought to be a hereditary condition. You do not inherit eczema as such – you inherit a predisposition to it. If there is anyone in the family who has an atopic condition, there is a chance that a new member of the family will have it too.

It is estimated that one in three people are affected by atopic eczema. However, the development of atopic eczema in a person who has a predisposition to it is likely to be greatly influenced by the environment.

One of the most common symptoms of atopic eczema is its itchiness which can be almost unbearable. Other symptoms include overall dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema the skin may crack and weep (‘wet’ eczema).

It is thought that people with atopic eczema are sensitive to allergens in the environment which are harmless to others. In atopic eczema there is an excessive reaction by the immune system producing inflamed, irritated and sore skin.

Other types of eczema are caused by irritants such as chemicals and detergents, allergens such as nickel, and yeast growths. In later years eczema can be caused by a blood circulatory problem in the legs. The causes of certain types of eczema remain to be explained, though links with environmental factors and stress are being explored.

Atopy occurs where an individual inherits the capacity to produce excessive antibodies called immunoglobulin E (IgE). These antibodies are particularly aggressive and attack foreign substances that enter the body. Eczema, asthma and allergic rhinitis are the most common atopic conditions. These antibodies exist to defend the body against attack. In atopic eczema the large number of antibodies are encountering alien substances or allergens and reacting to them. The reaction causes inflammation and itchiness. Allergens include dust, pollen, chemicals or food and drink.

The role of allergy to dust mites, pets and food in atopic eczema is controversial. In a high proportion of sufferers, the application of a dust mite allergen to the skin will worsen their condition.

The condition of a child may improve in hospital where mite counts are low. It is thought that environmental exposure and lifestyle may be as much a factor in the development of childhood eczema as genetic factors. With atopic eczema, it is believed that a predisposition to the condition is inherited and it is then triggered by allergens.

In the Western world allergies have become a growing problem. The changes in society that may be impacting on the incidence of allergies include: the levels of nitrogen oxides (from diesel engines), ozone in the air, central heating and double insulation in homes, soft furnishings, and fumes from gas cookers, sprays and cigarettes.

The role of food allergy is also controversial. The most reliable means of establishing a food allergy is to keep a food diary and then to eliminate the suspected item from the diet. If the eczema improves, it can be re-introduced. If the condition worsens again, this provides reasonable proof of the cause.

Treatments may include emollients to maintain skin hydration and to reduce inflammation. An emollient is an agent that softens and soothes the skin to make it softer. They are usually produced from a combination of water, oil, fat and wax. They are an essential element in the successful treatment of the dry skin found in eczema, and are safe and effective. However, they are often underused.

One of the most pronounced features of atopic eczema is very dry skin that is sensitive. When this dryness becomes extreme cracks appear in the skin that can be extremely sore. For example, when this occurs on the backs of the knees it is very difficult to walk. If the skin cracks at the side of the mouth, it is difficult to talk. It is therefore understandable; that people with the condition can become irritable and stressed because of the discomfort they are enduring. The importance of routine skin care should not be underestimated.