Eczema - what's new? | Expert Guide from the Dailymail

(Dailymail.co.uk) - In this, the final part of our unique HOW TO BEAT series, we have worked closely with experts in each field of dermatology to bring you cutting-edge information about your complaint and the newest treatments available. It could be life-transforming.

Dermatitis (or eczema) affects one in ten adults and one in five children, causing patches of dry, scaly, red and itchy skin.

In some cases, an unknown allergy to substances such as perfumes, creams, hair dyes or nickel jewellery can be enough to prompt the body to mount a defence, triggering an inflammatory reaction in the skin.

But most eczema is atopic eczema, an inherited condition that is linked to other sensitivities such as hay fever and asthma. The distinctive, red, itchy patches of skin are a sign that your immune system has over-reacted to harmless allergens and has triggered the inflammatory process in its defense.

The usual cause is an inherited gene that leads to a deficiency in a protein that’s supposed to keep the skin moist and act as its barrier, explains Professor Hywel Williams, director of the Centre for Evidence-based Dermatology at the University of Nottingham. ‘This deficiency means the skin dries out, becomes itchy and inflamed and — if scratched — red and sore.’

Other inherited genes can trigger the body to mount an abnormal immune response in the skin to allergens such as house mites or even certain foods.

Very often eczema sufferers have to endure a combination of the two: the deficient skin barrier and an abnormal response to allergens.

However, the rogue genes might never be switched on until the person is exposed to specific environmental triggers, such as low temperatures or low humidity, which dry the skin to the point that brings on eczema.


DON'T SCRATCH THAT ITCH, IT'LL PROLONG THE AGONY 

While scratching that itch may feel fantastic, it can very often prolong the problem. 

‘When skin is inflamed it is a sign that inflammatory cells have gathered beneath its surface,’ explains Dr Joanna Gach, consultant dermatologist at BMI Meriden in Coventry and University Hospital Coventry. 

‘These cells stimulate the release histamine - a natural chemical the body produces in response to an allergen – which causes the itching. Scratching produces more inflammation, more histamine and more itch.’

She recommends trying a non-soap cleanser such as Dermol 500 (£11.94 from Lloyds pharmacy) and frequent use of preservative and fragrance free emollient creams such as E45 cream, Aveeno, Cetraben or Olaten.

‘Never ignore itching skin,’ warns Dr Gach. ‘In extreme cases it could be a sign of iron deficiency, diabetes, thyroid, kidney or liver disease so always see your GP if the itching persists.’ 

Itching can also be caused by a fungal infection - characterised by a flaky round and itchy wound - which can be treated with oral anti-fungal agents. 

Hives - a raised itchy rash which may be triggered by allergy to insect bites, medications or general anaesthetics – or an infection can be treated with antihistamines (in higher doses than those taken for hay fever).



SO WHAT WORKS?

The latest thinking in eczema treatment focuses on protecting the skin barrier first with emollients (moisturising oils, creams and ointments) and then dampening down the immune system (with steroid creams) when red, itchy skin inflammation occurs.

However, continuous and over-use of steroid creams can cause skin-thinning — the steroid appears to reduce the production of collagen, a protein that helps supports the top levels of skin. 

So Professor Williams advises judicious use: ‘Once the initial “attack” phase is under control, we often put people on “weekend therapy”, using the creams only on a Saturday and Sunday night,’ he says. ‘This rarely causes skin-thinning and dramatically reduces the number of flare-ups.’

Specialists are excited by newer topical anti-inflammatory ointments, called tacrolimus or pimecrolimus, which can be prescribed by your GP and which won’t cause skin-thinning.

Although Professor Williams says it’s too early to know if they are safe long term, evidence shows they seem to be highly effective. In extreme cases light therapy can help.


Soap is too harsh for eczema sufferers, he says, and avoid any skincare products containing preservatives or washes containing sodium laurel sulphate, which can irritate eczema.
Instead, ‘a simple emulsifying ointment from the chemist can be mixed with water as a cream soap and used as a direct application cream,’ he suggests. Or try Dermol Shower Emollient, £6.65.

The experts’ favourite products: Try Avene XeraCalm AD (a range of creams, cleansing oils and lotions for varying degrees of dryness which contains compounds that can help restore the skin’s barrier), from £5.50 to £35, suggests Dr Anthony Bewley, consultant dermatologist at Bart’s and the London NHS Trust.

Aveeno moisturising cream, £8.93, contains oatmeal, which is anti-itch and helps restore the skin barrier, says Dr Nick Lowe, a dermatologist and former senior lecturer at University College London’s school of medicine.

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