(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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