eczema, itchy skin – allergy

Eczema is a dry skin condition which becomes red and itchy when inflamed known as active eczema. It is also known as atopic dermatitis, and is a common condition, particularly in childhood but in some cases can persist, present or reoccur in adulthood. Eczema has a high impact on health and quality of life for patients and their families but good management and support can reduce the impact.

The skin has an important role as a barrier and has been described as being like bricks and mortar. In eczema, there is a problem with the mortar and this allows the skin to leak losing moisture and allow irritants in which inflame the skin. Because the skin is not able to maintain its barrier function it is also very prone to infections from bacteria on the skin and/or through contact.

The main symptom of eczema that patients experience is itch. The response to this is to scratch the affected area which might provide temporary relief,however scratching damages the skin even further and increases the risk of infections. It is a difficult condition to manage with flare-ups often happening for no known reason., There is no cure, although most children (and adults) will outgrow it with time.

1. Moisturise the skin with soap/detergent/fragrance-free moisturisers* several times a day or more if possible, to help maintain its barrier function (available on prescription from your doctor).

2. Bathing once a day to clean and hydrate the skin. Antiseptic baths twice a week can help reduce infections (see the Eczema Management Plan and Guidelines for Antiseptic Baths section below for more information).

3. Apply steroid creams (called topical steroids) if the skin becomes inflamed and itchy (active eczema), to bring this under control as soon as possible. Most active eczema cannot settle without topical steroids. See your doctor if the inflammation does not get better in two weeks.

It is also important to see your doctor particularly if the skin becomes weeping, angry and red; antibiotics and antiseptic baths may be necessary.

Click here to see video footage from the NZ Paediatric Society on the three steps to managing eczema in children. (The messages are the same for adults with eczema).

Click here for an Eczema Management Plan (Caring for your childs eczema)

2. Suitable moisturisers, as well as topical steroids and antibiotics, are available on prescription from your doctor. Ask your doctor to write an Eczema Management Plan for you/your child to follow (available here). Note that depending on the severity of the eczema - some people will need to use a pot of moisturiser or more per week.

3. Avoid skin products with soap, detergent or fragrances. These can dry and irritate the skin. Look for products which state soap-free, fragrance-free, suitable for eczema. Do not use bubble baths. Often the same cream that you have been prescribed as a moisturiser can be used as a soap substitute.

4. Minimise the risk of skin infections by:

5. Shampooing hair: to avoid getting soap on the skin, lean over a handbasin or tub to rinse off or wash the hair at the end of the bath to avoid sitting in the shampoo in the bath water. Hair does not need to be shampooed every day.

6. No bath? if showering, put moisturiser on first then get in the shower to rinse off.

7. Minimise the risk of scratching and causing more damage to skin:

8. Avoid those things that irritate your/your childs skin as much as possible. More information is in Avoiding Triggers section (below).

However it is important to understand that having IgE antibodies to an allergen does not mean the person is allergic to that allergen. On the other hand eczema skin can be irritated and inflamed by non-allergenic triggers, such as chemicals, heat and stress. For many people there is a process of trial and error to work out what their particular triggers are. However if an allergy is diagnosed by a doctor, such as to house dust-mites or food, then minimising exposure to them will help reduce active eczema.

Children with eczema are more likely to develop allergies, and, while they may outgrow the eczema, go on to experience hayfever (allergic rhinitis) and asthma symptoms as they grow older.

Testing for allergies in patients with eczema, particularly young children, is difficult for a number of reasons. Infants and children with severe eczema, and/or where there is clinical evidence of food allergies, and/or inflamed or infected eczema not responding to treatment, should be referred to the local (DHB) paediatric service.In adults, food additives are a possible trigger for eczema inflammations, particularly artificial colourings and preservatives. These are not food allergies and cant be diagnosed through skin prick or blood tests. Consultation with a dietitian to trial an elimination diet may help.

i) Choose the right bleach: the bleach should be plain, without added fragrance or detergent (Janola brand contains detergent and is not recommended)

ii) Fill your bath or tub with warm water

iii) Add bleach and mix well

iv) Soak in the bath for 10-15minutes. Wash with the soap substitute (e.g. moisturiser/emollient) towards the end of the soak

v) Rinse off with tap water

vi) Use dilute bleach baths 1-2 times a week

i) Food:

ii) Eczema skin in children and adults is commonly irritated by things in the environment. These may include:

Soap, detergent and fragrances:

Allergens such as house dust-mites, pet fur, grasses, pollens and moulds: information about avoiding these allergens can be found here.

Overheating:

Rough fibres in clothing and bedding and even carpet can irritate skin with eczema and some people find lanolin in wool can irritate. Find fabrics that work, such as 100 per cent cotton, and use where possible for clothing particularly if next to the skin; bedding including blankets and bedspreads; and as covers on vinyl or leather car seats, kitchen chairs/sofas and on carpet if the child is going to be sitting or playing on this. Remove name/brand tags from clothing to prevent irritations to the neck.

Chemicals contained in aerosol sprays (e.g. insecticides, air fresheners and polishes) and paints, resins, and varnishes can irritate eczema skin in some people. Avoid using or contact with these as appropriate.

Chlorinated swimming pools: look for pools with low chlorine levels, or saltwater pools or the sea. Make sure to apply moisturiser before swimming, rinse off in a fresh-water shower after swimming then apply more moisturiser.

Laundry: Use a gentle laundry product when washing clothes, bedding and towels, avoid use of bleaches or fabric softeners, and make sure to rinse well to remove any soap, detergent or fragrance. Wash new clothes, bedding and towels before use as these may contain chemicals from the manufacturing process. Hot washing bedding at greater than 55c can help remove house dust-mites if these are an irritant.

iii) Eczema skin is prone to infections which will inflame the skin. To avoid infections:

iv) Stress and anxiety can also play a role in inflaming eczema skin, particularly in older children and adults. Allergy New Zealands booklet Letting go: teaching your food-allergic child responsibility may be of help. (This is free to members or can be purchased for $5 click here for more information). Constant lack of sleep due to itchy or painful skin can also increase stress for the patient and their family. Use of sedating antihistamines at night might help - discuss this with your doctor.

Read this article:
eczema, itchy skin - allergy