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Atopic Eczema


What is 'atopic' eczema?


‘Atopy’ is the term used for the tendency to develop eczema, asthma and/or hay fever.

Atopic eczema is a dry, itchy inflammation of the skin. The words ‘eczema’ and ‘dermatitis’ are interchangeable and mean the same thing. Atopic eczema, therefore, is the same thing as atopic dermatitis. For simplicity we shall stick to the word ‘eczema’ here.


Atopic eczema can affect any part of the skin, including the face, but the areas most commonly affected are the bends of the elbows, around the knees, and around the wrists and neck. These are known as ‘flexural’ areas. It affects both sexes equally and usually starts in the first weeks or months of life. It is most common in children, affecting at least 10% of infants, although it can carry on into adult life or come back in the teenage or early adult years.


What causes atopic eczema?


This is still not fully understood. Atopy runs in families (see below) and is part of your genetic make-up. Atopic people have an overactive immune system and their skin easily becomes inflamed (red and sore). Their skin ‘barrier’ does not work well, so that their skin may become dry and prone to infection. Atopic eczema is not catching.


What makes atopic eczema flare up?


Many ‘external’ factors can make eczema worse. These include:


* Heat, dust, and contact with irritants such as soap or detergents.

* Being unwell: for example having a cold can make eczema flare.

* Infections with bacteria or viruses can make eczema worse. Bacterial infections make the skin yellow, crusty and inflamed, and may need treatment with antibiotics. A viral infection with the herpes simplex virus can cause a painful flare of eczema, and may need treatment with antiviral tablets.

* Dryness of the skin.

* Stress may also trigger flare ups.


Is atopic eczema hereditary?


Yes - atopic eczema (as well as asthma and hay fever) tends to run in families. If one or both parents suffer from eczema, asthma, or hay fever, it is more likely that their children will suffer from them too. In addition, there is a tendency for these conditions to run true to type within each family: in other words, in some families most of the affected members will have eczema, in others, asthma or hay fever will predominate.


What are the symptoms of atopic eczema?


The main symptom is itch. Scratching in response to this may be responsible for many of the changes seen on the skin. Itching can be bad enough to interfere with sleep.


What does atopic eczema look like?


If you have eczema, it is likely your skin will be red and dry. When the eczema is very active (during a ‘flare-up’) you may develop small water blisters on the hands and feet or your skin may become wet and weepy. In areas that are repeatedly scratched, the skin may thicken in response - a process known as lichenification.


How is atopic eczema diagnosed?


It is usually easy for health care professionals, such as health visitors, practice nurses and general practitioners, to make the diagnosis when they look at the skin. However, sometimes the pattern of eczema patches in older children and adults is different, and the help of a hospital specialist may be needed. Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.


Can atopic eczema be cured?


No, it cannot be cured, but there are many ways of controlling it. Most children with atopic eczema improve as they get older (75% clear by their teens). However, many of those who have had eczema continue to have dry skin and need to avoid irritants such as soaps or bubble baths. Eczema may persist in adults it but should be controllable with the right treatment.






All information from The British Skin Foundation. The Charity for Skin Disease Research