Those of you who suffer from eczema will understand what is meant by "that itchy problem". It is an irritating condition of the skin, which in many cases comes and goes almost at random — although many people can identify things which will precipitate it, such as stress, or contact with particular substances.

What is eczema?

The term eczema actually describes any condition in which there is itching and superficial inflammation of the skin. What we're talking about here is the situation where this condition is caused by allergy — also known as atopic dermatitis.

Atopic dermatitis is a form of eczema which is most common during infancy and childhood. The incidence of this type of eczema in the general population is between 1 and 5 percent. However, as with other allergies, there has been a steady increase in its incidence over the past few decades.

It often starts at two to four months of age. The disease comes and goes, and about 50 percent of children with eczema develop allergic rhinitis, and between 20 and 30 percent develop asthma. About 50 percent of children with eczema will grow out of the disease with time.

What causes eczema?

There are probably many different things which cause eczema and the exact cause is not known. People who have eczema usually have an inherited allergic tendency. Foods such as cow's milk, eggs, wheat, soya protein, peanuts, fish and citrus can cause the condition or make it worse. Allergy to house-dust mites can also exacerbate the disease.

Abnormal immune system responses are thought to be responsible for eczema.

Complications of eczema

Generally eczema is a mild condition, but it can become severe enough in some cases to need hospitalisation, usually if it covers the whole body, which is more common in children than adults.

Eczema can also become infected with Staphylococcus aureus, a bacteria. Infection with this can make eczema worse, and may need to be treated with antibiotics. If eczema is infected, it forms thick crust over the affected area of skin.

What happens to the disease over time?

Atopic dermatitis may become less severe in the teens and may disappear around puberty. However, it may relapse again around the age of 20, for reasons which are unclear.

If eczema continues well into adulthood it usually disappears at menopause in women, and is rare in the elderly. However, when it is present in old age, it is often severe and widespread.

How do you treat eczema?

  • Avoid precipitating factors — the most important step in managing eczema is to identify possible "trigger" factors. Stress management may be useful if stress is a factor. Various foodstuffs may be removed from the diet.

  • Corticosteroids — these remain the main treatment of atopic eczema. Doctors usually try to find the least potent steroid cream which will control symptoms. Only very mild steroid creams — 1 percent strength — should be used on the face and in young children. Sometimes strong steroids need to be used to control particularly bad exacerbations, but should only be used for short periods, and never on the face. Topical steroids come in different formulations, either creams or ointments. Creams are often preferred because they are less messy, but ointments are often better because they don't dry the skin. Creams can actually dry the skin out, which can make eczema worse.

  • Tar — is a traditional treatment for atopic eczema and is safer than corticosteroids. Pastes containing tar are applied under light bandages. The problems are an unpleasant smell, and the possibility that dry skin may be irritated.

  • Moisturising preparations — also called emolients, are an essential part of treatment, as they help to lubricate dry skin. They should be used as a soap substitute, in the bath, or applied to the whole body while still wet from the bath. The choice of ointments or creams is a personal one. Ointments are often more effective, but are messy because they are greasy. Creams such as aqueous cream and E45® are less greasy, but need to be applied more often.

  • Evening primrose oil is a controversial treatment. Some people believe that it is of no value at all, while others are convinced that it helps. Evening primrose oil capsules are expensive, and people need to take eight to 12 each day for six weeks to see whether or not it is working.

  • Treating infection is important in controlling eczema, either with oral antibiotics, or antibiotic/antiseptic lotions.

  • Chinese herbs are popular, but problematic because it is not clear what is in them. There are reports of excellent responses, but equally, some have been found to contain steroids. There have also been reports of kidney damage in people using these preparations, even when they are used according to instructions. However, there is collaboration between Western dermatologists and Chinese practitioners to attempt to create a standardised preparation based on some of the most frequently used herbs.

    Most people will respond to the simple treatments outlined. However, some have eczema which is severe and widespread and defies all conventional treatment. These unfortunate individuals need to see a dermatologist since they may need to be treated in hospital, or with highly specialised forms of treatment such as UV therapy or immunosupressive drugs.

    Click on the following headings to find out more about...

  • Who gets allergies?
  • Hay fever - when you just can't stop sneezing!
  • Rhinitus - a constant runny nose!
  • How your environment can cause allergies, and how allergies can be prevented


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