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Useful facts on eczema (eksem)

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Facts about eczema

Useful information concerning eczema – NAAF’s fact sheet

What is eczema?

Eczema is a collective term describing various skin disorders characterised by itchy skin. The most common forms are atopic eczema, contact eczema, seborrhoeic eczema and nappy rash. The word atopic means “different”, which in this context means that the skin is “different”, and is used to describe hereditary allergic eczema.

Eczema may be chronic, i.e. long-lasting or acute, and in the majority of cases there is a cycle, with improvement in the summer and worsening in the winter. The chronic form is characterised by an itchy rash. As a result of scratching, areas of thickened, easily cracked skin are formed. Acute eczema is characterised by red, swollen and itchy skin, possibly with fluid-filled blisters.

In eczema, the skin’s defence against infection is weakened, and infections can readily lead to exacerbation of the eczema.

What are the symptoms of eczema?

Atopic eczema leads to itchy, dry skin.

Contact eczema which has just broken out or flared up again, causes red and swollen skin with small and large blisters and oozing sores, Eczema occurs in places exposed to direct contact with the causative agent. If the contact eczema has been ongoing for some time, the skin is dry and cracked. Severe itching is common. In its early stages, the eczema is limited to that part of the skin which has been in contact with the agent to which you have reacted, but can later spread to other skin areas.

In infantile seborrheic eczema, the skin is oily and red, with oily scabs on the forehead, scalp, face and skin folds in the neck and abdomen. In adults it takes the form of red, oily, thickened, flaking skin in central areas of the face, scalp, behind the ears and on the chest.

Nappy rash takes the form of red, smooth or possibly weeping skin in the nappy area.

Who gets eczema?

Atopic eczema predominantly affects small children. It is estimated that 15% of Norwegian children are affected by eczema. The disease often begins when the child is a few months old and resolves in 60% of sufferers before they reach the age of four. It may, however, have a later onset, in the teenage years or as an adult.

Contact eczema is rare in small children, but there is an increase in occurrence in school-age children. Ear piercings, other body piercings and the use of non-noble metals against the skin have led to a significant increase in contact allergy to nickel. Tattooing can lead to an allergic contact eczema that can arise weeks and months after the tattoo has been added. Hair colouring is an increasingly common cause of eczema, particularly as steadily younger people are colouring their hair.
Seborrheic eczema is relatively common. Eczema can occur already during the first few months after birth; however, it is more common at an adult age.

The causes of eczema

The cause of atopic eczema is unknown. Allergies are significant for some forms of eczema – but never in isolation. It is an illness which is subject to inherited and environmental and lifestyle factors. The presence of atopic illnesses (asthma, eczema or hay fever) in other family members is a normal finding. In 20-30% of patients, an allergy can be identified which has some significance for the eczema. Food allergies are never the sole reason for eczema.

The underlying causes of seborrhoeic eczema are not a result of hypersensitivity but a disease response in the sebaceous glands and may perhaps be due to special yeasts normally present on the skin. Individuals with oily skin and high sebum production are predisposed.

Contact eczema occurs when the skin reacts to contact with certain agents. The condition may be both allergic and non-allergic. The non-allergic reaction is due to direct contact with skin irritants such as cleaning agents, water and disinfectants. The allergic reaction is triggered by allergy-provoking agents such as nickel, chrome, latex, formaldehyde and perfume. Paraphenylenediamine (PPD) is a substance that often causes allergic contact eczema. PPD is found in a great number of hair colourants.

The cause of nappy rash is irritation from urine and faeces.

Treatment of eczema

The most important aspect in the treatment of eczema is good hygiene, preventing dry skin and itching with the systematic use of creams and ointments, reducing irritants and avoiding known food triggers. Exposure to sunlight and salt baths has a good effect on mild and moderate eczema. Regular baths with potassium permanganate have an important preventive effect on exacerbation of eczema.

Cortisone cream is however necessary in the majority of cases. The use of these types of cream is safe where the correct preparation is used on the right part of the body at the right intervals. After gaining control of the eczema, it is important to reduce the strength of the cortisone cream and possibly increase the intervals between applications. The correct use of cortisone cream does not involve any risk of adverse effects. Ask your doctor for a treatment/reduction schedule.

Generally speaking, you should use the right strength of preparation for the right length of time. Preparations that are too weak will not bring about proper control of the eczema. A poor treatment response often results in the entire cortisone treatment being discarded. The result is often a worsening of the condition. It is important to be aware that a poor effect from a cortisone cream can be caused by infection in the eczema, which must be treated with antibiotics, locally or generally.

If a flare-up occurs in children, you should start up with group 2 or 3 cortisone. When the itching is under control, lengthen the interval between applications, to every 2-3 days. If further improvement is seen, change to a milder cream, and thereafter reduce the treatment to every 2-3 days.

If the skin has healed, continue to apply 1-2 times per week for a minimum of 2-4 weeks, to ensure the best possible result. It is recommended that a moisturiser is used in the morning and evening and after showering or bathing, also during periods of intact, eczema-free skin.

Children with frequent, re-occurring eczema have great benefit from potassium permanganate baths also during good periods. In eczema-affected periods, potassium permanganate baths can be used daily or every other day.

Eczema creams without cortisone, so-called immunomodulators (Elidel® and Protopic®) can be good alternatives to cortisone creams. These can be applied 2 times per day. The advantage of Elidel and Protopic is that they do not affect the thickness of the skin when long-term eczema treatment is necessary, they can be used if cortisone creams do not have the desired effect and if it is not possible to gain control of the eczema without the risk of adverse effects.

 If there are skin infections, it is important that the infection itself is treated before these medicaments are used.

Medical light treatment (UVA + UVB) can be effective on long-term eczema. Some sufferers will experience a temporary worsening of the condition, possibly as a result of irritation from sweating. The treatment is time and resource-consuming and is seldom relevant for children younger than school age. The treatment is only given by a skin specialist.

A successful treatment result is dependent on that the patient has been well informed of the treatment. Eczema can be an extremely distressing illness; however, early treatment will in most cases lead to good control of the disease. Fortunately, the condition often disappears on its own – 80% no longer have the disease by the age of 18. There is reason to assume that good eczema treatment improves the prognosis.

Potentially exacerbating factors

Stiff and tight clothing, coarse wool products, polyester, clothing containing strong dyes, moisture, stress, infections, some foodstuffs, chlorinated water, tobacco smoke, perfume, allergies, alkaline soaps, degreasant chemicals and heat.

The child is usually the best judge of which textiles itch!

Prevention of eczema

Preventive measures in the mother’s diet during pregnancy and after birth have no effect on the development of atopic eczema in the child; however, research indicates that symptoms of atopic eczema can be deferred in some individuals if the child is breastfed for the first four to six months.

How to get help

In milder cases of episodic eczema in children, advice and guidance from the local health clinic can be sufficient. In more severe cases, contact your GP who may refer you on to a specialist. Free Hospital Choice Norway can help you to make an informed choice. The website www.frittsykehusvalg.no or the free telephone number 800 41 004 can provide relevant information about treatment locations and the right to use the hospital of your own choice.

Those with eczema and skin problems, or those that work with these patient groups, can speak to professional staff at the Dermatology Dept. outpatient clinic, Villa Derma, OUS, by telephone 3 hours per week. The contact telephone number, 23 07 58 03, has the following opening hours: Tuesday and Friday 08.00 – 09.00 and Thursday 12.00 – 13.00. (Check if this is still a valid number!)

Facts about eczema have been drawn up in consultation with NAAF’s medical board