Dr Sonja Bobart
General Practitioner, D4Medical, Donnybrook, Dublin, Ireland
Eczema is a complex, relapsing medical condition that occurs when the skin is red, dry and irritated. Typically there is a family history of hay fever, asthma or allergic rhinitis (atopic illness). Eczema affects 20% of children and less than 10% adults.
Most children will grow out of eczema by late childhood but may flare again in adulthood. Eczema accounts for one in 30 general practice consultations and about 15% of dermatology referrals. Although the majority is mild, it can have a significant psychological effect on the individual.
Eczema often presents where you flex your joints and on the face
Eczema can occur anywhere but common sites are the flexural areas (behind knees, wrists and front elbows) and face. It is initially itchy then the skin becomes scaly, red, dry and inflamed.
In fair-skinned patients, these areas may be red. Among darker-skinned people it appears light grey or black. If untreated, the skin can become weeping, blistered, scaling and lichenified (thickened).
The cause of eczema is unknown
The exact cause of eczema is unknown but it may be due to an immune response to any irritant (such as pets, paints, pollens, dust) due to a defect in the skins barrier. This barrier allows moisture out, therefore the epidermis is vulnerable to bacteria, viruses or even fungus.
Moisturisers are the best form of management
As most patients present with itch, the treatment is geared towards relieving and preventing itching, which can lead to infection. As the skin is dry and itchy (itch-scratch cycle) lotions and creams are recommended to keep the skin moist. It is best to use these emollients and washes when the skin is damp to keep the skin moist. Applying emollients should be in the direction of hairs as this will prevent blocked pores/infection.
Eczema can be kept under control by knowing triggers and applying emollients, washes and cold compresses for itch. If emollients are stored in the fridge, they are effective for itch management.
If Eczema does not settle, you should see your general practitioner for stronger topical steroids +/- a topical or oral antibiotic or antifungal. Good communication between the GP and the patient is essential as treatment failure due to poor adherence is common. Education and communication is very important and information should be provided with regards to steroids, the management of flares and recognising infected atopic eczema.
Education provides better treatment adherence. HCPs (health care professionals) need to take time to educate the affected individual and families and provide information leaflets, feedback and follow up at regular intervals.
New product feedback pathways should be provided by HCPs in order to assess compliance, autonomy and progress.
Few patients will need a dermatology referral. They may require potent steroids, phototherapy or immunomodulators.
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