What are the causes of eczema and atopic dermatitis in adults?
Children suffer more from this particular form of eczema. But they’re not the only ones. It’s estimated that in industrialised countries, about 10% of adults also have it. Some have had to live with it throughout childhood and adolescence. For others, atopic eczema appears for the first time when they are adults. This chronic skin disease can appear at any age. It’s initially caused by an epidermis that is excessively porous, often a hereditary feature. People with eczema have skin that is very dry and that poorly fulfils its barrier function of blocking irritants from the surrounding environment.
What is it like to live with Eczema?
Atopic eczema can occur all over the body. It causes dry, reddened skin that may be very itchy, scaly or cracked. Constant scratching can split the skin, which may lead to infection – usually characterized by weeping or ‘wet’ eczema. Having a skin condition like eczema can affect the way you look, how you feel about yourself, other people and the world around you. It is not just a matter of physical discomfort or inconvenience. Eczema can affect your emotional, social and personal wellbeing. It can disrupt family life, personal and social relationships, leisure, holidays, and all sorts of day-to-day activities. The physical severity of your eczema does not necessarily dictate the extent to which your life is affected. It may depend on how noticeable your eczema is or where it occurs on your body. No-one else can really say how ‘mild’ or ‘moderate’ or ‘severe’ your eczema is for you – it is how you feel about your eczema that counts. Having eczema may make you feel anxious, embarrassed, or lacking in confidence. It could also make you feel angry, frustrated or depressed. It may affect how you relate to other people, and how they relate to you. It may influence how you feel about life and the choices that you make. There is no single solution to coping with eczema – we all have different ways of meeting challenges and new situations. If you feel that you are finding it hard to cope with your own or your child’s eczema you may need to consider finding extra support. Please speak to your doctor if you are struggling. You can also find psychological therapies services near you.
Managing your eczema
A good skincare routine: A good skincare routine is essential for any kind of eczema. If eczema is not treated appropriately, your skin may become even more irritated and itchy, leading to more scratching and damage. You may lose sleep at night, making you tired and less able to cope. Cracked, bleeding or weeping areas of skin are at risk of becoming infected. Infection makes eczema worse and delays healing. Washing, showering and bathing Cleansing the skin is integral to eczema care in order to remove dirt and skin debris, which could cause infection. A daily bath/shower is recommended and it is very important to always use an emollient for washing. Plain water without emollient will dry out the skin, whereas an emollient will cleanse the skin, reduce itching and repair the skin barrier by trapping moisture. Emollients Leave-on emollients – sometimes referred to as non-cosmetic or medical moisturisers – are designed to stay on the skin and be absorbed. Emollients not only moisturise the skin and soothe the itch, they also coat the skin’s surface with an oily layer which traps water beneath it. The resulting restoration of the skin’s barrier function prevents the penetration of irritants, allergens and bacteria. They are available to buy over the counter or can be prescribed according to local guidelines. Adults should expect to use at least 500g per week, when the eczema is affecting a large area of the body. Dealing with flares When your eczema flares, your skin will become red, itchy and sore. Your eczema is unlikely to be controlled with emollients alone, and during a flare additional treatments should be used. Topical steroids are the mainstay of eczema treatment and have been used to treat eczema flares for over 60 years. Infections Skin infections are fairly common in people with eczema. There are a number of different types of infection associated with eczema, but they can be treated effectively, especially if caught at an early stage. Bacterial infections Atopic eczema is most often infected by a bacterium called staphylococcus aureus, which is found in greater numbers on the skin of people with eczema than in the general population. Infected skin looks red and ‘angry’ and it is usually wet with small yellow spots and sometimes yellow crusts. Viral infections Avoid contact with anyone with a cold sore – if the cold sore virus infects eczema, it can cause a serious condition called eczema herpeticum. Fungal infections Seborrhoeic eczema is caused by the body reacting to a yeast called Malassezia. Over-production of this yeast on the scalp may also cause dandruff. However, regular use of anti- yeast shampoo can help to control it. Psychological approaches to beating the itch There are many psychological and emotional factors that may affect eczema and you may find it gets worse when you are under stress (indeed, eczema can itself be a source of stress). • It is impossible to avoid stress altogether, so probably the best advice is to find ways of managing it. Just making time for yourself to relax and doing something you enjoy may help. • Try to care for your skin as effectively as possible, even though this is time- consuming – in the long term, this will help to relieve the stress caused by itching and discomfort. • Aim to distract yourself from the itch by doing something you enjoy – something that involves using the hands can be the most effective. • Try to avoid smoking, drinking too much alcohol (this can dry your skin) and other unhealthy approaches. • If you feel unable to cope, seek support from your family, friends or local healthcare professional. If those close to you can learn about eczema, they will be better able to understand and support you. Habit reversal therapy Stress can increase the desire to scratch; and sometimes scratching (which can be pleasurable) may occur as subconscious behaviour and become a habit which makes eczema worse. Some people have benefited from habit reversal therapy: For one week keep a daily tally of bouts of scratching. Try to identify when and how you scratch, what you scratch with and how your skin looks and feels afterwards. When you feel like scratching, clench your fist gently instead or grasp something like a small ball for 30 seconds. Sleeplessness People with eczema often have poor sleep patterns connected to itching, which can make stress considerably worse. Controlling your eczema is key. Some people find that a sedating antihistamine, which can be prescribed by a doctor or bought over the counter at pharmacies, is helpful. If you still have difficulty sleeping, ask your doctor if there are other treatments to improve your sleep pattern or your eczema. Enjoying life Relationships Unfortunately, some people are unsympathetic and uninformed and believe that any skin condition is unhygienic and contagious. Eczema is neither of these things, but it takes courage and a confident attitude to dismiss other people’s ignorance. If you have problems, it is important to discuss them openly rather than punish yourself by scratching or picking your skin. Give yourselves time to talk objectively and explore how you both feel. Your doctor or other healthcare professional may be able to help you, or refer you both for therapy or counselling. Meeting new friends Eczema can lower your self-confidence and self-esteem, which could lead to difficulty in going out and mixing with others. Leading a full and active life can help you to forget your eczema – once people get to know you, they will not even notice your skin. Pregnancy Family issues Atopic eczema is usually inherited and many adults, especially those whose eczema has been severe, worry about passing it on to their children. The chances of a baby having atopic eczema are greater if both parents have it than if only one parent or neither parent has it. However, eczema is not always passed on by parents. Sometimes, it is not clear where the condition has come from. Planning a family If you decide to start a family, look at your lifestyle to make sure it is as healthy as possible, paying particular attention to smoking, alcohol intake and diet. For the female partner whose eczema is affected by diet, particularly milk, a doctor or dietician should be consulted to ensure adequate intake of dietary requirements.
Eczema during pregnancy
Hormone changes that occur in pregnancy inevitably affect the skin. Some women find their eczema gets worse, while others find it completely clears. During the later stages of pregnancy, women may find their skin is especially itchy and uncomfortable. It is safe to use emollients before and during pregnancy. Pay particular attention to moisturising the nipples to avoid cracking and soreness later on during breastfeeding. Eczema at work Some jobs can make eczema worse, particularly if you have contact dermatitis. Nursing, outdoor work, wet work (e.g. bar work and hairdressing), handling certain substances and the need for frequent hand washing can cause problems for your skin. If you have hand eczema, you will not be able to undertake nurse training. People who have eczema on their hands are more likely to develop a skin reaction as substances can easily penetrate dry, cracked skin. If something associated with your job is triggering your eczema, your symptoms will probably improve when you have time away. Finding the right job Choosing a career and finding the right job is difficult for most people. For people with eczema some kinds of work have the potential to aggravate their skin and are better avoided. Choice is most restricted if you have atopic eczema or your hands are affected. Try to make informed choices throughout your working life so that the career you follow is satisfying, appropriate and compatible with having eczema. Constructive guidance is available from a variety of sources to help you make appropriate decisions. It is usually helpful to inform your employer of your eczema. Most employers are keen to help their staff overcome skin problems associated with work. Sometimes it may be necessary to take time off when your skin suffers a setback, and an informed employer is more likely to be understanding. However, some employers may be reluctant to offer you work if they feel that the job would be hazardous to your health. Sports and recreation Don’t let eczema stop you doing exercise, whether it’s football on a Saturday, a dance class or an evening cycle home from work. Activity, however, involves getting hot and sweaty, with the potential consequence of scratching, so adapting what you do or the frequency/intensity might be a reasonable compromise. Avoiding triggers Establishing a good skin care routine is essential, but you will also benefit from identifying and avoiding things (there may be several) that trigger a flare. Unfortunately, there is currently little clinical evidence to confirm which of the commonly suspected triggers really do produce flares. Nevertheless, the experience of patients and the clinical observations of dermatology doctors and nurses point to a number of possible culprits. If the neck or face are affected, consider airborne allergens such as house-dust mite, pollen, perfume, chemicals, etc. Avoiding triggers is the best way to manage your symptoms and live a normal and happy life.