Your Health   -  A to Z of Common Medical Conditions

Eczema and Dermatitis

Description - Eczema is a common skin condition characterised by itching, redness, swelling, scaling and thickening of the skin sometimes associated with the presence of small, weeping blisters. Sometimes only one or two of these features are present, though itching is almost always present. The commonest medical use of the word ‘eczema’ is for atopic eczema, which affects about 20% of the population and is often associated with asthma and hay fever. There is no apparent cause, though there is a familial tendency, and it can be particularly troublesome in children, even small babies, sometimes affecting most of the surface of their bodies. Other forms of eczema include gravitational eczema or varicose eczema (see Varicose Veins), pomphylox (a highly irritating condition of the feet and hands) and seborrheic eczema (a very common, itching, scaling condition of the scalp and face). Whereas eczema comes from within, dermatitis, in which the skin appearances can be identical to eczema, comes from without. Dermatitis may be caused the continual exposure to an irritant – housewives to washing-up liquids and detergents, hairdressers to shampoos and colorants, nurses to antiseptics, pastry cooks to sugar (so-called ‘sugar dermatitis’). This group includes all those subject to ‘occupational dermatitis’. The other common form of dermatitis is allergic dermatitis where the sufferer reacts excessively, in an allergic fashion, to something that will give no problem to the majority of people. Typical of this is nickel allergy, where people react with skin rashes to nickel studs or nickel-containing watches, bracelets, etc.

Management - Atopic eczema can be a great problem and may necessitate numerous approaches of treatment. Dietary changes may be made, particularly the exclusion of dairy products. Much thought has to be given to this, particularly in the young, as the evidence to support this action, though often quoted enthusiastically, is not strong. Emollients that keep the skin soft, and less dry, are used widely, so are steroid creams and ointments. These preparations must be used in the appropriate strength and form, so medical advice is required. Some people, eschewing conventional medicine and using ‘traditional’ Chinese herbal preparations have been horrified to find that these preparations sometimes contain steroids in doses way above what their doctors would prescribe. Antibiotics may be needed if the eczema becomes infected and many now believe that the flare-ups of eczema that occur in children are, indeed, the result of infection. The management of dermatitis is, mainly, removing the irritant cause, avoiding it or protecting oneself against it – gloves, barrier creams, etc. The commonest dermatitis in babies was always nappy rash. This has, to a large degree, disappeared with the use of disposable nappies, free as they are from accumulated soap products, chemicals, yeast spores, etc., which the old towelling nappies contained after a few washes. In acute cases of dermatitis the doctor may be consulted and the appropriate steroid application may be used until the problem has settled.

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