Atopic eczema

Atopic eczema is one of the commonest causes of an itchy, scaly weepy red rash. It is also the most common form of eczema and is very widespread in the Irish population. The prevalence of atopic eczema in children may be as much as 20% with 65% of cases occurring before six months. It usually starts between the ages of 2-6 months, often occurring on the face. There is usually a family history of eczema or other atopic conditions like asthma and allergic rhinitis.

People with this condition make larger than usual amounts of immunoglobulin E (IgE). These antibodies exist to defend the body against attack. In atopic eczema the large number of antibodies are encountering alien substances or allergens and reacting to them. The reaction causes inflammation and itchiness. Allergens include dust, pollen, chemicals or food and drink. In a small child, the rash may spread all over the body. In about 50% of affected children, the rash will clear by the time they are a year and a half. In the others, it my spread to the skin folds including the backs of the knees and insides of the elbows. The side of the neck, wrists and ankles may also be affected. In small children the condition may persist on the face.
Atopic eczema is less common in adults and there is a reasonable chance it will disappear by the age of 30. For many people though, it is a lifelong condition that will require daily treatment.

However, it is thought that emotional problems may prolong the course of the disease. Patches may appear on the lips and nipples and may reappear for various reasons. For example, in some occupations such as hairdressing it may reappear on the hands. In older people patches of eczema may return around the ankles and this is associated with varicose veins.

One of the most pronounced features of atopic eczema is very dry skin that is sensitive. When this dryness becomes extreme, cracks appear in the skin that can be extremely sore. For example, when this occurs on the backs of the knees it is very difficult to walk. If the skin cracks at the side of the mouth, it is difficult to talk. It is therefore understandable; that people with the condition can become irritable and stressed because of the discomfort they are enduring.

The importance of routine skin care should not be underestimated. Redness of the skin (known as erythema) is another feature of atopic eczema. This is caused by an increased flow of blood to the skin due to a trigger such as an allergen or stress. Triggers include dust mites, pet dander, pollens, moulds, food and stress. The person with eczema is very vulnerable so must take great care over what they expose themselves to. For example, people with eczema are particularly vulnerable to herpes simplex (cold sores). If infected the virus can spread and develop into a serious condition called eczema herpeticum. This underlines the needs not to share dishes, towels etc. Scaly skin and lichenification (thick and leathery skin) are also characteristics of atopic eczema. Even with the best care in the world, people will suffer flare-ups of their condition. Learning how to manage these can make life a lot easier.

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