Atopic Eczema | Dr Atiq Ahmad Bhatti

Atopic Eczema - is believed to have a hereditary component, most children with eczema have atopic eczema, where there's a strong family history of atopic or allergic disorders, such as asthma, eczema, hay fever or food allergies, and no other obvious cause for the rash. It tends to develop in childhood, sometimes just after birth. An itchy rash is particularly noticeable on face and scalp, neck, inside of elbows, behind the knees, and buttocks.

As many as one in five children develops atopic eczema. It usually begins in the first year of life, but rarely before two months. Children from families with atopic illnesses are at greater risk - as many as 50 per cent of children with atopic eczema also have asthma or hay fever. Most children grow out of eczema by their teenage years.
Breastfeeding may help to prevent atopic eczema developing.

The cause is not known. The lipid (oily) barrier of the skin tends to be reduced in people with atopic eczema. It can lead to an increase in water loss and a tendency towards dry skin.
Some cells of the immune system release chemicals under the skin surface which can cause some inflammation. Nobody is sure why these things happen. Atopic eczema occurs in about 8 in 10 children where both parents have the condition, and in about 6 in 10 children where one parent has the condition.
The exact genetic cause is not understood, (which genes are responsible, what effects they have on the skin, etc).

Atopic eczema has become a lot more common in recent years and there are various theories for this.
Factors which may play a role include:

However, there is no proven single cause. There may be a combination of factors in someone who is genetically prone to eczema which causes the drying effect of the skin and the immune system to react and cause inflammation in the skin.

Given the many possible reasons for eczema flare-ups, a doctor is likely to look at a number of other things before making a judgment of which type it is:

An insight to family history
Dietary habits
Lifestyle habits
Allergic tendencies
Any prescribed drug intake
Any chemical or material exposure at home or workplace

One test for eczema is skin patch testing - The suspected irritant is applied to the skin and held in place with an adhesive patch, another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the patch test result is considered positive and suggests that the person is probably allergic to the suspected irritant.

Triggers or precipitants, which make symptoms worse, include dietary factors (such as cow's milk), stress and contact with substances such as perfume, nickel, lanolin and detergents. Woollen clothing can also irritate ezcema.

The rash of eczema is dry, red and itchy. It may become dry, scaly and cracked, oozing yellowish fluid and forming crusts, especially if the child has been scratching. The rash may develop anywhere on the body, but in younger children the face, cheeks, scalp, forearms and front of legs are most commonly affected. In older children, the rash is usually more localised to flexures (the inside surfaces where joints bend the skin), especially at the wrists, elbows, knees and ankles.

Don't scratch
Wear cotton clothing
Reduce stress
Avoid known triggers
Moisturise daily
Use treatments as recommended

Conventional Treatments:
Topical steroids (steroid creams and ointments)

Topical steroids work by reducing inflammation in the skin. (Steroid drugs that reduce inflammation are sometimes called corticosteroids. These are very different to the anabolic steroids which are used by some body-builders and athletes, etc.)
Topical steroids are grouped into four categories depending on their strength - mild, moderately potent, potent, and very potent.
There are various brands and types on the market in each category. For example, hydrocortisone cream 1% is a commonly used steroid cream and is classed as a mild topical steroid. The greater the strength (potency), the more effect it has on reducing inflammation, but the greater the risk of side-effects from continued use.

Side-effects of topical steroids

Short courses of topical steroids (less than four weeks) are usually safe and usually will not cause any problems.
Problems may develop if topical steroids are used over long periods, or if short courses of strong topical steroids are repeated frequently.
The main concern is if strong topical steroids are used over the long-term. Side-effects from mild topical steroids are uncommon.

Thinning of the skin is the most common possible problem. If skin thinning occurs it often reverses when the topical steroid is stopped.
With long-term use of topical steroid the skin may develop permanent striae (like 'stretch' marks), bruising, discolouration, or thin spidery blood vessels (telangiectasia).
Topical steroids may trigger or worsen other skin disorders such as acne, rosacea and perioral dermatitis.
Some topical steroid gets through the skin and into the bloodstream. The amount is usually small and usually causes no problems unless strong topical steroids are used regularly on large areas of the skin. The main concern is with children who need frequent courses of strong topical steroids. The steroid can have an effect on growth. Therefore, children who are given repeated courses of strong topical steroids should have their growth monitored.

Atopic Eczema Knowledge Academy