London - Skin diseases such as eczema are the most common reason we go to the GP, according to new figures from the British Skin Foundation.
The condition, characterised by dry, itchy red skin, is now estimated to affect up to 20 percent of school children and up to 10 percent of adults. “In 99 percent of cases, eczema can be controlled,” says Professor Mike Cork, head of dermatology research at the University of Sheffield and consultant dermatologist at Sheffield Children”s Hospital.
“But tragically we see adults with horrendous eczema - their situation would have been dramatically different had they been referred as a baby. Caught early, we can prevent mild or moderate eczema from getting worse.”
The condition is caused by a lack of fat between the skin cells; as a result, water is lost from the skin cells - this causes them to shrink, and cracks open up between them. Allergens, the substances that can trigger an allergic reaction, can then get into the skin, causing inflammation.
The problem with leaving the condition untreated is that the longer allergens penetrate the skin, the more allergic the immune system becomes and the worse the reaction. But which treatment is right for you? Here, Professor Cork gives his verdict on some of the most popular products.
EMOLLIENT CREAMS: These are basically medical moisturisers and the mainstay of eczema treatment. The more you use, the less of other products such as steroid creams you will need. Emollients act like an artificial fat, filling in the gaps between the skin cells so they can fill with water and swell up again.
The average sufferer should be using between 250 and 500g of emollient a week - all over their body, even where the skin isn’t affected. Use liberally and frequently - every hour if the skin is very dry, but at least two times a day. Apply after bathing, while water is still trapped in the skin, for extra hydration.
Also ensure you use a gentle stroking action in the direction of hair growth. Never rub up and down vigorously as this could trigger itching, block hair follicles or create more heat in the skin.
Emollients with a higher oil content will be more moisturising but also greasy. The most important thing to consider is what you prefer the feel of.
You might need thicker emollient on some parts of your body or at certain times of year when central heating dries skin out. For patients with mild eczema (areas of dry skin and itching infrequently, with little impact on everyday activities and sleep), try light emollients such as Oilatum lotion and E45. For moderate eczema, use more oily products such as Aveeno cream, Diprobase cream, E45 cream, Dexeryl and Oilatum.
For severe eczema (widespread areas of dry skin, incessant itching, redness, weeping, flaking and a significant impact on sleep and everyday activities) try Diprobase ointment, 50/50, Hydromol ointment.
EMOLLIENTS WITH UREA: Urea attracts water to the skin and some evidence suggests products with it are more effective than standard emollients, but their use has not been investigated in children, who account for the majority of eczema sufferers.
Be aware that if used on very dry skin, urea can irritate it, so you might need to apply regular emollient first. Products to try include Balneum Plus, Aquadrate, Balneum cream, Calmurid and Eucerin cream. Another ingredient used in emollients is oats, which contain natural anti-inflammatory chemicals and may be soothing.
In a trial of children who used a moisturiser containing oat extract and evening primrose oil, there was some improvement in quality of life, but no reduction in the severity of eczema.
Oat products aren’t suitable for children under one because this can cause a reaction to the protein oats contain. Products to try include Aveeno cream.
BATH PRODUCTS: Bubble baths in particular are extremely drying, yet a daily bath or shower does remove the dirt that could cause infection in broken skin. Again, emollient products are best. Try Bath/Shower E45, Aveeno Body Wash, Cetraben Bath Wash, Oilatum Bath/Shower or Diprobase Diprobath.
Antiseptic emollient wash products are good for eczema prone to getting infected. Products to try include Dermal 600, Eczymol and Oilatum Plus bath oil.
PRESCRIPTION TREATMENTS: When eczema flares up, steroid creams can provide rapid relief.
Used for five to seven days usually, they interfere with the production and action of the chemical messengers that cause inflammation.
If used incorrectly or for shorter than you are directed to, steroid creams can cause thinning of the skin or reddening. Never use over-the-counter creams to treat eczema without the advice of a healthcare professional.
Elidel cream (which has the active ingredient pimecrolimus) and Protopic ointment (tacrolimus) are a newer class of medicines for reducing inflammation.
They can be used in combination with steroids to get the best effect, and don’t cause thinning of the skin, so can be applied to delicate areas such as the face.
AVOID: And finally, don’t use aqueous cream for eczema - not even to wash with. It’s incredibly damaging to skin, especially children’s, because it contains sodium lauryl sulphate, which is the harshest possible detergent.
As a consequence, it breaks the skin down, making eczema worse. Very worryingly, many people are still given it by GPs as a moisturiser as it’s the cheapest option. Research has shown that more than half of children who used it suffered an immediate bad reaction, such as stinging. - Daily Mail
* For more information contact the National Eczema Society on 0800 089 1122 or eczema.org