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How to diagnose Eczema in adults

Eczema is one group of skin conditions that can cause various symptoms including bleeding, sores, oozing, crusting, scaling, thickened skin and pigmentation changes.

The most common type of eczema is atopic eczema, which usually affects children but can affect adults too.

‘Atopic’ means the condition is caused by allergy sensitivity.

eczema on skin close up

Eczema is a chronic problem for many people of all ages. It’s very common for infants and children, many of whom outgrow it before school age or some as teenagers.

Eczema affects about one in five children and about one in 12 adults in the UK. With appropriate treatment, the condition can be controlled by the majority of people.

What are the symptoms of eczema?

No matter which part of the skin is affected, eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does the rash most commonly occurs on the face, arms, knees, hands or feet. It may also affect other areas as well.

Affected areas usually appear very dry, thickened or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.

In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but patches may appear anywhere.

What causes eczema?

The exact cause of eczema is unknown, but it’s thought to be linked to an overactive response by the body’s immune system to an irritant. It is this response that causes the symptoms of eczema.

In addition, eczema is commonly found in families with a history of other allergies or asthma.

Some people may suffer “flare-ups” of the itchy rash in response to certain substances or conditions. For some, coming into contact with rough or coarse materials may cause the skin to become itchy. For others, feeling too hot or too cold, exposure to certain household products like soap or detergent, or coming into contact with animal dander (skin or hair) may cause an outbreak. Upper respiratory infections or colds may also be triggers. Stress may aggravate the condition.

Although there is no cure, most people can effectively manage their eczema with medical treatment and by avoiding irritants. The condition is not contagious and can’t be spread from person to person.

How is eczema diagnosed?

Your GP can make a diagnosis of eczema. Since many people with eczema also suffer from allergies, your GP may refer you for allergy tests to determine possible irritants or triggers.

How is eczema treated?

The goal of treatment for eczema is to relieve and prevent itching, which can lead to skin damage and infection. Since the disease makes skin dry and itchy, lotions and creams (emollients) are recommended to keep the skin moisturised.

These products are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching.

Steroids, such as hydrocortisone cream which is available over-the-counter, or prescription creams and ointments containing more potent corticosteroids, are often recommended to reduce inflammation. For severe cases, your GP may prescribe oral corticosteroids. In addition, if the affected area becomes infected, your GP may prescribe antibiotics to kill the infection-causing bacteria.

Other treatments include antihistamines to reduce severe itching, phototherapy (therapy using ultraviolet light applied to the skin) and sometimes medication for people whose condition doesn’t respond to other treatments.

Alitretinoin is a medication for severe, long-term (chronic) hand eczema that has failed to respond to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist (a specialist in treating skin conditions). Alitretinoin should never be taken during pregnancy or when breastfeeding because it can cause severe harm to your baby. Because of the risk of birth defects when taking alitretinoin all women of child-bearing age who are considered able to become pregnant are recommended to enroll in the ‘Pregnancy Prevention Programme’ to reduce the chance of pregnancy occurring.

Guidelines from the National Institute for Health and Care Excellence (NICE) cover current treatments (described above) and newer non-steroidal creams, such as tacrolimus and pimecrolimus. These medications would be prescribed only in certain circumstances by doctors with special experience in skin diseases.

How can eczema flare-ups be prevented?

Eczema outbreaks can sometimes be avoided or the severity lessened by following these simple tips.

  • Moisturise frequently
  • Avoid sudden changes in temperature or humidity
  • Avoid sweating or overheating
  • Reduce stress
  • Avoid scratchy materials, such as wool
  • Avoid harsh soaps, detergents, and solvents
  • Be aware of any foods that may cause an outbreak and avoid those foods

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