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The terms eczema and dermatitis actually refer to the same skin condition, even though many people think they are different. Eczema can be described as a pattern of skin inflammation, where the area involved looks like a red, scaly rash. It is usually very itchy.

There are several different types of eczema and several different causes. We will be looking at atopic eczema.

The term atopic describes a tendency towards a group of conditions including eczema, asthma and hayfever. If a person has one of these conditions, they may be referred to as atopic. There is usually someone else in their family who also has an atopic condition, so we describe the conditions as inherited. Atopy refers to the inherited tendency to be very sensitive to the environment. It is not necessarily the same as being allergic to something in the environment. For example, a person with atopic eczema may find their condition gets worse in winter. This means that they are sensitive to cold, dry air but they are not allergic to it.

Atopic eczema is an inflammation of the skin. It causes a dry, red, flaky or scaly rash, and sometimes there is also an oozing and crusting of the skin. People with atopic eczema generally have dry skin even when their eczema is not active. The areas most commonly affected are the face, the front of the elbows and ankles and behind the knees. The condition is usually very itchy and in some people it disturbs their sleep.

Atopic eczema commonly starts in the first year of life. It can also start later in childhood, adolescence or less commonly in adulthood. Atopic eczema will generally get better as the person grows older, but some adults continue to suffer from the condition.

Although we do not know the exact cause of atopic eczema, there is a simple formula that is often used to help determine whether someone has this condition.

Atopic Eczema = Inheritance + Environment

When a person has atopic eczema, there is usually someone else in their family who also has an atopic condition, such as eczema, asthma or hayfever and we therefore describe their condition as inherited. There are several environmental factors that can make atopic eczema come out or make a person with the condition worse. These are described below. When inheritance of the tendency and environmental factors are combined in the right way, it will lead to the development of eczema.

There are many things in the environment that can affect a person with atopic eczema. These include:

Stress can cause people to feel anxious, worried and irritated, and this can make their skin itchy. Scratching can also make the rash worse and increase the chance of secondary infection.

What about diet???
Many people feel that eating certain foods and not eating others will improve atopic eczema. Unfortunately, there is no proof that making changes to diet will make any difference to most people with atopic eczema. The best advice is to have a healthy, well balanced diet, but to seek further advice if there are concerns related to food.

(1) Prevention

There are several ways people with atopic eczema can look after their skin and prevent it from becoming worse.

Avoid woollen garments and wear loose cotton clothing. Labels on clothing should be removed as these can irritate the skin. Avoid frequent wetting and drying of the hands or body where possible. Wearing cotton-lined PVC gloves can help if the hands are coming into frequent contact with water, such as during art classes or when cleaning up. Gloves can also be useful if a person's hands are coming into contact with harsh chemicals and other substances. Long, hot showers or baths should be avoided and water for bathing should be lukewarm or tepid. Soap should be avoided where possible, but if soap must be used, then a very mild soap containing oil would be best.

Using a good moisturiser is particularly important. There are several available, but simple aqueous or sorbolene cream can be purchased from the pharmacy (chemist) or the supermarket. It is best to apply a moisturiser at least twice a day, particularly following a bath or shower, and continue this even when the eczema has cleared. Bath oil can be very useful. After bathing or showering, the skin should be gently patted dry, not rubbed, and extra moisturising after bathing or showering is very important.

(2) Treatment

When atopic eczema flares, corticosteroid (cortisone) creams, lotions and ointments may be applied to the affected areas. These products are prescribed by a medical practitioner and are usually very effective. Once the eczema has settled down, it is best to stop using these treatments as they may become less effective the more they are used. Even though these treatments are called steroid creams, they are not the same as the steroids that have been banned in sporting competitions.

Sometimes anti-histamines are recommended by medical practitioners to help ease the itching. These are taken orally. Antibiotics can also be prescribed when a secondary infection occurs. Infections can be caused by scratching and picking at areas of atopic eczema and can be very unpleasant.

These are all treatments for when the eczema is active. However, the most important approach is to follow the advice in the "Prevention" section. This will reduce the frequency of problems and will also reduce the severity of eczema if a flare-up occurs.

© 2002, Department of Dermatology, St. Vincent’s Hospital Melbourne, Victoria Parade, Fitzroy, Victoria 3065 Australia.