Atopic Eczema is a common chronic (but eventually self-limiting ) itchy skin condition that usually presents in childhood/infancy, occasionally persisting into adult life. Patients present with itchy, dry, red scaley skin, predominantly in the flexures/crease of the joints (elbow, knee, ankle) but may affect anywhere in the body, including the face and neck. The skin may be thickened and weeping as a result of scratching. The term atopy is used to describe a group of conditions including asthma, eczema, hay-fever/allergic rhinitis, food allergy and urticaria. These can either present in the patient or in the immediate family. The cause of eczema is not fully understood but atopy runs in families.
Atopic eczema can not be cured but can be very well maintained. The mainstay of treatment is emollients. These need to be applied on a daily or twice daily basis. Steroid creams or ointments can be used in the acute phase to control inflammation but these need to be strictly monitored by your Dermatology Doctor. Topical calcineurin inhibitors can be prescribed by your Doctor. These can sting on application but this is usually only temporary. Anti-histamines can be very useful initially to control the itch. Your Doctor will give you a treatment regime for the initial treatment of eczema and after that a maintenance regime will be recommended.
Very occasionally patients don’t respond to topical treatments and other options will be discussed like oral steroids, azathioprine, cyclosporin, methotrexate but this is unusual.
Adult Seborrhaiec Dermatitis
This is an eczematous process of varying degrees of severity, that usually affects the scalp,face, flexures and upper trunk. The main symptoms are flaking, redness and dryness of the skin. It is a very common presentation at the Dermatology clinic.
The cause is unknown and it is not curable but with proper skin care it can be very well maintained and can go into remission for years. Twice daily cleansing with a glycolic acid cleanser will exfoliate the skin, Vitamin C 20% serum is a powerful anti-oxidant and all reduce the appearance of redness, vitamin B5 gel should be used twice days it has an anti-inflammatory effect on the skin and hydrates it ,and a daily moisturiser./sunscreen should also be used. See www.reformskincare.ie for further information.
Your Doctor will prescribe an anti-fungal cream until the rash clears and sometimes Nizoral shampoo can be used on a weekly basis for maintenance. The skin products should be used every day.
Discoid( nummular eczema).
This is a form of eczema that is characterised by extremely well defined, round (coin-shaped) extremely itchy lesions. It is treated in a similar fashion to atopic dermatitis (eczema)
Pompholyx (Dyshidrotic Eczema)
Pompholyx is a distinctive eruption of vesicles on the palms and soles and sides of the fingers that is extremely itchy.
Lichen Simplex: this is an eczematous response to continual rubbing or scratching of a localised area of skin.
Lichen Striatus: This is a self-limiting form of eczema that occurs in children or young adults. This line of mildly itchy eczema appears like a line for example on an upper arm or across part of the trunk along one the Dermatomes ( similar to the presentation of shingles). Treatment is similar to the management of eczema; it will usually resolve by itself in 1-2 years.