Eczema
'Atopic' refers to an individual's tendency to develop allergic conditions, while 'dermatitis' describes skin inflammation. Therefore, atopic dermatitis, or eczema, is an inflammatory skin condition with a genetic link to the development of other allergic conditions, most commonly asthma and hayfever. Eczema affects people of all ages, but is most common in children, affecting five to 15 per cent of children younger than seven years old in the UK.
According to the NES, most children grow out of their symptoms, with around 65 per cent being symptom-free by the age of seven, and 74 per cent by 16. Eczema is characterised by periods of symptom flare-ups, followed by times when symptoms ease or disappear. While each individual is different, the most common symptoms include dry, itchy skin and rashes. If the affected skin is scratched, this can lead to redness, swelling, cracking, weeping, crusting, scaling and eventual thickening of the skin. It may also be susceptible to secondary bacterial infections.
In infants, symptoms typically appear as a patchy rash on the cheeks or chin at six to 12 weeks of age. This can progress to red, scaling and oozing skin that is more prone to infection. Once the child starts crawling, the inner and outer parts of the arms and legs may also be affected. Itching and discomfort can make children restless and irritable.
In older children, the rash tends to appear behind the knees, inside the elbows, on the sides of the neck, around the mouth and on the wrists, ankles and hands. The exact cause of eczema is unknown, but it is probably a combination of genetic and environmental factors. It is not contagious.
Genetics play an obvious role as those who have one or both parents with eczema, or a similar atopic condition, are more likely to suffer themselves. People who have a non-identical twin with eczema are also three times more likely to suffer than the average person. Environmental factors are triggers that initiate symptoms in genetically predisposed individuals.
Triggers can vary, but commonly include soap and detergents, house dust mites, animal fur and saliva, pollen, and wool or synthetic material. Hot weather, high or low humidity, cigarette smoke and excessive perspiration can also be factors. Some sufferers also report stress as a trigger. However, how this contributes to the condition is unclear. Eczema is also occasionally linked to food allergens, particularly in young infants. Foods most commonly associated with the condition include dairy or soy products, eggs, nuts, seeds and wheat.
Reflective exercise
Susan, 58, has suffered from occasional episodes of mild eczema since she was a child. She comes to the pharmacy to buy a treatment for a small patch of eczema on her wrist. The patch is red and itchy, but the skin is not broken. Susan also regularly suffers from dry skin.
What would you recommend?
An emollient ointment preparation may help to add moisture to Susan's skin, which could help to ease itching and reduce redness. Susan should apply this liberally and frequently every day. It may be trial and error to find a formulation or product that effectively relieves Susan's symptoms. However, the majority of mild to moderate cases of eczema can be successfully treated with emollient therapy alone.
What if:
Susan mentions that her skin has reacted to eczema treatments in the past.
Recommend that she tests the product on a small, unaffected patch on her arm to see whether a reaction develops within 24 hours. If no reaction occurs then the product is unlikely to irritate her eczema and should be applied as directed by the manufacturer's instructions. If a reaction does occur, Susan should come back to the pharmacy and talk to the pharmacist.
What if:
Susan is not satisfied with the product you recommended.
Finding the right emollient can be trial and error. Susan may benefit from applying a range of products: an ointment before bed, a cream or lotion during the day, and a bath oil or soap substitute instead of her usual shower gel or cleanser. This method of 'complete emollient therapy' can manage eczema and help to prevent flare-ups.
What if:
Susan is wearing a metal watch.
Ask Susan if she has started wearing the watch recently. Metal, particularly nickel and cobalt, can cause allergic contact dermatitis. If unsure, refer Susan to the pharmacist.
What if:
Susan asks for a corticosteroid cream.
Provided the skin is unbroken, corticosteroid creams can be effective at relieving eczema. As Susan describes her skin as itchy, recommend a product that contains an anti-itch ingredient as well. Advise Susan that corticosteroid creams should be used for a maximum of seven days and should only be applied once or twice a day.
What if:
Susan thinks her four-year-old grandson has eczema on his knee and wonders whether a corticosteroid cream may be effective.
Topical OTC corticosteroids are not suitable for children under 10 years of age. Ask Susan whether her grandson has been diagnosed with eczema as the condition often runs in families. Tell Susan to bring her grandson into the pharmacy so that a suitable product can be recommended.