A Comprehensive Guide to Eczema in Adults and Children

PAEDIATRIC | ADULT | SURGERY

Eczema is a fairly common skin condition. In fact, 1-3% of adults [1] and 1 in 5 children [2] grapple with it. This number is steadily rising, with approximately 8 new cases reported daily. While not everyone suffers from eczema, you are probably aware of one or two symptoms associated with this condition.

Understanding the nuances of eczema is crucial for effective management and relief from its symptoms. Whether it's triggered externally or stems from internal factors, seeking professional guidance is key to addressing this chronic skin condition.

Read on to learn more about what makes eczema sufferers itch more than others!

What is eczema?

Eczema, also known as dermatitis, is a chronic inflammatory skin condition that can affect both adults and children. It results in dry, inflamed, and scaly skin, often accompanied by persistent itching. The severity of symptoms varies depending on the type of eczema.

There are several types of eczema; these are:

Atopic dermatitis: the most common type of eczema, atopic dermatitis, is typically seen in children but can be triggered later in life [3].
Contact dermatitis: contact dermatitis can be further subcategorised into allergic contact dermatitis and irritant contact dermatitis.
Neurodermatitis: also known as lichen simplex chronicus, neurodermatitis has been known to be linked to depression, emotional triggers, and nerve damage.
Dyshidrotic eczema: dyshidrotic eczema typically presents in females between the ages of 20 and 40.
Nummular eczema: commonly characterised by raised coin-like patches, nummular eczema may ooze and develop a crusty top when dried.
Endogenous dermatitis: endogenous dermatitis results from internal conditions, such as atopic dermatitis [4]

atopic dermatitis — Atopic dermatitis is the most common type of eczema.

Is eczema contagious?

A common misconception is that eczema is an infection and contagious. The good news is that eczema is not contagious but simply characterised by flare-ups and/or remission periods. This is when eczema symptoms improve or disappear for a certain amount of time. Eczema can be unique to each individual as it may or may not be related to allergies.

There is currently no definitive cure for eczema, but it can be managed with an appropriate treatment plan.

What are the symptoms and triggers of eczema?

Eczema can present itself in a variety of ways, affecting more than just the skin and disrupting life both physically and emotionally.

Common symptoms of eczema include:

Pruritus (itchiness) [5]
Dry, cracked skin
Scaling of the skin
Redness and inflammation
Small raised bumps (on darker skin)
Oozing and crusting of the skin
Darkened skin around the eyes
Thickening of the skin
Raw and sensitive skin (from scratching)
Emotional impact

Similarly, eczema flare-ups can be triggered in several ways, this includes:

Environmental

Climate change (such as haze and/or extreme heat or cold)
Dusty environments or dust mites at home
Heat and/or perspiration (sweating)
Smoking
Strong soaps, detergents and/or long bubble baths
Pets (namely their fur), carpets, and/or stuffed toys

Infections

Flu
Upper respiratory tract infections
Skin infections (such as bacteria, viruses and/or fungus)

Others

Food allergies
Insect or mosquito bites
Stress
Scratching
Vaccinations

Eczema sufferers should avoid perspiring where possible to prevent flare-ups.

Can you self-diagnose eczema?

The only way to know if you have eczema is to get an accurate diagnosis. Generally, most cases of eczema don’t require lab testing, as they are easily identifiable based on the skin's condition and symptoms. However, your dermatologist may still use certain tests to rule out other skin conditions from the diagnosis.

These tests may include:

Blood test(s): a small sample of your blood will be taken to test for high levels of eosinophil cells (immune reaction) and/or IgE antibodies. These blood components can help detect common allergies related to food and environmental factors.
Patch test(s): patch tests test your skin’s reaction to contact allergies from various products such as rubber, metals, fragrances, and more.
Skin prick test(s): similar to patch tests, your skin will be observed for 20 minutes to see how it reacts to a diluted allergen. If your skin becomes red and itchy, you may be having an allergic reaction to the allergen. Anti-histamines must be avoided for at least a week before the skin prick test.
Skin biopsy: a small skin sample will be taken for laboratory analysis to rule out other skin diseases.

The best way to manage eczema is to understand the severity of your condition. Your dermatologist may use Scoring Atopic Dermatitis (SCORAD) [6] to assess the severity of your eczema.

This table summarises the grades of eczema severity:

Eczema Grading	Mild	Moderate	Severe
SCORAD	< 15	15 to 40	> 40

Eczema in children

Managing eczema in babies and children comes with its own set of challenges. It's important to recognise that the symptoms and optimal treatments for children with eczema may differ from those for adults. Understanding these unique aspects is vital for effectively managing eczema in kids.

Infantile eczema (atopic dermatitis) commonly begins between 2 to 4 months of age [7]. If your baby has infantile eczema, red rashes may appear on the face, scalp, chest, back, arms, and legs. Establishing child-friendly skincare routines and using topical steroids of appropriate strength for proper care and management is important. Many children outgrow infantile eczema by age 2; however, some may continue to experience persistent eczema into their childhood years.

Addressing the specific challenges children face lays the foundation for successfully managing this chronic condition as they transition into adulthood.

childhood eczema — Eczema in children can begin as early as 2 to 4 months old

Eczema in adults

As children grow into teens and young adults, the responsibility of managing eczema shifts from parents to themselves (or you if you are transitioning into adulthood). It's crucial to raise self-awareness, learn coping strategies, and develop self-advocacy skills for this transition. If your condition is severe, access to personalised medical care and support remains vital in adulthood.

As children progress through childhood, eczema management must adapt – incorporating appropriate products, monitoring steroid effects on growth, and addressing emotional impact. Instilling confidence and habits early on prepares you to handle eczema more independently as a teenager and adult.

Despite the challenges, having a proper foundation empowers you to take control and live comfortably with eczema at any age.

How can I clear my skin from eczema?

Managing eczema involves a range of treatment options tailored to the severity of your symptoms. Core strategies include avoiding triggers, gentle skin care, and daily moisturising. Non-medication approaches such as wet wraps and specialised bathing techniques can add moisture to the skin while reducing irritating bacteria. In limited and monitored doses, UVB phototherapy is recognised as beneficial for eczema sufferers [8].

When these methods are ineffective, prescription medications may be necessary. These can include topical steroid and non-steroid creams to reduce inflammation and skin symptoms. For those with asthma and allergies, antihistamines and asthma medications may offer relief. Complex cases may require short-term courses of oral steroids and/or antibiotics.

For mild eczema, schedule a follow-up appointment with your dermatologist within 4 weeks to review your condition. If you're dealing with moderate to severe eczema, follow up with your dermatologist within 2 weeks after starting your home eczema management plan. Continue to ensure ongoing assessment and appropriate management for your specific eczema severity. This can help to address your needs effectively and promptly.

Most eczema patients manage their condition with topical medications.

Can eczema be prevented or cured?

While there is no cure for eczema, you can take steps to prevent flare-ups indefinitely or, at the very least, for more extended periods. As a rule of thumb, ensure your environment is free from house dust mites, steer clear of stuffed toys, pets and carpets, and opt for mild soaps. If you experience frequent skin infections, your dermatologist may prescribe an antiseptic wash to help manage it better.

Try to avoid extreme temperatures and excessive perspiring, especially during acute flare-ups; consider pausing physical activities. Minimise scratching by regularly trimming and filing your fingernails. Keep your skin well-hydrated by moisturising two to three times daily with a fragrance-free moisturiser, applying it generously. Collectively, these measures contribute to effectively managing eczema, promoting skin health, and reducing the likelihood of flare-ups.

Conclusion

In conclusion, understanding and managing eczema is essential for both adults and children. Recognising symptoms and triggers and seeking professional assistance are key to effective eczema management. Adapting skincare routines, accessing personalised medical care, and fostering self-awareness empower individuals to navigate this chronic condition from infancy to adulthood. By incorporating preventive measures and appropriate treatments, you can enhance skin health and lead a more comfortable life despite the challenges posed by eczema. Remember, there may be no cure, but proactive management significantly improves the quality of life.