health articles Eczema
Eczema is a common skin condition that causes dry, itchy, red and irritated skin. It’s a common problem, particularly in children, with one in five children affected.
Eczema can be itchy and uncomfortable. If you or your child are scratching and suffering, the experienced doctors at Virtually Healthcare can provide expert advice, support and treatment to ease itching and prevent flare-ups.
Eczema care at Virtually Healthcare
Virtually Healthcare is an innovative GP practice, providing expert care in the comfort, safety and privacy of your home. The Virtually Healthcare service is designed to fit with modern lives. Consultations are easy to access, discreet and convenient with virtual appointments available seven days a week.
The highly-skilled team includes more than 40 clinicians working together to investigate and treat disease, and help you optimise your health and wellbeing. As well as experienced GPs, the team includes sexual health specialists, physiotherapists and practice nurses to offer a comprehensive primary care service.
During the pandemic, many patients are finding it more difficult to access healthcare. Virtually Healthcare provides rapid access video or telephone appointments; with consultations available the same day if you contact us before 3pm. Our clinicians can provide professional assessment and advice, arrange investigations, prescribe treatment or arrange for a face-to-face review.
At Virtually Healthcare our focus is on you. Our clinicians take a holistic approach to eczema treatment. They can arrange for allergy testing, provide practical guidance, and prescribe a range of treatments to control your eczema and improve your quality of life.
What is eczema?
Eczema or atopic dermatitis is a skin disorder that causes dry, inflamed and itchy skin. Most people develop the condition during infancy or childhood, usually noticing flare-ups before five years of age. During flare-ups the skin can become red, sore and irritated.
Eczema can run in some families. This is called an ‘atopic tendency’. If a parent has eczema, hay fever or asthma, any children are more likely to also be affected by the conditions. However, it’s not inevitable. If just one parent has eczema, their child has a 37.9% chance of developing the skin condition, this increases to 50% if both parents have eczema.
Unfortunately there is still no cure for eczema, but many people grow out the condition during adolescence, with up to 7 in 10 achieving total remission.
Eczema symptoms
Eczema makes the skin dry, rough and flaky. It also causes an itchy red rash, especially during flare-ups. Symptoms include:
- Dry, rough and flaky skin. In young babies, eczema typically affects the face, scalp and body. But in older children and adults the folds of the skin are more frequently affected, especially the bends of the knees, elbows and wrists.
- During flare-ups, the skin becomes itchy sore, red and inflamed. Fluid-filled blisters can develop on affected areas and the skin can be moist and weep fluid.
- Itching: Eczema can make the skin ferociously itchy. You may notice scratch marks and bleeding on affected areas.
- Skin thickening: Chronic scratching can make the skin thick and rough. This is known as lichenification and can make the skin even more itchy. It’s part of eczema’s frustrating itch-scratch cycle.
How to help yourself with eczema
Eczema can be uncomfortable and distressing, but there are ways to soothe the skin and prevent flare-ups:
- Avoid soap: Soaps, shower gels and bubble baths can irritate the skin and strip the natural oils and irritate delicate skin. Ask your pharmacist for soap substitutes to clean the skin without drying it out.
- Apply emollients: Emollients are treatments that trap in water, moisturising the skin and protecting the surface. Apply them often to decrease itching and prevent flare-ups. [include link to hot topics]
- Soft, smooth clothing: Woollies and rough clothes can irritate sensitive skin and make itching worse. Choose soft natural fibres instead.
- Protect from scratching: Scratching can irritate and tear the skin. It can also introduce infection, so try to protect your skin. Keep nails short and wear cotton gloves or mittens at night.
- Identify triggers: Some things can make eczema worse, try and spot any patterns to your flare-ups. Typical triggers include chemicals in skin preparations, mould, pets, stress, central heating, sun and swimming.
- Humidify the air: Eczema can be worse when the air is dry. Try to increase moisture in the air by hanging a damp towel over a radiator, or leaving a bowl of water in each room.
- Keep things cool: High temperatures can make your eczema worse. Turn down the heating and ensure the water in baths and showers is tepid.
When to see a doctor
Make an appointment with one of the doctors at Virtually Healthcare if you are struggling to control your eczema, or that of your child. If eczema is disturbing your sleep and affecting your quality of life, there are effective treatments available to reduce inflammation and ease itching.
If the rash isn’t responding to treatment, the skin is weeping, there’s increased inflammation, crusting or pus it’s important to have a medical review. There may be an infection that needs antibiotic or antiviral treatment.
Eczema treatment
The doctors at Virtually Healthcare can provide the latest evidence-based advice, support and treatment for people living with eczema. Treatments include:
- Emollients: Topical treatments to moisturise and protect the skin.
- Soap substitutes: Products to clean the skin without causing irritation and dryness.
- Topical corticosteroids: Your doctor may prescribe steroid ointments or creams to reduce redness, itching and inflammation during flare-ups and to treat chronically inflamed and thickened skin.
- Antibiotics: Your doctor may prescribe antibiotics if your eczema becomes infected.
- Antihistamines: If eczema is affecting sleep, antihistamines have sedative properties which can reduce sleep disruption.
- For severe eczema which may need further treatment, such as bandaging or light therapy, the doctors at Virtually Healthcare can refer to a specialist dermatologist.
Hot topics in eczema Choosing emollients
Emollients are moisturisers used for eczema and other dry skin conditions. When used regularly, they can help prevent flare-ups, soothe your skin and ease itching. However, many patients don’t use their emollients correctly. The GPs at Virtually Healthcare explain how to choose and apply emollients so that you can optimise your skin health.
You may find that you need different formulations for different areas of skin and varying times of day. You may also need to tailor your treatment when your eczema flares. You need to apply emollients regularly, up to four times a day. So, always keep some close at hand, at work, school or in the car.
Emollients are made out of combination of oils and water, the relative balance of these can affect the consistency, the ease of application and the effectiveness of the product.
Ointments
Ointments are greasy emollients that are oil-based. They contain relatively less water, which means they need fewer preservatives. They are thick in texture, so can be sticky and tricky to apply and are often visible on the skin after application. They are however highly moisturising, retaining water in the skin and restoring the barrier function. This makes them the treatment of choice for skin that is very dry, thickened or inflamed, such as during eczema flare-ups. They can also be useful for overnight use or under wet-wraps. They are usually applied every six to eight hours.
A word of caution, ointments that contain more than 50% paraffin could potentially be flammable so should not be used near someone who smokes or in the vicinity of a fire or open flame.
Lotions
Lotions have a lighter, more liquid formulation. They have a higher proportion of water than oils, making them light, cooling and very easy to apply. They need to be applied more generously and more frequently than ointments. Lotions are not as effective at moisturising very dry skin, however they can be good for use on hairy areas, if the skin is wet and weeping, or for times when time is at a premium and quick absorption is necessary.
The high proportion of water means that lotions need more preservatives, which can cause skin sensitisation. For some people, their skin will burn during application, especially if it is scratched or sore.
Creams
Creams fall in-between ointments and lotions. They are formulated from a mixture of fat and water and are lighter and easier to apply than an ointment. They are thicker than a lotion but are still easy to spread and can be used in the day time when a greasy ointment may be cosmetically unacceptable. Creams are also easy to apply over skin that is sore or weeping.
The water content, means that creams also need preservatives, which can cause skin sensitisation in some people. To be effective creams need frequent and generous application, around every 3 to 4 hours, in order to restore the skin’s barrier function.
Hydrating gels
Gels have a different chemical structure, meaning they can be light, cooling and non-greasy even though their oil content is high. They usually need to be applied every 3 or 4 hours, however if they contain a humectant like urea, hyaluronic acid or glycerine, this can help hold water within the skin for longer, so that some products need only be applied every 6 or 8 hours.
Soap substitutes
Soaps and hand-washes can strip the skin of its natural oils, dehydrating and irritating sensitive skin. These products also frequently contain fragrances, colours and other chemicals that can cause sensitisation.
Emollient soap substitutes can effectively clean the skin, without drying it out. However, they can take a little getting used to; they don’t foam and feel very different from soaps and washes you may have used in the past. The good news is that bubbles play no role in the cleansing process, so your skin can be both clean and healthy.
Bath and shower oils
Bubble-baths and shower-gels often contain soaps and chemicals that can irritate and inflame the skin. However, hot water alone can be very drying for the skin. Use tepid water and apply emollient before bathing or showering. Emollients can also cleanse and hydrate the skin, leaving a fine oily coating on the surface to trap moisture.
Testing times
Before using any new emollient for the first time, it’s important to test your skin’s reaction. Patch test the product on a small area, to make sure you don’t have an allergy or any other skin reaction.
Apply a little of the cream, ointment, lotion or gel to an area of skin. Many people use the skin behind the ear, but you can try wherever your skin is most sensitive. Leave for 48 hours and keep an eye out for any reaction. If there’s no irritation, it should be safe to apply over the body.
The regular use of emollients can decrease dryness and itching and reduce the risk of eczema flare-ups. By forming a protective layer over the skin surface, trapping in water and moisturising the skin cells they can keep the skin healthy, so you can get on with your life.
Allergy testing
Young children and babies with moderate or severe eczema are more likely to have allergies to food and other substances. Food allergies can trigger eczema and also cause other symptoms including anaphylaxis.
Common food allergies include:
- Cows’ milk
- Hens’ eggs
- Nuts
Allergy testing can be a simple, low risk way of identifying food and other allergens. Virtually Healthcare can refer children for specialist testing to identify substances that could trigger eczema flare-ups. The doctors will refer children under the age of five with moderate or severe eczema for investigation if their eczema is not well controlled by treatment.
Your child has moderate eczema if they have patches of dry skin, frequent itching and redness. They may also have thickened skin and scratch marks.
Your child has severe eczema if they have large areas of dry skin across their body, the itching is incessant and the skin is red and inflamed, They may also have skin thickening, scratch marks, bleeding and there may be areas of oozing, cracking and pigmentation changes.
Our doctors, together with the specialist allergy team, use the test results to guide your child’s care. Avoiding foods, products containing certain chemical, pets or removing carpets can all help reduce allergen exposure and improve eczema control.
Allergy testing for contact dermatitis
Allergy testing can also be beneficial for people with allergic contact dermatitis, a type of eczema that is triggered by exposure to allergens such as nickel, latex, dyes, fragrances and preservatives like formaldehyde10.
Patch testing is an investigation on which small amounts of allergens are placed in contact with the skin. They are attached (usually to the skin on your back) using tape. After two days the tester will remove the patches and check for any reaction. By identifying allergic triggers, you can work to avoid allergens and prevent skin inflammation in the future.
Find out more:
- https://www.nhs.uk/conditions/atopic-eczema/
- https://knowyourskin.britishskinfoundation.org.uk/condition/eczema/
- https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/35-eczema-dermatitis
Types of consultations we offer
We offer written, telephone and video consultations with a range of male and female clinicians from GPs, nurse practitioners, and primary care specialists such as physiotherapy.
Telephone
Video
Written