Eczema

Skin conditions are very common with around 19% of all GP consultations concerned with skin complaints. I in 5 school age children have eczema, whilst most common in children, 1 in 12 adults also suffer.

There are several types of Eczema. Atopic eczema is believed to be hereditary where the sufferer reacts to one or more substances. Atopy describes a group of conditions, which are genetically linked. These are eczema, asthma, hay fever and urticaria. Often in a family one or more of the conditions may be present with one sibling having eczema whilst another has asthma.

Other types of eczema are caused by certain substances irritating the skin, although finding the "offending" irritant substance is often easier said than done.

Venous/Gravitational eczema tends to be found in older people whose venous blood flow back to the heart is not as effective as it used to be, they may be prescribed compression hosiery to overcome this.

Effective skin care is vital in eczema management, with emollients (moisturizers) being used in either cream, ointment, gel, lotions or spray. They add moisture to the skin and form an artificial lipid layer over the surface. Soap substitutes are also available for bathing, showering and hand washing.

Steroid creams have been around since the 60s and have revolutionized the care of eczema. The recognition of side effects from steroids has led to the development of safer methods of application. They tend to be used when emollients/moisturizers alone can not manage the condition.

Children may have to wear a two layer bandage suit, Wet Wrapping Technique as a way of treating and preventing flare ups.

If you or a member of your family has Eczema you'll know how itchy and uncomfortable it can be, as well as sufferers feeling self conscious about how their skin looks. Anything that stresses the immune system can trigger an eczema flare up such as a cold or a late night.

Moisturizers

These can be in cream, ointment, gel, lotion or spray form. Their job is to help maintain healthy skin by adding moisture to the skin and form an artificial lipid layer over the surface. Regular soap and detergents remove not just dirt but the lipid layer of the skin, making conditions like eczema worse. Your nurse or doctor can recommend soap substitutes for bathing, showering and hand washing.

Wet Wrapping Technique

This is usually only used on small children to break the "itch/scratch cycle" and is a bandaging technique well established in skin care nursing to treat or prevent flare ups of eczema. It is not suitable for all eczema patients so should only be used following medical or nursing advice.

An ActiFast tubular bandage suit is applied in two layers a warm, wet layer covered with a dry layer. Click here for a step by step guide to Wet Wrapping Application.

Other actions to improve eczema symptoms:

House Dust Mites - One such way is to remove house dust mites as their droppings are believed to aggravate eczema. This involves damp dusting, vacuuming beds and repeated washing of soft toys or placing them in the freezer during the day.

Pets - Fluffy pets can be a source of aggravation for eczema sufferers. The dander (dead hair and skin cells) can be very difficult to eradicate even with daily vacuuming. Weekly washing of pets may decrease the level of dander around the home. Although this may be nigh on impossible with cats!

Diet - Certain foods may cause eczema to worsen. Never remove a foodstuff, particularly from a child's diet without consulting your nurse or GP and only when a definite connection between the food and a worsening of the eczema can be seen.

Clothing - Soft cotton clothing can be helpful in managing eczema.

Laundry - The general consensus is using a non-biological washing product and avoiding fabric softeners is appropriate.

The National Eczema Society provides information and support at www.eczema.org

The ActiFast tubular bandage from Activa Healthcare is ideal for the wet wrapping technique and keeping ointments in place. Click here for Wet Wrapping Application.

Widths, Lengths and Pip Codes

Click here for further bandage information.

Atopic Eczema
Atopic Eczema is endogenous; it is an immunologically stimulated response to one or more substances. The term Atopic comes from the Greek for without a place, Eczema comes from the Greek word meaning 'to boil'. Atopy describes a group of conditions, which are genetically linked. These are Eczema, Asthma, Hayfever and Urticaria; there may be a link in a familial pattern. One or more of the conditions may be present; often one sibling will have asthma and another eczema.

Atopic eczema often presents within the first six months of life as vesicular, (tiny palpable, blisters in the epidermis) weepy skin on the face and head, with a diffuse distribution elsewhere. The skin in the napkin area is often not affected. Parents frequently report that the child does not sleep through the night; the knock on effect of this is that the whole family will probably be exhausted from lack of sleep. In slightly older children the pattern of the eczema changes, it loses the vesicular appearance and becomes more chronic. There are often bands of lichenified skin in a flexural pattern around wrists, backs of knees and elbows. Lichenified skin is the result of chronic irritation associated with eczema. Inspection of the epidermis reveals magnification of the skin markings with dry thickened skin.

This presents as bands of eczematised skin, often without erythema, particularly around the inside of the wrists, elbows and ankles. The wet wrapping technique is particularly useful in this group as it enables intensive rehydration of the skin and aids control of the irritation. In adults the pattern of eczema is similar to that of childhood but there may be more involvement of the trunk and limbs generally. In it's acute phase, eczematised skin is usually erythematous and exuding. The localised inflammation in the skin causes dilation of capillaries, and oedema in the epidermis (Spongiosis); this forms tiny blisters (vesicles) which in turn coalesce and rupture. The local oedema and inflammation cause pressure on nerve endings in the skin and cause the irritation that is a hallmark of atopic eczema. The resulting itchy, weeping skin leaves a breach in the barrier to infection.

A clinical deterioration in atopic eczema is often associated with infection. The main pathogen implicated is Staphylococcus aureus. Oral antibiotics may be prescribed. Antibacterial/steroid combination preparations are also available.

Traditionally potassium permanganate has been used as an antiseptic for weeping eczema this should be diluted to a 'rose pink' colour (1:32000 solution). Lotions and bath emollients with antiseptics added are recent additions to the range of antiseptic products available. These products are much cleaner and more user friendly, than potassium permanganate which stains skin, nails and clothing brown; it does not wash off so is not suitable for use in domestic bathrooms.

Venous / Gravitational Eczema

Venous eczema, also known as gravitational eczema, occurs on the lower limbs. When venous insufficiency is present there is often oedema of the lower limb. The resulting increased permeability of capillary walls allows irritant proteins to infiltrate the interstitial spaces. This irritant reaction causes eczema. The patient may have venous eczema with or without the presence of an ulcer.

The presentation of venous eczema is marked by intensely itchy skin, there may be palpable vesicles on the skin but often these have ruptured and present as moist, weeping skin. Erythema is often a feature of venous eczema; this is due to the dilation of capillaries in response to the irritant effect.

Signs of infection in eczematised skin

• Erythema (redness or deeper colour in dark skins)
• Weeping or blisters
• Localised heat
• Yellow crusting or exudate
• Tenderness (there may be very reduced movement in the skin)

Diffuse erythema may be a sign of cellulitis, however, this is an unlikely diagnosis if the other signs of infection are absent; these being localised heat, tenderness, swelling or increased exudate where an ulcer is present. The exudate may be pale, straw coloured or if heavily colonised with Staphylococcus aureus, a bright glistening yellow. Contact eczema may also complicate the picture where leg ulceration is present. As the long term use of medicaments in the form of dressings and creams may cause sensitivity. This eczema can usually be distinguished by the pattern of its presentation, sometimes in the outline of a particular dressing.

Skin management in eczema of the lower limb is treated in a similar way to other forms of eczema, with use of emollients forming the first rung of the skin management ladder. The use of an ointment rather than a cream will reduce the potential for sensitisation. In addition, topical steroids are used where needed. Potent topical steroids may be needed to gain control of the eczematous reaction.

In eczema related to venous insufficiency, it is imperative for the patient's comfort to gain control of the eczematous reaction. Build up of product residue and the accumulation of dead cells on the skin (hyperkeratosis) can also cause discomfort, and it is important to remove this before the reapplication of emollients and bandages. Good skin care will assist in the relief of eczema, however without reversal of the underlying hypertension, this will offer only temporary resolution. Control of oedema, reversal of venous hypertension and the management of excessive exudate can be achieved by the correct application of adequate compression. It is vital that the nurse conducts a thorough assessment of the patient's vascular status and limb measurement so that the correct bandage regime is applied. Padding should be used to protect the skin from damage that could be caused as a result of incorrect bandage application technique.