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Itchy inflammation of the skin for any reason but most typically atopic (genetically linked).

The words 'dermatitis' and 'eczema' both mean inflammation of the skin. To Dermatologists the words are completely interchangeable and mean exactly the same thing.

There are many possible types but the commonest is 'atopic' eczema. The condition is inherited and is associated with asthma, hay fever and a family history of these problems. In fact, if you were able to trace your family (including aunts and uncles, etc.) back for two or three generations, then you would almost certainly find at least one person with one or other of these related conditions. However, it is quite common for the condition to miss out generations.

Unfortunately, the disorders may later reappear in the children of unaffected people. In other words, my mother may have had asthma (eczema and/or hay fever), I may have none of these 'atopic' disorders, but my children may have them. Childhood atopic dermatitis is extremely common; it waxes and wanes in severity but there is a definite overall tendency to improve gradually over a period of years. Very occasionally atopic eczema does not appear until adult life.

Usually the condition will come and go of its own accord and apparent associations (with, for example, certain foods or changing the washing powder, etc.) are entirely coincidental and do not directly explain the frequent ups and downs of the disease. Atopic eczema is one of the commonest of all skin diseases and has been very thoroughly studied in many thousands of patients for years; it is clear that no good association between diet or other environmental factors is detectable in most patients.

There is usually little point in dietary restriction unless there is some clear indication, from observing the affected individual's eating routine, that certain foodstuffs aggravate the condition. There are no good tests which help to detect those very few patients in whom food intolerance is a significant factor; the only way to tell is to keep a food 'diary' and try to detect possible associations in this way. Elimination diets should only be attempted with professional supervision. What is well recognised about atopic eczema is that it is related to emotional or physical stress such as exams, family upsets, serious illness or even ordinary coughs and colds.

This is one reason why holidays (removal from the stress of normal day to day life) often lead to an improvement, it is not usually due to an environmental alteration such as different food or water. A further factor which definitely does help in general is sunlight, and clearly this is relevant on many holidays where improvements occur. Unfortunately, prolonged sunny holidays are not usually a practical treatment for most of us.

Scratching or rubbing the skin will always make the condition worse. Unfortunately, the more you scratch, the worse the skin becomes, and the more you itch. This is impossible to explain to young children and sometimes the only way to stop them from seriously damaging their own skin is to physically prevent them from scratching by applying heavy bandaging and dispensing sedatives to help the child sleep overnight when most of the skin-scratching is done. Atopic eczema can cause distress to both the affected individuals and also their relatives.

Improvement (but not cure) can nearly always be obtained quickly with the correct treatment. Some patients need quite prolonged treatment and this should be supervised by your family General Practitioner or Dermatologist. In nearly all cases, great natural improvement occurs as time goes by. It is important not to damage the skin of a young patient by overusing strong creams with potential side effects. Treatment is always aimed at controlling the condition with the weakest appropriate cream.

However, sometimes it is very important to 'get on top' of eczema quickly and we do sometimes recommend stronger creams for short periods. Atopic eczema quite frequently becomes infected, especially if the skin is broken and weeping, treatment with antibiotics is sometimes needed. People with atopic eczema nearly always have rather dry skin which gets inflamed more easily than other people's skin. Things which commonly lead to such inflammation include wet work (such as hairdressing, bar work, food preparation/catering, nursing, etc.) or jobs where vigorous hand-washing is needed (motor mechanics, etc.) Teenagers with active atopic eczema should consider, very carefully, what type of employment they think might be suitable for the long-term benefit of their skin.

Patients are often frustrated with advice about this extremely troublesome condition - now you can have a personal online consultation where I can give you my recommendations and/or management program.

by Dr John Ashworth

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