Eczema

The most common form, often starting in childhood and linked to asthma and hay fever. It causes chronic inflammation and intense itching and typically affects the inner elbows, behind the knees, face, and neck. Flare-ups alternate with periods of remission.

Triggered by exposure to irritants or allergens, causing localised inflammation. Irritant contact dermatitis results from direct skin damage by chemicals or solvents, while allergic contact dermatitis stems from delayed immune reactions to substances like nickel or fragrances.

Identified by small, intensely itchy blisters on the fingers, toes, palms, and soles. Often linked to stress, seasonal allergies, or metal exposure, these blisters last for weeks before drying, sometimes leading to cracks.

Characterised by circular, coin-shaped patches of irritated skin that may ooze fluid. Typically appearing on the arms, legs, hands, and torso, it can be triggered by dry skin, insect bites, or reactions to metals and chemicals.

Affects oily areas such as the scalp, face, and chest. It involves inflammation and the yeast Malassezia, leading to greasy, yellowish scales with redness, often worsening in cold, dry weather.

Develops on the lower legs due to poor circulation and fluid buildup, causing inflammation, itching, and discolouration. Most common in older adults with venous insufficiency, it may increase the risk of leg ulcers if untreated.

Moisturisers: Regular use of emollients is necessary to keep the skin hydrated and restore the skin barrier. Thick, fragrance-free creams or ointments are recommended as they provide long-lasting hydration.

Topical Steroids: These are commonly used to reduce inflammation during flare-ups. They come in various strengths, with the appropriate potency chosen based on the severity and location of the eczema.

Topical Calcineurin Inhibitors: Non-steroidal treatments like tacrolimus and pimecrolimus are used for sensitive areas (e.g., face, eyes) to control inflammation without the side effects of steroids.

Topical Crisaborole (Eucrisa): This is a steroid-free anti-inflammatory phosphodiesterase 4 (PDE4) inhibitor topical treatment. It helps reduce inflammation and is typically used for mild to moderate atopic dermatitis.

Oral Antihistamines: These medications help relieve itching, especially during flare-ups that disrupt sleep. They block histamine, reducing allergic reactions, and some can also aid sleep. However, they only provide temporary relief and do not treat the underlying inflammation.

Oral Steroids: These are prescribed for severe flare-ups to quickly reduce inflammation and control symptoms. They are typically used for short periods, as prolonged use can lead to serious side effects, such as weakened immune function and bone thinning.

Oral Immunosuppressants: Ciclosporin, and methrotrexate are recognised treatments for severe recalcitrant eczema. However, monitoring is required with blood tests and outpatient review because these medications have toxic effects on organs and also the immune system.

Oral Jak Inhibitors: Janus kinase (Jak) inhibitors, such as baricitinib, abrocitinib, and upadacitinib target immune pathways responsible for inflammation. These are used for moderate to severe cases of eczema that do not respond to topical treatments. Blood tests monitoring and regular review are essential to ensure there are no toxic effects on the immune system and cardiovascular systems.

Dupilumab: Dupilumab is an injectable biologic treatment that targets interleukin-4 and interleukin-13, two molecules involved in the inflammatory response. It is an approved treatment for moderate to severe eczema, from the age of 6 months old. It is a safe treatment with minimal side effects.