Complications Related to Eczema

Are there any complications related to eczema? Apart from the obvious misery of constant itch, occasional infec­tion, disrupted sleep and social embarrassment, there are two serious complications of eczema which should be noted. Both of these relate to eczema which is extensive and out of control. The first (and more subtle) complication is a failure to thrive in childhood. These children have stunted growth and must be offered urgent and effective treatment if they are to rejoin the growth curve. One can easily imagine the great drain of energy suffered by the body in trying to cope with extensive inflamma­tion of the skin. Energy which would normally be directed towards growth is now being siphoned off to repair vast areas of damaged skin. The equivalent complication in (fully grown) adults is constant fatigue.

The second serious complication arises when the eczema flares severely and spreads to affect all or most of the body. It is called erythroderma. It is a medical emergency which requires expert help in a hospital setting to regain control.

It must be stressed that these complications are very rare, and that careful and regular attention to the underlying eczema is your best chance of avoiding them altogether.

What can we do about it?

In dealing with eczema you win want to:

1. Identify your relevant allergens and reduce your exposure to them

2. Understand your non-allergic triggers.

3. Reduce inflammation with medication and treat complications if they arise.

4. Consider the use of nutritional supplements.

5. Consider a course of desensitization to switch off your aller­gies.

What are some allergic and non-allergic triggers?

• Any child or adult with eczema which fails to respond simple measures should be considered a candidate for the Low Allergy Diet. In children, dietary investigation should be performed only under the supervision of a medical doctor with knowledge of the subject.

• All patients with eczema which fails to respond to simple measures should be skin-tested for dust mite and pollen allergy.

• All patients with eczema should be aware of the list of foods which contain histamine. They may eat them in moderation, but should avoid them during times of exacerbation.

• Any late-teenager or adult with eczema which fails to respond to simple measures should be patch-tested, particularly those who have 'odd' patterns of rash, or who are at risk occupationally.

• Contact allergic dermatitis is not common in young children. There is, therefore, no point in patch-testing them unless they have very troublesome symptoms, or symptoms not typical of atopic eczema.

Other practical measures include the following:

• Nails should be kept short and clean. This will minimise damage from scratching during sleep. If necessary, use mittens on babies' hands for the same reason.

• Clothes worn next to the skin should be pure white cotton. This is less irritating than wool and synthetic fibers. Wool is also potentially allergenic. Wash clothes in non-irritant soap.

• Baths should be restricted to a maximum of fifteen minutes. They should not be too hot because excessive heat dries the skin. Use an emollient in and immediately after the bath: pat the skin dry with a towel (no rubbing), and 'seal' the skin at once with aqueous cream or emollient, even when it is still moist from the bathwater.

• Soap and shampoo should be avoided. They have a detergent effect, taking natural oils away from the skin. Use aqueous cream and emollients instead; your doctor or chemist will advise you on the various preparations available.

All are hugely important to follow religiously to avoid eczema.