Atopic eczema

What is atopic eczema?

Atopic eczema is the most common type of eczema affecting 10-20% of children and 1-3% of adults.^[1] The word ‘atopic’ means sensitivity to allergens, and eczema is a condition where patches of your skin become inflamed, dry or blistered. So, ‘atopic eczema is when your skin becomes inflamed because of a reaction to an allergen, like pollen. Sometimes the condition can be inherited from a parent.

Atopic eczema typically begins during childhood, with 85% of cases starting before the age of five.^[1] But most eczema patients will go into clinical remission, which means they will have no symptoms, before adulthood. For those who don’t, treatment might be necessary to prevent the symptoms from worsening.

Who can get atopic eczema?

Anyone can get eczema including adults, children and people of different ethnicities. It’s more common in children, with most eczema patients getting it before the age of five. It’s also more common in urban populations and developed countries. Eczema is a complex condition that can affect anyone and since there are so many factors that can cause it, it’s hard to predict who will get it.

How does atopic eczema differ from other types of eczema?

There are seven main types of eczema and the most common one is atopic eczema. Each eczema type is characterised by different symptoms. For example, dyshidrotic eczema causes itchy blisters on your feet, palms and hands.

Atopic eczema can appear anywhere on your body – it’s not specific to some areas, unlike ‘neurodermatitis’. It will appear red (or purple on darker skin) and will be itchy and dry. It sometimes can blister, but it’s less common than with dyshidrotic eczema. Additionally, it won’t have defined patches, such as circular patches in nummular eczema, or bordered patches in psoriasis.

You should get your eczema diagnosed by a clinician or doctor before starting treatment. This is because each type of eczema has different symptoms that will require different medications to treat them.

What causes atopic eczema?

Atopic eczema is a chronic, complex skin condition that can be caused by genetic, environmental or immunological factors.

Genetic factors
Mutations to genes that are important to your skin are common in eczema patients. A common mutation that’s found in 30% of eczema patients is in the FLG gene, which makes the protein filaggrin. Filaggrin is found in the outermost layer of your skin called the stratum corneum. It plays many roles in your skin, such as retaining water to help moisturise your skin, repairing damaged skin and maintaining the integrity of your skin barrier. When a mutation occurs in this gene, the production of filaggrin is reduced resulting in filaggrin-deficient skin.^[1] This makes your skin dry and more prone to infections.

Eczema can also be passed down from your parents. Research suggests that if one parent has eczema, there’s a 50% chance their offspring will have it too, and if both parents have eczema, the chance increases to 80%.^[2]

Environmental factors
Environmental changes can affect your eczema, for example, increased pollen levels can trigger your immune system to overreact and cause inflammation. Additionally, different weather conditions can cause flare-ups. For some, cold, dry conditions might draw the moisture from your skin, making it dry and itchy. Whereas, a humid climate might improve your symptoms. Some foods might also make your eczema worse. For example, eggs, cow’s milk and peanuts are common hypersensitive agents in eczema patients. So even if you’re not allergic, it might be best to avoid them if you’re getting symptoms. Everyone’s eczema triggers are different, so it’s good to track when your eczema flares, so you know what your triggers are.

Immunological factors
If you have eczema you’ll tend to have an overactive immune system. When your skin comes into contact with a substance, like pollen or a fragrance, your immune system deems it harmful and triggers an immune response. As a result, your body produces cells that cause inflammation to get rid of the ‘harmful’ substance. Although it doesn’t ‘qualify’ as an autoimmune disease, your immune system does play an important role in eczema.

What are the symptoms of atopic eczema?

Symptoms of atopic eczema are different depending on how severe it is. Generally, the common symptoms include dry, itchy and sore skin. If it worsens, these can be red (or purple/grey on darker skin), inflamed and painful to touch. The patches might also spread to other parts of your body where you don’t usually have eczema.

In some cases, the symptoms of eczema can be confused with psoriasis symptoms. Both have similar symptoms, like redness and itching, but unlike eczema, psoriasis patches are more defined, with skin that’s crusty and scaly.

Can atopic eczema lead to other problems?

Atopic eczema can lead to other problems if not managed properly. The most common infection, which 90% of eczema patients get, is caused by the bacteria Staphylococcus aureus ^[3] (also known as a ‘staph infection’). It occurs when your skin becomes cracked and opens, which makes it easy for germs to enter. This causes your skin to be blistered and filled with pus and if not treated with antibiotics it can become worse. To avoid getting infections, try not to scratch your skin. Instead, apply something cool on top or apply an anti-itch cream.

Another infection is Eczema herpeticum (EH), which is a viral infection caused by the herpes simplex virus. Although it’s less common than Staphylococcus aureus infections, it’s more dangerous and can be life-threatening. When infected, small, red, blisters appear on your skin that are painful to touch. You might also get a fever. If you think you’re infected with EH, it’s important you see a doctor as soon as possible.

Asthma and food allergies are also more common among eczema patients. About 50% of children with eczema will develop asthma and 33% will have a food allergy.^[4] This is known as the allergic march or atopic march. It’s caused by many factors, including genetic and environmental. There are ways you can lower these risks, such as by breastfeeding for early protection and using emollients frequently.^[5]

Mental health issues are common in eczema patients, especially in severe cases. Having to deal with a chronic condition is never easy and repeated flare-ups can affect your daily life. Stress might also make your eczema worse, which can further take a toll on your mental health. If you’re struggling with your mental health, seeing a doctor or talking to a loved one can help.