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Atopic eczema

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  • Eczema is a chronic skin condition characterised by the presence of dry, red, itchy and crusty skin. Atopic eczema, also known as atopic dermatitis occurs in individuals with a family history or personal history of allergy and is usually associated with the production of allergic antibodies (IgE).
  • Atopic eczema can affect people of all ages. It usually begins in childhood, between 2 and 6 months of age. It affects up to 15% of children by the age of 7 and 5% of the UK population, although the prevalence does appear to be increasing.
  • Research has shown that atopic eczema is primarily an inherited condition, that may be made worse by external factors (dust, foods, pet fur, climate) and/or internal factors (stress, hormonal changes, exercise). A family history of “atopy” is present in 70% of the cases of atopic eczema. More recently, an important gene for eczema has been identified or/and a mutation in their gene (Fillaggrin) has been shown to be present in about 40-50% of Caucasian children affected with atopic eczema.
  • Eczema often runs in families who have allergic diseases. Some children with eczema develop food allergies, allergic rhinitis or/and asthma as they get older. This course is known as the “atopic march”, that explains how allergic diseases progress throughout the life of an allergic individual.

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Symptoms of atopic eczema vary in severity from individual to individual. Some people have only small areas of dry and occasionally itchy skin. Others present with more severe symptoms, such as broken, bleeding, weeping and sore skin.

  • Mild cases: commonly present with dry, crusty, itchy and red patches of skin.
  • Severe cases: may present with weeping, crusting, bleeding and vesicle formation.
  • Flare-up episodes: skin may be wet, red, hot, swollen, itchy, scaly, weeping, sore and infected.
  • Chronic cases: are accompanied by dryness, scaling, fissuring and thickness of the skin.

Atopic eczema often causes a significant impact on the individuals affecting their quality of life. In all the stages, the skin is almost always itchy, it is specially distressing for young babies and children, because scratching can disrupt their sleep and make their skin bleed. This can lead to children to be sleepless at nights and to present lack of concentration at school. Secondary infection is common.

Localization of atopic eczema can be:

  • In infants, common localizations of eczema are the face, neck and trunk. Sparing of the napkin area is usually observed.
  • Later, flexural involvement appears behind knees, inside the elbows, wrists and ankles and thickness of the skin may result from repeated scratching.
  • In severe cases, eczema can cover most of the parts of the body.
  • In 30 to 50% of cases of eczema, there is an association with food allergy. Eggs, fish, nuts and dairy products may be relevant in some patients, especially infants and young children.
  • About 90% of children are free from dermatitis by the age of 12 years, but predicting which child will outgrow their eczema may be difficult.
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