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Atopic dermatitis (commonly known as eczema) is an inherited, chronic inflammatory skin condition that usually appears in early childhood.
Patches of skin become red, scaly and itchy.
Sometimes, tiny blisters containing clear fluid can form and the affected areas of skin can weep.
Weeping is a sign that the dermatitis has become infected, usually with the bacterium Staphylococcus aureus (‘golden staph’).
Eczema is not contagious.
Eczema can vary in severity and symptoms may flare up or subside from day to day.
If your eczema becomes worse, disrupts sleep or becomes infected, see your doctor.
Using moisturisers and cortisone-based ointments can help ease the symptoms.
It is also important to avoid skin irritants, such as soap, hot water and synthetic fabrics.
Children with eczema have a higher risk of developing food allergies, asthma and hay fever later in childhood.
Causes of eczema
Eczema is caused by a person’s inability to repair damage to the skin barrier.
This is due to a mutation in the gene called filaggrin.
Filaggrin is important for formation of the skin barrier.
Normally, every cell in the skin has two copies of the filaggrin gene.
However, people who are susceptible to eczema only have one copy of this gene.
Although you only need only one copy of the gene to form a normal skin barrier, two copies are important for skin barrier repair.
If a person’s skin is exposed to irritants and their skin barrier is affected, a person with only one copy of the gene may find that their ability to repair the skin barrier is limited.
Once the skin barrier is disrupted, moisture leaves the skin and the skin will become dry and scaly.
Environmental allergens (irritants from the person’s surrounds) can also enter the skin and activate the immune system, producing inflammation that makes the skin red and itchy.
You are more likely to get eczema if your family has a history of eczema or allergic conditions, including hay fever and asthma.
In most cases, eczema is not caused or aggravated by diet.
If you feel a food is to blame, see your doctor or a dietitian for proper allergy testing and dietary advice.
While eczema causes stress, and stress may increase the energy with which you scratch, stress does not in itself cause eczema.
Triggers of eczema
Some things make eczema more likely to appear.
contact with irritants in the environment
heat, which can aggravate the itch and make affected people more likely to scratch
allergic reaction to particular foods – this is rare.
Food allergy appears as redness and swelling around the lips within minutes of eating the offending food.
Symptoms of eczema
The physical effects of eczema can include:
red and scaly areas on the front of the elbows and the back of the knees
watery fluid weeping from affected skin
lesions (sores) that may become infected by bacteria or viruses.
Management of eczema
Most people with eczema find that their symptoms are made worse by common aspects of daily living, such as hot weather, frequent showering, soap, ducted central heating and overheating in bed at night.
There are things you can do that may help you to better manage your eczema and reduce the frequency of flare-ups.
Always see your doctor or dermatologist for further information and advice.
Eczema coping tips – good hygiene
Skin affected by eczema is more vulnerable to a range of infections, including impetigo, cold sores and warts.
The bacterium Staphylococcus aureus may cause a secondary infection of impetigo, and possibly contribute to the symptoms of eczema.
Suggestions for washing include:
Take lukewarm baths or showers, and avoid really hot showers.
Don’t use ordinary soap, as the ingredients may aggravate your eczema.
Wash your body with warm water alone.
For armpits and groin, use soap-free products, such as sorbolene cream.
Bath oils can help to moisturise your skin while bathing.
When towelling dry, pat rather than rub your skin.
Eczema coping tips – reducing skin irritation
People with eczema have sensitive skin.
Irritants such as heat or detergents can easily trigger a bout of eczema.
Suggestions for reducing skin irritation include:
Avoid overheating your skin.
Wear several layers of clothing that you can remove, as required, instead of one heavy layer.
Don’t put too many blankets on your bed and avoid doonas.
Don’t use perfumed bubble bath or bath products labelled ‘medicated’.
Wear soft, smooth materials next to your skin, preferably 100 per cent cotton.
Avoid scratchy materials, such as pure wool, polyester or acrylic.
You could try a cotton and synthetic mix material – this is fine for some people with eczema.
Remove labels from clothing.
Always wear protective gloves when using any type of chemical or detergent.
You may want to wear cotton gloves inside rubber or PVC gloves.
Avoid chlorinated pools.
If you have to swim in a chlorinated pool, moisturise your skin well when you get out.
Diet for Eczema
For people with eczema, eating certain foods can trigger the body to release immune system compounds that cause inflammation, which, in turn, contributes to an eczema flare-up.
An anti-eczema diet is similar to an anti-inflammatory diet.
Examples of anti-inflammatory foods include:
Fish, a natural source of omega-3 fatty acids that can fight inflammation in the body.
Examples of fish high in omega-3s include salmon, albacore tuna, mackerel, sardines, and herring.
Foods high in probiotics, which are bacteria that promote good gut health.
Examples include yogurt with live and active cultures, miso soup, and tempeh.
Other fermented foods and drinks, such as kefir, kombucha, and sauerkraut, also contain probiotics.
Foods high in inflammation-fighting flavonoids.
Examples of these include colorful fruits and vegetables, such as apples, broccoli, cherries, spinach, and kale.
Eating more of these foods and cutting down on any trigger foods could help to reduce eczema flare-ups.
Food-sensitive eczema reactions will typically occur about 6 to 24 hours after a person eats a particular food.
Sometimes, these reactions may be delayed even longer.
To determine what foods may be causing the reaction, a doctor will often recommend an elimination diet.
This diet involves avoiding some of the most common foods known to cause eczema.
Before eliminating any foods, a person will need to slowly add each food type into their diet and monitor their eczema for 4 to 6 weeks to determine if they are sensitive to any particular food.
If a person’s symptoms get worse after adding a particular food to the diet, they may wish to consider avoiding it in the future.
If a person’s symptoms do not improve when eliminating a food, they probably do not need to remove it from their diet.
Some common foods that may trigger an eczema flare-up and could be removed from a diet include:
- citrus fruits
- gluten or wheat
- spices, such as vanilla, cloves, and cinnamon
- some types of nuts
A doctor may also recommend allergy testing.
Even if a person is not allergic to a particular food, they may have sensitivity to it and could experience skin symptoms after repeat exposure.
Doctors call this reaction food responsive eczema.
People with dyshidrotic eczema, which typically affects the hands and feet, may experience benefits from eating foods that do not contain nickel.
Nickel is found in trace amounts in the soil and can, therefore, be present in foods.
Foods that are high in nickel include:
- black tea
- canned meats
Some people with eczema also have oral allergy syndrome or sensitivity to birch pollen.
This means they may have reactions to other foods, including:
- green apples
People with eczema are more prone to oral allergy syndrome and should speak to their doctor if they have a pollen allergy or experience mild allergic reactions to the above foods.
Dietary supplements and eczema
Research has shown that taking probiotic supplements may reduce the symptoms of eczema.
More studies are needed, however, to confirm the effectiveness and dosage required.
Probiotics are available in a variety of supplements, such as the selection available here.
If a person is not sure which probiotics to buy, they may find the online reviews helpful and can also talk to their doctor.
Probiotics are also naturally present in many foods.
Probiotic foods include:
Other supplements that have been studied include fish oil and Chinese herbal preparations; neither of which made a significant difference in eczema symptoms.