Eczema: What It Is & How To Treat It

Eczema, often called atopic dermatitis, is a persistent skin condition defined by inflammation, dryness, and itching. It typically appears as red, scaly areas on the skin and can range in severity from minor irritation to highly uncomfortable. 

Eczema affects people of all ages, but it is most common in children. This type of condition is not contagious but can significantly impact daily life due to its persistent symptoms.  

While topical treatments and pharmaceuticals can provide immediate relief, diagnosing and treating the underlying cause is necessary for long term management.   

Let’s explore; 

• What causes eczema 

• The symptoms and causes of eczema 

• The types of eczema and their effects on the skin 

• Triggers that can cause eczema 

• Medications commonly used for eczema 

• How to diagnose and treat eczema 

Our highly trained team of medical specialists at Allergy Testing Sydney has over 40 years of experience working with patients, and offers medical solutions for eczema; by pinpointing triggers, personalised eczema treatment programs, and testing to help you identify and manage your allergies at the root cause. 

What Commonly Causes Eczema? 

There is no specific predetermined cause for eczema. However environmental factors and genetics that may run in a family bloodline are important factors..  

Eczema often begins with a highly uncontrollable impulse to scratch. Scratching momentarily reduces the discomfort, but it can worsen the problem by disrupting the skin barrier, causing further dryness and irritation and allowing Staphylococcal aureus bacteria to colonise. 

Symptoms and Causes  

Eczema causes dry, itchy and irritated skin, which may drip with fluid or develop a crust on the surface of the skin over time. Common symptoms include: 

• Dryness: The skin feels rough, flaky, or brittle 

• Redness and scaling: Commonly seen on elbows, the knees and face 

• Itchiness: Ongoing itching, can cause thicker or thickened skin over time. 

• Lesions: Open sore might develop and become infected 

 

 

The causes of eczema are multifactorial, including: 

• Genetics: A family history of eczema, asthma or hay fever can increase susceptibility. 

• Immune system responses: Excessive or overactive immune responses to allergens or irritants cause inflammation 

• Environmental factors: Exposure to allergens such as pollen of pet dander exacerbates symptoms 

• Stress: Emotional stress can aggravate flare ups, but it does not direct;y cause eczema.  

 

Eczema Types 

Eczema is classified into several forms, each with its own set of features that can be identified based on their appearance and skin reactions. 

 

Atopic dermatitis 

Is the most common form of dermatitis, causing acute itching, redness and scaly patches that appear on the elbows, knees and cheeks. 

It is connected to genetic changes in the filaggrin protein, which lowers the skin barrier and allows allergens to get through to the skin. 

 

Dyshidrotic dermatitis 

This form of dermatitis manifests as small, fluid filled blisters on the hands and feast, which can be triggered by nickel exposure or stress. 

Blisters can rupture, resulting in painful cracks and peeling. Topical steroids, cold compress, and potassium permanganate soaks are used to treat dry blisters in the short term. 

 

Contact dermatitis 

When skin reacts to allergens such as nickel, perfumes or latex, it causes localised redness and swelling.  

Patch testing aid in identifying triggers, with avoidance being critical to prevention. In very severe eczema cases, oral steroids or calcineurin inhibitors may be required to reduce inflammation. 

 

Nummular Eczema 

Can be identified by coin shaped lesions on the skin, commonly caused by dry weather or skin injuries. These plaques ooze fluid and crust over the skin, and may require emollients and antibiotics if infected.  

Unlike atopic dermatitis, it has no strong genetic component and responds well to UV light therapy. 

 

Neurodermatitis 

This begins as a single itchy patch that thickens with repeated scratching, usually around the ankles or wrists. Stress and tight clothing can increase the eczema symptoms. 

Treatment may involve behavioural therapy to reduce scratching, occlusion dressings and steroid injections.  

 

Stasis dermatitis 

Associated with poor leg circulation, which can lead to swelling, redness, and ulcers. 

Compression stocking increases blood flow, with topical medicines preventing further infection. Patients will often have concomitant venous insufficiency, requiring vascular treatment and care. 

 

Seborrheic dermatitis 

This affects oily parts of eczema on the face and scalp especially which develop greasy, yellowish scales.  In babies and infants, it can appear as a condition called “cradle cap” and is associated with overgrowth of a yeast from the Malassezia genus. 

Antifungal shampoos for example, (ketoconazole) and moderate steroids can alleviate flare ups which are more likely in hot and humid environments. 

 

What are the Triggers of Eczema? 

Eczema flare ups are frequently caused by external causes that irritate sensitive skin or impair the skin barrier functionality. This includes: 

Common Triggers: 

Dry skin:  

The Filaggrin gene mutations can have profound effects on the skin barrier impeding moisture retention, but primarily by allowing allergens such as dust mite proteins and also animal dander and pollen to penetrate the skin. Daily emollients (such as paraffin based lotions) can help to restore barrier function. 

 

Food allergies:  

Such as eggs and dairy cause flare ups in 30% of children with eczema. Elimination diets based on IgE blood testing can help with symptoms, but they must be followed under strict medical supervision. Our highly trained medical specialists offer treatment options for this and can test for food allergies based on your individual circumstances. 

 

Environmental allergens:  

Pollen and dust mites cause IgE mediated reactions that exacerbate irritation. HEPA filters and allergen proof mattresses help reduce exposure to further dander and pollen particles. 

 

Contact irritants:  

More commonly in adults nickel in (jewellery), formaldehyde in (cleaning products), and lanolin in (moisturisers) can cause delayed hypersensitivity. Patch testing can reveal what is causing this specific reaction for specially targeted avoidance. Our clinic offers patch testing and can determine this through laboratory testing.  

 

Stress:  

Cortisol spikes from stress can inhibit skin repair systems, which may amplify inflammation. Therapies can help with the management of stress, however it’s always best to speak with a qualified medical professional if you are experiencing triggers like stress.  

 

Heat and sweat:  

Sweat’s salt/sodium content can cause skin irritations, specifically in the flexural areas. Cooling vests and loose fitting clothing can help mitigate these types of flare ups.  

 

Does Eczema Spread by Touch? 

No, eczema is not contagious and cannot be spread by physical touch. The above mentioned factors including genetic predisposition and immune system dysfunction, rather than external transmission are the key. 

Especially scratching skin as a result of itch-scratch cycle. The old adage is that one scratch is too many, a thousand scratches are not enough. 

 

Common Medications for Eczema 

Medications are intended to relieve symptoms rather than cure eczema completely. Proper diagnosis is necessary for successful long-term management. 

 

Types of Medications 

 

Topical Corticosteroids: 

Function: Reduces inflammation by inhibiting immune cell activity 

Forms: Ointments (occlusive) providing a protective barrier on the skin, for dry patches and creams for weeping lesions. 

Examples: Hydrocortisone 1% (mild) and betamethasone (potent) 

 

Calcineurin Inhibitors: 

Function: Prevents T cell activation without causing skin thinning. 

Use cases:  

• Tacrolimus, (Protopic) brand for facial eczema. 

• Pimecrolimus, (Elidel) brand for mid instances. 

 

Antihistamines: 

For sedating: Diphenhydramine lowers night time scratching. 

Non-sedating: Loratadine relieves daytime itch without causing drowsiness. 

 

Biologics: 

Function: Advanced medications that help to relax the immune system. Dupilumab, for example reduces inflammation by targeting specific elements of the immune response (known as IL-4 and IL-13). 

Administration: It is normally administered as an injection under the skin every two weeks. 

 

Phototherapy: 

Protocol: This treatment uses a specific form of UV light known as (narrowband UVB) to alleviate eczema symptoms.  

Efficacy: It is performed in a clinic 3-4 times per week for 8-12 weeks. Patients with moderate to severe eczema find that it has reduced the itching by up to 60%, according to the most current medical studies at the National Eczema Association. 

 

It’s important to note, while these treatments offer alleviation, they do not address the underlying causes. Allergy Testings medical specialists provide vital testing to determine the root cause, develop a comprehensive treatment plan which targets your individual conditions directly, and help you control and  manage this for the long term. 

 

Diagnosis and Treatment for Eczema 

Our team can help support your treatment of eczema, by discovering what causes your allergies and triggers through varied testing and methodologies, which is determined through physical examinations and testing. 

 

Diagnosis and Allergy Testing Process 

 

Step 1: Clinical Evaluation 

Our specialists will evaluate rash morphology, family history and causes.  

The Australisian College of Dermatologists recommends using the Eczema Area Severity Index (EASI) to assess severity.   

You can read further information at the National Library of Medicine about how this is calculated, on The Eczema Area and Severity Index, A Practical Guide. 

 

Step 2: Allergy Test 

Skin prick testing:  

Our specialists will perform a test by applying allergens such as pollen or different food types to your forearm to measure the wheal size after 15 minutes of the pricks being applied to your arm. The wheal size determines how far the allergen has spread or not. 

Patch tests:  

Around 30+ different allergens are applied to your arm including metals and preservations, this is left on the skin for 48-72 hours. Our specialists will observe the reactions to your skin after a set amount of time.   

Blood testing:

Determine IgE levels to food for example, eggs or peanuts or environmental allergens that appear in your blood cells. We conduct blood tests directly at our clinic and will send your blood sample for testing at our laboratory for the final results.  

 

 

Step 3: Personalised Management 

Allergy Testing, will use the results to generate and develop a tailored plan, based on your specific conditions. This can include, 

Avoidance strategies:  A trial focusing on avoidance of potentially important food additives or chemicals or a trial not using fragrance based products in the home. If we find you have reactive skin to items such as this. We’ll work directly with you and design the most appropriate strategy for you. 

Follow up appointments: We’ll review and make further evaluations, that way we can adjust any treatments on-goingly, which will help monitor and track your progress. 

 

Australian Medical Resources for Eczema 

For reliable and supportive information on eczema: 

Better Health Channel: Provides highly detailed insights about eczema symptoms and management techniques. 

Australasian Society of Clinical Immunology: Offers information on allergy testing options available under Medicare rebates. 

Eczema Association of Australasia: Provides educational tools for triggers and treatment options, particularly their study on understanding eczema. 

 

How Allergy Testing can help with Eczema Management  

Our highly specialised medical practitioners and team at Allergy Testing can help you manage the hidden triggers and flare ups associated with eczema, with comprehensive services designed to help support and manage your conditions effectively. 

We provide: 

• Skin prick & patch testing 

• Blood tests for allergen specific IgE levels 

• Individualised treatment programs 

• Consistent support from specialist doctors 

Get in touch today and schedule an appointment with our friendly medical team.