Itchy, dry, cracked and sore skin – this can be a 24/7 ordeal for those who have the skin condition known as eczema. Professor Anne-Marie Tobin, a consultant dermatologist at Tallaght University Hospital, says it is very common.
“One in 10 adults have it [eczema] and more than one in three children; and it is often accompanied by other allergic type conditions such as hay fever and asthma.”
The professor explains that dermatitis and eczema are, in fact, the same thing.
“The terms are used interchangeably,” she says. “The most common type is atopic eczema or atopic dermatitis.
“You have that from childhood and it is mostly genetically driven,” she says.
“Atopy relates to the tendency of the skin to produce an exaggerated immune response to substances in the environment that are otherwise harmless.”
The next type is allergic contact dermatitis, she explains.
“That’s when someone develops an allergy, the most common ones being nickel and fragrance,” Anne-Marie explains. “People can develop a rash around their eyes or their neck if they spray perfume, for example, or where a particular irritant comes in contact with the skin.”
Hand dermatitis is the third kind. “You see this in people who wash their hands a lot, for example nurses and hairdressers.”
There is also a fourth, rarer type. This is called photosensitive eczema, where people’s skin reacts abnormally to sunlight.
“Men in their 50s and 60s who are outdoors a lot can sometimes become photosensitive and develop this type of eczema on their face and neck,” she says.
Prof Anne-Marie Tobin, a Consultant Dermatologist at Tallaght University Hospital.
Three factors are involved when an eczema flare-up occurs, she states.
“The first one is that the person’s skin barrier isn’t as good as it should be. This is a genetic factor. If the barrier isn’t good, you are more likely to let allergies in.” The second is that redness develops.
“This comes from the inflammation and the third is when you come into contact with an irritant – a substance that directly damages the outer layer of skin. The thing about eczema is that it is very itchy and those who have it can lose a lot of sleep because of it, unfortunately.”
Care for skin barrier
The base on which all treatment of eczema is built is therefore, caring for the skin barrier, she says.
“As well as avoiding irritants, it means doing simple things like using soap-free products to wash yourself and applying moisturiser to restore the barrier. These are the two key things. If your skin is not dry, it won’t crack and let allergens in.”
At what stage should a person with eczema seek a referral to a consultant dermatologist?
“That time comes when they are attending their GP and regularly requiring topical steroid cream to ease the inflammation or if they are getting recurrent skin infections. A consultant dermatologist will work to optimise their treatment so we would recommend soap substitutes, appropriate moisturisers and we would optimise their topical steroids.
“If the person is not responding to this we might suggest a course of phototherapy (light therapy) to ease the inflammation.
“Systemic medications are available. These are drug therapies that work throughout the whole body and are given orally, by injection or infusion (intravenously).”
The treatment of eczema has undergone a revolution in the last eight years, she states.
Targeted medications
“We have these targeted, systemic medications mentioned above available to us since 2018. The main one is methotrexate but there are also new treatments – injections like dupilumab and tralikinumab – and what’s called JAK inhibitors. These inhibitors slow down the overactivity of the immune system, reducing inflammation and pain.”
When it comes to children with eczema, the good news is they can outgrow it, explains Anne-Marie.
We’re hoping (that because of this knowledge) the prevalence of eczema in children will go down. It’s now not a given that babies will develop it
“About 75% of children who develop it as babies grow out of it. It often abates when they are in their early teens,” she says.
“That’s probably because their immune system stops reacting so much to allergens that they are coming in contact with. The skin barrier may also have repaired itself over time.”
There is also some good news in relation to preventing children developing eczema.
“If you have a history of eczema yourself,” she says, “there is good research to show that if you are careful about applying emollients [creams that will soften or soothe the skin] to your baby’s skin from very early on, you can prevent your child from developing eczema. We’re hoping (that because of this knowledge) the prevalence of eczema in children will go down. It’s now not a given that babies will develop it.”
Tips to manage eczema
On a day-to-day basis, Anne-Marie also gives this advice: “Remember that when it comes to what you wear, cotton and linen fabrics are best as they don’t irritate dry skin.”
The home environment needs to be considered too.
“No smoking, no carpets and no pets in the home – all that helps. Tobacco smoke can trigger inflammation and people can be allergic to the dust mite in carpets and also to pet hair,” she says.
Keeping rooms cool is also important while hot showers are not advised.
“That’s because the heat brings a lot of blood supply to the skin and makes it more inflamed,” she says.
Case study
IT worker Geraldine Andrews, from Kildare, has had eczema since she was a baby.
“I have what’s classed as severe atopic eczema, so it covers my entire body, head to toe,” she says. “It’s very itchy and sore and I have memories, as a young child, of my mom sitting me up on the kitchen sink to soak my socks in a basin of water so that she could take them off my feet without ripping the skin off. That’s how bad it was.”
Geraldine was hospitalised a couple of times each year because of skin infections and her mother had to go to her primary school each lunchtime to apply cream to keep her skin moist.
“In secondary school, I would do it myself,” she says.
Geraldine, now 51, says that learning to manage her condition properly only happened after she left school.
“You’re in a bit of denial about the condition when you’re young, so I only started to manage it properly when I started working.”
Working mainly from home helps her hugely, she says.
“That’s something I’m truly grateful for because the air conditioning in offices can dry out the skin really fast. At home, you can have windows open.”
Geraldine’s everyday skincare routine is comprehensive.
“Daily, I do three layers of cream. First I put a base layer of emulsifying cream all over my body, then a layer of steroid creams, particularly on the patches of eczema. I then do a layer of emollient on top. This top layer is a really thick cream which gives me my skin a barrier for the day,” she says.
When Geraldine has a serious flare-up, she must repeat this regime as often as every two hours.
However, some of the new treatment options have helped improve her quality of life enormously.
“I get an injection twice a month, of dupilumab, and it’s been life-changing for me,” she explains.
“It has brought my inflammation down a lot since I started it five years ago. It is a biologic treatment that you store in the fridge. It’s not a miracle cure but it alleviates your symptoms. It has made me feel human again. Prior to that I was just consumed by my eczema every minute of the day, trying to keep myself comfortable.
I get an injection twice a month, of dupilumab, and it’s been life-changing for me
“With a condition like this you have to manage your mental health as well because it can lead to depression and anxiety.”
Painful sores and nerve-end pain can also be an issue for those suffering from the condition.
“This means that as well as wearing cotton clothes all the time, you have to wear loose clothes that cover your whole body, too, and you don’t always want to do that,” adds Geraldine.
Her advice for readers who have eczema is to see a dermatologist.
“Ask about new treatments as there are many options now. The daily moisturising routine is still essential, though, as it reduces the itch.”
Geraldine also recommends contacting the Irish Skin Foundation for support and information.
See irishskin.ie/eczema/ for the ISF’s
downloadable information booklet
‘What You Need to Know About Eczema’.
There is also a dedicated Irish Skin
Foundation Ask-a-Nurse Helpline:
01- 4866280 or email info@irishskin.ie
Itchy, dry, cracked and sore skin – this can be a 24/7 ordeal for those who have the skin condition known as eczema. Professor Anne-Marie Tobin, a consultant dermatologist at Tallaght University Hospital, says it is very common.
“One in 10 adults have it [eczema] and more than one in three children; and it is often accompanied by other allergic type conditions such as hay fever and asthma.”
The professor explains that dermatitis and eczema are, in fact, the same thing.
“The terms are used interchangeably,” she says. “The most common type is atopic eczema or atopic dermatitis.
“You have that from childhood and it is mostly genetically driven,” she says.
“Atopy relates to the tendency of the skin to produce an exaggerated immune response to substances in the environment that are otherwise harmless.”
The next type is allergic contact dermatitis, she explains.
“That’s when someone develops an allergy, the most common ones being nickel and fragrance,” Anne-Marie explains. “People can develop a rash around their eyes or their neck if they spray perfume, for example, or where a particular irritant comes in contact with the skin.”
Hand dermatitis is the third kind. “You see this in people who wash their hands a lot, for example nurses and hairdressers.”
There is also a fourth, rarer type. This is called photosensitive eczema, where people’s skin reacts abnormally to sunlight.
“Men in their 50s and 60s who are outdoors a lot can sometimes become photosensitive and develop this type of eczema on their face and neck,” she says.
Prof Anne-Marie Tobin, a Consultant Dermatologist at Tallaght University Hospital.
Three factors are involved when an eczema flare-up occurs, she states.
“The first one is that the person’s skin barrier isn’t as good as it should be. This is a genetic factor. If the barrier isn’t good, you are more likely to let allergies in.” The second is that redness develops.
“This comes from the inflammation and the third is when you come into contact with an irritant – a substance that directly damages the outer layer of skin. The thing about eczema is that it is very itchy and those who have it can lose a lot of sleep because of it, unfortunately.”
Care for skin barrier
The base on which all treatment of eczema is built is therefore, caring for the skin barrier, she says.
“As well as avoiding irritants, it means doing simple things like using soap-free products to wash yourself and applying moisturiser to restore the barrier. These are the two key things. If your skin is not dry, it won’t crack and let allergens in.”
At what stage should a person with eczema seek a referral to a consultant dermatologist?
“That time comes when they are attending their GP and regularly requiring topical steroid cream to ease the inflammation or if they are getting recurrent skin infections. A consultant dermatologist will work to optimise their treatment so we would recommend soap substitutes, appropriate moisturisers and we would optimise their topical steroids.
“If the person is not responding to this we might suggest a course of phototherapy (light therapy) to ease the inflammation.
“Systemic medications are available. These are drug therapies that work throughout the whole body and are given orally, by injection or infusion (intravenously).”
The treatment of eczema has undergone a revolution in the last eight years, she states.
Targeted medications
“We have these targeted, systemic medications mentioned above available to us since 2018. The main one is methotrexate but there are also new treatments – injections like dupilumab and tralikinumab – and what’s called JAK inhibitors. These inhibitors slow down the overactivity of the immune system, reducing inflammation and pain.”
When it comes to children with eczema, the good news is they can outgrow it, explains Anne-Marie.
We’re hoping (that because of this knowledge) the prevalence of eczema in children will go down. It’s now not a given that babies will develop it
“About 75% of children who develop it as babies grow out of it. It often abates when they are in their early teens,” she says.
“That’s probably because their immune system stops reacting so much to allergens that they are coming in contact with. The skin barrier may also have repaired itself over time.”
There is also some good news in relation to preventing children developing eczema.
“If you have a history of eczema yourself,” she says, “there is good research to show that if you are careful about applying emollients [creams that will soften or soothe the skin] to your baby’s skin from very early on, you can prevent your child from developing eczema. We’re hoping (that because of this knowledge) the prevalence of eczema in children will go down. It’s now not a given that babies will develop it.”
Tips to manage eczema
On a day-to-day basis, Anne-Marie also gives this advice: “Remember that when it comes to what you wear, cotton and linen fabrics are best as they don’t irritate dry skin.”
The home environment needs to be considered too.
“No smoking, no carpets and no pets in the home – all that helps. Tobacco smoke can trigger inflammation and people can be allergic to the dust mite in carpets and also to pet hair,” she says.
Keeping rooms cool is also important while hot showers are not advised.
“That’s because the heat brings a lot of blood supply to the skin and makes it more inflamed,” she says.
Case study
IT worker Geraldine Andrews, from Kildare, has had eczema since she was a baby.
“I have what’s classed as severe atopic eczema, so it covers my entire body, head to toe,” she says. “It’s very itchy and sore and I have memories, as a young child, of my mom sitting me up on the kitchen sink to soak my socks in a basin of water so that she could take them off my feet without ripping the skin off. That’s how bad it was.”
Geraldine was hospitalised a couple of times each year because of skin infections and her mother had to go to her primary school each lunchtime to apply cream to keep her skin moist.
“In secondary school, I would do it myself,” she says.
Geraldine, now 51, says that learning to manage her condition properly only happened after she left school.
“You’re in a bit of denial about the condition when you’re young, so I only started to manage it properly when I started working.”
Working mainly from home helps her hugely, she says.
“That’s something I’m truly grateful for because the air conditioning in offices can dry out the skin really fast. At home, you can have windows open.”
Geraldine’s everyday skincare routine is comprehensive.
“Daily, I do three layers of cream. First I put a base layer of emulsifying cream all over my body, then a layer of steroid creams, particularly on the patches of eczema. I then do a layer of emollient on top. This top layer is a really thick cream which gives me my skin a barrier for the day,” she says.
When Geraldine has a serious flare-up, she must repeat this regime as often as every two hours.
However, some of the new treatment options have helped improve her quality of life enormously.
“I get an injection twice a month, of dupilumab, and it’s been life-changing for me,” she explains.
“It has brought my inflammation down a lot since I started it five years ago. It is a biologic treatment that you store in the fridge. It’s not a miracle cure but it alleviates your symptoms. It has made me feel human again. Prior to that I was just consumed by my eczema every minute of the day, trying to keep myself comfortable.
I get an injection twice a month, of dupilumab, and it’s been life-changing for me
“With a condition like this you have to manage your mental health as well because it can lead to depression and anxiety.”
Painful sores and nerve-end pain can also be an issue for those suffering from the condition.
“This means that as well as wearing cotton clothes all the time, you have to wear loose clothes that cover your whole body, too, and you don’t always want to do that,” adds Geraldine.
Her advice for readers who have eczema is to see a dermatologist.
“Ask about new treatments as there are many options now. The daily moisturising routine is still essential, though, as it reduces the itch.”
Geraldine also recommends contacting the Irish Skin Foundation for support and information.
See irishskin.ie/eczema/ for the ISF’s
downloadable information booklet
‘What You Need to Know About Eczema’.
There is also a dedicated Irish Skin
Foundation Ask-a-Nurse Helpline:
01- 4866280 or email info@irishskin.ie
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