It's human nature: if you develop an itch on your body, you scratch. For eczema patients, scratching only brings temporary relief and, ultimately, a worsening of their condition. “The hallmark of eczema is a vicious cycle of itching and scratching, which drives the disease process,” says Dr Carsten Flohr, Consultant Dermatologist at St John’s Institute of Dermatology at Guy’s & St Thomas’ NHS Foundation.

Eczema commonly starts in early life and affects up to 20 per cent of children and over 5 per cent of adults. When mild, it's characterised by itchy, scaly and inflamed skin. In its more severe form, patches on the body can be left weeping, crusted or even bleeding. Sleep loss because of the itching is frequent, and patients are often socially withdrawn and more likely to develop anxiety and depression.

The initial problem is a lack of moisture in the skin, often due to a gene mutation that makes the skin barrier more ‘leaky’ and results in skin dryness virtually from birth. As a second step, the skin becomes inflamed, which triggers the itching. Once the itch-scratch cycle has been established, skin infections are a common problem, as pathogenic bacteria introduced through the scratching colonise the eczematous skin and drive the upregulation of the immune system further.


What are the causes


Although eczema often affects those who are genetically predisposed, environmental factors also play a major part. “For instance, hard domestic water can contribute to the skin barrier breakdown,” says Flohr.

Other environmental factors that have been linked to eczema include exposure to allergens (such as house dust and foods) and extremes of temperature and UV light. Soaps and detergents may also act as irritants to the skin and contribute to the skin barrier damage.


Treatments options


Treatments vary. For those with a mild-to-moderate form of the condition, a topical steroid cream — in the form of hydrocortisone, for example — can be prescribed, along with emollients to moisturise the skin. “Removal of irritants, as well as recognising if foods or other allergies contribute to flare-ups, is also important, in particular in patients with more severe eczema,” says Flohr.

For patients with severe eczema, a new class of drugs — known as biologics — offer a breakthrough. “This is a very exciting time,” says Flohr. “Biologics target specific pathways of the immune system involved in eczema, and the first few trials that have been published are very promising, but they compared this new treatment to placebo and so far only enrolled adults. We now need similar studies in children and research that directly compares biologics with the established tablet treatments we use for severe eczema, such as ciclosporin and methotrexate. It will still take a while before these new medicines will enter routine NHS clinical practice.”