Eczema

Eczema (also known as atopic dermatitis) is a recurring, non-infectious, inflammatory skin condition that is very common, affecting many people in different stages of their life. Eczema is most common in people with a family history of an atopic disorder such as hay fever or asthma.

Although eczema affects all ages, it usually appears in early childhood and disappears around six years of age. In fact more than half of all eczema sufferers show signs within their first 12 months of life and 20 per cent of people who will be affected by this condition, will develop eczema before the age of five. Most children grow out of the condition, but a small percentage may experience severe eczema into adulthood. Adult onset eczema is often difficult to treat and may be caused by other factors such as medications.

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WHAT TRIGGERS ECZEMA?

There are many different triggers for eczema, meaning you may need help from your Dermatologist in order to bring it under control. Common causes and triggers are:

  • Psychological stress

  • Contact with certain triggers such as water, chemicals or detergents

  • Contact with allergens such as perfume or preservatives

  • Genetics

  • Medications

 
 
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TREATMENT OF ECZEMA

Treatments will vary depending on the cause and severity of the eczema. The management of eczema focuses on three things:

  • Determining and eliminating the causative factor (eg. allergy to soap, hair dye or other products you currently use)

  • Settling the inflammation

  • Repairing the skin barrier and minimising any further breakdown of the skin.

Depending on the stage of your eruption, you may receive treatment for one or all of the factors.

 

WET WRAPS

What are wet wraps?

‘Wet wraps’ are wet bandages over emollients and/or topical steroid creams to areas of red, hot, weeping eczema.

How do wet wraps work?

Wet wraps work via three different ways:

  1. cooling - as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness

  2. moisturising - emollients covered over with wet bandages are deeply absorbed into the skin to provide a longer lasting moisturising effect

  3. steroid absorption - enhanced absorption of topical steroid molecules into both the superficial and deeper layers of skin where inflammation is present

In addition, the bandages provide protection from the itching and scratching cycle so that your skin gets a chance to heal properly.

How do you apply wet wraps?

Wet wraps are most often applied in a hospital for severe eczema. However, wet wraps may also be applied in the community or at home at the first signs of a worsening condition to reduce the need for hospital admission.

There are different methods and bandages used for wet wrapping but the basic technique is as follows.

  • Depending on the area being treated the patient may first soak in a bath with bath oil or emollient solution

  • An emollient and/or steroid cream (as prescribed by the doctor) is liberally applied to the area

  • Bandages (often a tubular bandage is used) soaked in warm water are wrapped or applied over the top of the creams

  • Dry bandages are placed over the top of the wet bandages to protect clothing

  • Later on, the dry bandage may be removed and water sprayed on the underneath layer to keep it damp, before reapplying the dry outer bandage.

Convenient eczema garments have been developed for wet wrapping children with eczema, Medical-grade silk garments are not suitable for wet wrapping.

Generally, wet wraps are used for a few days until the redness, swelling and weeping has settled down. To maintain results, emollients should be applied frequently throughout the day to the affected areas.

What are the benefits of wet wrapping?

The benefits of wet wrapping include:

  • Reduced itching and scratching

  • Reduced redness and inflammation

  • Skin rehydration

  • Better skin healing process

  • Reduced steroid usage once the condition is controlled

  • Improved sleep

 

Bleach baths

Diluted household bleach has been safely used for many years to help treat skin infections including eczema. If you child has eczema, bleach baths can be helpful when the eczema is infected and difficult to control.

what you need

  • White King household bleach (4.2% sodium hypochlorite) - do not use lemon or lavender bleach

  • Measuring cup

  • Standard sized bucket (10 litres)

how to give a bleach bath

  • Fill the bath with tap water to the desired level using a standard sized bucket. Count the number of buckets you use. Then mark your bath with tape so you don’t need to use the buckets again.

  • Add 12ml of bleach for every 10 litres of water (final bleach concentration of 0.005%)

  • Let your child soak in the bath for 10 minutes

  • Wash your child’s head and face with the bath water. You can immerse their head in the water as the concentration of bleach is very low and it will not cause any problems.

  • Wipe away any crusting or weeping at the infected area while your child is in the bath. Use a soft disposable towel (eg. chux type cloth) and throw it away afterwards

  • Do not rinse your child’s skin after the bath

  • Use old or white towels to avoid possible bleaching of coloured towels

  • Repeat the bleach baths as often as recommended by your child’s dermatologist

Possible side effects

Household bleach can sometimes cause a stinging or a burning sensation on the skin. The instructions outlined in this fact sheet are for a very diluted bleach bath, which means there is less risk of stinging happening. The final bleach concentration is lower than a swimming pool, which most people can safely swim in without damage to their skin or hair.

If your child does have stinging or irritation in the diluted bleach bath, rinse them off with plain water. Discuss this with your child's dermatologist before giving them another bleach bath.

Key points to remember

  • Diluted bleach baths are safe and effective in reducing bacteria on the skin

  • Add 12ml of bleach per 10 litres of bath water

  • Do not rinse the skin after a bleach bath