September 9, 2024 • 19 mins
In this eczema 101 episode, Dr George Moncrieff and Dr Roger Henderson answer:
- What is atopic eczema?
- What is the skin barrier?
- Do you need to take antibiotics when you have an eczema flare?
- What are the symptoms of eczema?
- How does eczema impact someone’s wellbeing?
- What does eczema look like?
- How is eczema diagnosed?
- What are common eczema triggers?
Thank you to our kind sponsor AproDerm, who provide a range of emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis.
Everyone’s skin is unique and what works for one person, may not work for another. That’s why AproDerm has developed the AproDerm Emollient Starter Pack. This pack contains all four of their emollients varying in their formulation, consistency and hydration, giving you the choice to find a routine which suits you.
Find out more here.
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We hope you find this podcast interesting and helpful. Please leave us a review or email info@aproderm.com with any feedback on this episode or suggestions on skin-related topics that you would like to hear about in future podcasts.
The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:10):
Hello and welcome to this latest Skin Deeppodcast, where we look at skin-related
issues, conditions and treatmentsin an interesting and informed way.
I'm Dr Roger Henderson, and I'm aGP with a long-standing interest
in this particular area of health.
And I'm Dr George Moncrieff,I was also a GP, although I've
(00:31):
now retired from my practice.
I'm also the past Chair of theDermatology Council for England.
Today, Roger and I will be talkingabout the basics of the very common
skin condition, eczema, and thisis the first of a two-part podcast.
Next time we'll be looking at howeczema is treated, including some
self-help tips and how to preventthe condition from flaring, along
(00:51):
with appropriate skin treatments.
Okay.
So for today though, George, let'sjust start with the basics, and perhaps
the most obvious question of themall, and one which you and I have both
been asked many times by patients.
What do we actually mean whenwe talk about atopic eczema?
(01:16):
Well, eczema is a dry, itchyskin condition, and the word
comes from two Greek stems.
'Ec-' meaning out of and 'zema', a boil.
So, in eczema you get littlebubbles coming through the skin.
Which then rupture onto the surface,the skin splits, and that fluid
is lost, rendering the skin drier.
And the word 'atopic' simplymeans, without a place.
(01:38):
When doctors first recognised, ahundred years ago, that eczema was
associated with asthma and hay fever,what we now call the 'atopic march',
and so these conditions, patients gothrough one to the other very often.
They didn't know where to putit in their textbooks, they had
nowhere to classify it, so withouta place they called it 'atopic'.
But atopic eczema is a very itchyskin condition, one of the most
(02:01):
itchy skin conditions associatedwith dry skin and associated with
this link to asthma and hay fever.
It typically starts in a young child, butwe'll come on to that and how it looks.
Compared to when I was a medical student,far too many decades ago, I've seen in
practice, a really rampant increase inthe number of patients in the last few
(02:26):
decades, presenting with eczema andthere's all sorts of reasons for this.
Now the skin is our biggest organwhich might surprise a lot of
people and understandably, it isan absolutely crucial barrier,
in stopping things getting in andalso stopping things getting out.
It might be worth just mentioning,why the skin barrier is so important
(02:50):
for our good health, I think.
Well, the skin barrier is thevery top layer of the top part
of the skin, the epidermis.
So it's the top part of the epidermis.
In some parts of our body, like,for example, the stratum corneum on
the eyelids, is exceptionally thin,it is half as thick as a piece of
(03:11):
paper, and it's very vulnerable.
It is a beautifully constructed barrierthat retains water, prevents water from
escaping, but also, very importantly,prevents pathogens, that's bacteria
and viruses, penetrating the skin,or allergens, penetrating the skin.
So we have this barrier,which is very sophisticated,
(03:32):
even though it's really thin.
If you haven't got that, newbornbabies haven't got a skin barrier.
When you're very first born, youhaven't got a skin barrier because
you've been living in a very sterile,humid environment inside the womb.
They've only got a few hours toswitch on the processes that make a
skin barrier, and if they can't dothat, they will die of dehydration.
(03:54):
So it's a really criticalpart of existing in this dry,
hostile world that we live in.
So the skin barrier is there, it's verydelicate, but it's very sophisticated.
You're right to say that thenumber of cases is increasing fast,
because I think our lifestyle todaychallenges that barrier disastrously.
We live in a very dry world.
(04:15):
We have central heating, dry carpets,dry walls, even air conditioning.
We're putting soaps and detergentson the skin, which actually do
enormous damage to the skin barrier.
So somebody who's got a vulnerable skinbarrier, and then they use soaps and
detergents on their skin, they can breakthe barrier, allow pathogens to come
(04:35):
through, and then if they react to thosepathogens, things that cause an allergic
reaction, react to those in an abnormalway, they will manifest with eczema.
And once you get eczema, it's itchy,you scratch it, you damage the barrier
further, and you're into a vicious cycle.
Now, antibiotics are a huge hot topic,at the moment, and I still remember my
jaw hitting the ground when I heard youtalking about eczema, when you said that
(05:01):
if you take one antibiotic, once in yourlife, at one time, your skin makeup,
the microbiome, is never the same.
Is that absolutely right?
That's what I've heard.
Yep.
In fact, and your gut microbiome,both your skin and your gut
microbiome, will never recover.
(05:24):
Which is obviously one of the reasonswhy we don't hand out antibiotics
willy-nilly, you know, to everyonebecause of the impact in so many
areas, including, on our skin.
But I suppose what we're saying isif you assault, this extra sensitive
part of our body, the skin, whichas you say, is so thin in parts.
(05:46):
If you assault that, either throughour lifestyle, through unnecessary
antibiotics, through infections, throughdetergents, you name it, we are going
to sort of, potentially, set up therisk of that skin reacting and getting
the eczema that we typically see.
(06:06):
I couldn't agree more.
We have evolved over millenniato live with the bacteria in
our gut and the bacteria on ourskin, and they play a vital role.
Healthy skin has a healthy microbiome,and that microbiome competes with
the bad bacteria and prevents thebad bacteria getting a foothold.
(06:30):
So, if you take an antibiotic and youwipe out all those bugs for a bit, then
sometimes the bad bacteria come backfirst and they then cause problems.
So, using an antibiotic, or in our modernworld with all the antiseptics, as
you say, we live in this very sterileworld as much as we can, we are
(06:51):
causing havoc with our microbiome.
And I'm sure over the next decade ortwo, more will be discussed about the
importance of maintaining a healthygut and a healthy skin microbiome.
You know, we're actually outnumbered.
The number of bacteria in our bodyoutnumber our own cells 10 to 1.
Only 10% of the cellsin your body are you.
(07:13):
90%, or more, are actually bacteria.
They're very small, so they onlyconstitute a few kilograms, but we
have evolved to live with these,they are critical, they're not just
there just riding on us, they'reactually playing critical roles,
as we're beginning to discover.
Absolutely, there's going to be a wholenew, exciting area, in our understanding
of eczema in that, I suspect.
(07:34):
Now, I suspect some of the peoplelistening will be listening because
they have eczema, so we may be sort of,teaching them to suck eggs, when we're
talking about the main symptoms of eczema.But for people who don't have eczema,
the ones I see in my surgery, absolutelytypically it's itch and it's scratch.
(07:55):
Those are the two terms that patientswith eczema always will talk about.
The itch-scratch cycle, and one willget better, and then they will have a
day or two or a week or two, and thenit's back again, we get the flares.
So those are the symptoms that I'mseeing and I'm guessing they're the ones
that you're seeing in clinic as well.
(08:16):
Itch is a horrible symptom isn't it,and atopic eczema is one of the most
itchy skin conditions, and the desireto scratch it is sometimes overwhelming.
Patients will prefer the pain, fromscratching and tearing their skin, to
living with that itch, and unfortunately,as you scratch the skin, you damage it.
(08:39):
Damaged skin is more itchy, and so youcan get into a vicious cycle, that you're
scratching it because it's damaged, andit's damaged because you're scratching it.
So that can cause a flare, and ofcourse, once it becomes inflamed, the
ability of the skin to preserve itselfand to make that barrier is compromised.
So things then get worse.
The broken skin allows bacteria toget through, so it gets infected, and
(09:02):
then you have a flare, and all flaresof eczema have bacteria growing there.
This itch then disturbs sleep,not just for the individual, but
for their entire family, theirhousehold, and that means that they
don't function so well the next day.
It's a huge disturbance there foreverybody, with tiredness, and the
risk of not getting good education orhaving a road accident or whatever.
(09:27):
And of course, the other considerationwe haven't really given much thought
to in the past, is the amount oftime spent, not just with their skin
care regimen, which can be huge,but also accessing health care.
Making appointments to see doctors,collecting their prescriptions,
going to appointments inhospital, having their treatments.
This all takes up time and money, and so,there are enormous consequences to eczema.
(09:51):
Interrupted sleep, though, and interruptedstudy and itch are the main ones.
The other thing, in fact, is, ofcourse, their skin feels uncomfortable.
It feels dry and can be a bit scaly andjust doesn't feel comfortable to touch.
Clothes will stick to it and thingslike that, particularly woollen clothes.
And I think it's also worth mentioning,because there is still this, almost
(10:14):
medieval, myth that some peopledo have, until you sort of correct
them, that eczema is infectious.
It is absolutely,categorically not infectious.
You cannot catch eczema.
But again, as if people with eczema don'thave enough on their plate, every now
and then I will hear about them beingshunned by colleagues at work, or in
(10:39):
social situations if they've got severeeczema because people feel that, somehow,
they're going to catch eczema off them.
It's absolutely awful, but it justfurther diminishes their self-esteem.
People don't want to sit nextto them on the tube or whatever.
Yes, and of course, dry, cracked skinmakes sporting activities more difficult.
(10:59):
The skin tears and things, inthe cold weather, and splits.
Yep, the ramifications are enormous.
Yep.
So, what it looks like.
You and I both know what it looks like.
But typically, we'd be thinking about,red, inflamed, dry, slightly rough
(11:22):
skin, often on the very thin partsof the body, often on places like the
knees, the elbows, around the neck,places that can easily be scratched.
If it's not infected, it tendsto be fairly obvious when you're
looking at it, doesn't it?
Yes, and it's mostly on the face ininfants, around the mouth, but not
(11:48):
right up to the edge of the mouth,onto the cheeks, that's where it's
most severe, but rapidly settles,as you say, into the fronts of the
elbows and the backs of the knees,particularly in white skin actually.
You get different patterns in skinof colour, you can get a reverse
pattern where it's on the fronts ofthe knees and the backs of the elbows.
You can get a follicular patternwhere you just get tiny little
(12:09):
bumps around hair follicles.
It looks trivial, very hard tosee, but intensely itchy and
very severe active eczema there.
So there are differentpatterns in skin of colour.
Where the eczema is affected, it typicallyhas a background redness and looks
cracked with a fine surface crackingto it, maybe a little bit of scaling,
(12:29):
occasionally oozing a bit, and oftenget secondary infections in it, and get
some crust on top of it, like impetigo.
There's a honey-colouredcrust if it's badly infected.
Interestingly, the background skincolour is often quite pale, in eczema.
I'm sure you've seen this.
The face of somebody witheczema, they have pallor.
(12:50):
It affects the circulation ofthe blood vessels in the skin.
Certainly the treatments can as well,steroids can cause a pallor in the skin.
They affect the arteries.
They can cause the arteries to constrict.
So you get a sort of paleness to theskin, as well as the areas looking
a bit redder where it's affected.
Yeah, now, I can't ever rememberdoing tests to diagnose eczema.
(13:15):
It's usually very obviouswhen you see someone.
As you mentioned, it can be alittle trickier if we've got
someone with skin of colour.
But as a general point, andsometimes patients will say,
well, can I be tested for eczema?
Usually there's no reasonat all to test, is there?
(13:35):
No.
The diagnosis is based on a history ofitch and typically, starting in the first
two years of life, this is atopic eczema.
And then, an association withasthma and hay fever, maybe in a
first-degree relative, particularlyin children under four, we look
for relatives with that atopictendency, and then generally dry skin.
(14:00):
And then it's a clinical diagnosis,there's no specific test for it.
Of course, as you mentioned, skin ofcolour can be particularly challenging
because you can't see that rednessvery easily, in skin of colour.
And nor can you see thatpaleness in the skin.
And then they get these very subtlepatterns, which can be very hard,
to know that is what eczema canlook like, so you get these variable
(14:20):
patterns where it looks different.
But as a general point, if you goand see your doctor or a healthcare
professional with eczema, you're likelyto get a diagnosis there and then without
needing to go for any specialised tests.
I'd like to briefly pause today'spodcast, to mention our kind
sponsor AproDerm®, and their rangeof emollients and barrier creams.
(14:43):
Now, as we know,everyone's skin is unique.
In my many years as a GP, it'soften been tricky to find an
emollient that immediately suitedone person and their one condition.
We know it's not as simple as onecondition, one type of emollient.
It's often a case of patients trying anemollient and then going back and forth
with several prescriptions, several visitsto the practice, which is far from ideal.
(15:08):
But fortunately, AproDerm® havedeveloped a genius solution to
simplify the whole process ofselecting the right emollient for you.
Their AproDerm® Emollient Starter Packcontains all four of their emollients
in one pack, each having a uniqueconsistency and level of hydration.
With just one prescription, you havethe opportunity to try each one and find
(15:29):
the one that works best for your skin.
This allows you to choose the one ormore that you prefer and that suits
your lifestyle while saving money,time, and more importantly, fewer
visits to the GP, pharmacist, or nurse.
Sounds like the perfectanswer to me as a GP.
And if you can't make it to yourhealthcare professional, it's available to
buy from your local pharmacy and Amazon.
(15:52):
I've been a big advocate of theAproDerm® range for a while now.
It's such a great range of products,all are suitable from birth and free
from common irritants and sensitisers.
Yeah, and I have to say I love them evenmore now and actually use them myself.
So, if you're affected by a dry skincondition and want to know which emollient
will be the best for you, then do trythe AproDerm® Emollient Starter Pack,
(16:16):
which incidentally, also comes witha handy self-care guide full of tips
on helping you manage your condition,including useful advice on applying
emollients and potential triggers.
It really is a game changer for theworld of dermatology, and as George said
earlier, it's available on prescription orto buy from your local pharmacy or Amazon.
(16:38):
Now at the start, I also mentionedthat patients with eczema often
have repeated flares throughoutthe year and it can really drag
them down when they get better.
They're almost waiting for the next flare.
What are the triggers thatcause people with eczema to
then get a subsequent flare?
(16:58):
They've been running along quitenicely and then suddenly, bang, their
skin is itching, they're scratchingit again, and they're, they're
literally scratching their headsaying, "I wonder what's caused this?"
There are a number of commontriggers, in my experience, and
adherence, you know, actually arethey taking their treatment properly?
Are they using things that dry their skin?
(17:19):
Even stress, stress is aword we use all the time.
But I think, you know, I have seen,and just last week I saw someone,
with purely stress-related eczema.
We could absolutelyclearly link it to that.
These are the big ones that we wouldsee most of the time, aren't they?
Absolutely, yes, certainly stress,yep, and of course, having severe
(17:39):
eczema is pretty stressful, soyou're into a vicious cycle there.
Your sleep's going to be disturbed, and sothe stress is going to be made even worse.
But many people will tell you it's thetime of going through a divorce, or
buying a new house, or doing exams, orwhatever, that eczema is the last thing
they need, and it then becomes even worse.
I suspect sometimes flares could bedriven by exposure to detergents.
(18:03):
So, they had a bubble bath or theywere using some shampoo which then
rinsed over their skin, and we'llcome on to that in management.
So I'm sure detergents, soaps, showergels, shampoos and bubble baths will
all cause the eczema to get worse.
And because once it gets worse, bacteriaget in, and then they drive it as well.
So all flares are infected.
(18:26):
You mentioned not adhering to treatment.
I think that's a big issue, which again,we'll discuss in our next podcast.
But our skin is constantly trying tocope with the world we live in, this
dry world that we live in, and thisworld of detergents and shampoos,
it's constantly challenging the skin.
And then a stressful event comes along andit flares and you're into a vicious cycle.
(18:48):
I hope you can see from thischat that there's a lot more to
eczema than seen at first sight.
And we hope you found ithelpful and interesting.
Roger and I look forward to you joiningus next time in the second part of this
podcast when we'll be talking about thetreatment of eczema, including self-help
tips, and how to prevent it flaring.
We'd also like to thank our sponsor,AproDerm®, for all their help in putting
(19:09):
these Skin Deep podcasts together.
So until the next time,it's goodbye from George.
Goodbye.
And it's goodbye from me.
Goodbye.
Hello and welcome to this latest Skin Deeppodcast, where we look at skin-related
issues, conditions and treatmentsin an interesting and informed way.
I'm Dr Roger Henderson, and I'm aGP with a long-standing interest
in this particular area of health.
And I'm Dr George Moncrieff,I was also a GP, although I've
(00:31):
now retired from my practice.
I'm also the past Chair of theDermatology Council for England.
Today, Roger and I will be talkingabout the basics of the very common
skin condition, eczema, and thisis the first of a two-part podcast.
Next time we'll be looking at howeczema is treated, including some
self-help tips and how to preventthe condition from flaring, along
(00:51):
with appropriate skin treatments.
Okay.
So for today though, George, let'sjust start with the basics, and perhaps
the most obvious question of themall, and one which you and I have both
been asked many times by patients.
What do we actually mean whenwe talk about atopic eczema?
(01:16):
Well, eczema is a dry, itchyskin condition, and the word
comes from two Greek stems.
'Ec-' meaning out of and 'zema', a boil.
So, in eczema you get littlebubbles coming through the skin.
Which then rupture onto the surface,the skin splits, and that fluid
is lost, rendering the skin drier.
And the word 'atopic' simplymeans, without a place.
(01:38):
When doctors first recognised, ahundred years ago, that eczema was
associated with asthma and hay fever,what we now call the 'atopic march',
and so these conditions, patients gothrough one to the other very often.
They didn't know where to putit in their textbooks, they had
nowhere to classify it, so withouta place they called it 'atopic'.
But atopic eczema is a very itchyskin condition, one of the most
(02:01):
itchy skin conditions associatedwith dry skin and associated with
this link to asthma and hay fever.
It typically starts in a young child, butwe'll come on to that and how it looks.
Compared to when I was a medical student,far too many decades ago, I've seen in
practice, a really rampant increase inthe number of patients in the last few
(02:26):
decades, presenting with eczema andthere's all sorts of reasons for this.
Now the skin is our biggest organwhich might surprise a lot of
people and understandably, it isan absolutely crucial barrier,
in stopping things getting in andalso stopping things getting out.
It might be worth just mentioning,why the skin barrier is so important
(02:50):
for our good health, I think.
Well, the skin barrier is thevery top layer of the top part
of the skin, the epidermis.
So it's the top part of the epidermis.
In some parts of our body, like,for example, the stratum corneum on
the eyelids, is exceptionally thin,it is half as thick as a piece of
(03:11):
paper, and it's very vulnerable.
It is a beautifully constructed barrierthat retains water, prevents water from
escaping, but also, very importantly,prevents pathogens, that's bacteria
and viruses, penetrating the skin,or allergens, penetrating the skin.
So we have this barrier,which is very sophisticated,
(03:32):
even though it's really thin.
If you haven't got that, newbornbabies haven't got a skin barrier.
When you're very first born, youhaven't got a skin barrier because
you've been living in a very sterile,humid environment inside the womb.
They've only got a few hours toswitch on the processes that make a
skin barrier, and if they can't dothat, they will die of dehydration.
(03:54):
So it's a really criticalpart of existing in this dry,
hostile world that we live in.
So the skin barrier is there, it's verydelicate, but it's very sophisticated.
You're right to say that thenumber of cases is increasing fast,
because I think our lifestyle todaychallenges that barrier disastrously.
We live in a very dry world.
(04:15):
We have central heating, dry carpets,dry walls, even air conditioning.
We're putting soaps and detergentson the skin, which actually do
enormous damage to the skin barrier.
So somebody who's got a vulnerable skinbarrier, and then they use soaps and
detergents on their skin, they can breakthe barrier, allow pathogens to come
(04:35):
through, and then if they react to thosepathogens, things that cause an allergic
reaction, react to those in an abnormalway, they will manifest with eczema.
And once you get eczema, it's itchy,you scratch it, you damage the barrier
further, and you're into a vicious cycle.
Now, antibiotics are a huge hot topic,at the moment, and I still remember my
jaw hitting the ground when I heard youtalking about eczema, when you said that
(05:01):
if you take one antibiotic, once in yourlife, at one time, your skin makeup,
the microbiome, is never the same.
Is that absolutely right?
That's what I've heard.
Yep.
In fact, and your gut microbiome,both your skin and your gut
microbiome, will never recover.
(05:24):
Which is obviously one of the reasonswhy we don't hand out antibiotics
willy-nilly, you know, to everyonebecause of the impact in so many
areas, including, on our skin.
But I suppose what we're saying isif you assault, this extra sensitive
part of our body, the skin, whichas you say, is so thin in parts.
(05:46):
If you assault that, either throughour lifestyle, through unnecessary
antibiotics, through infections, throughdetergents, you name it, we are going
to sort of, potentially, set up therisk of that skin reacting and getting
the eczema that we typically see.
(06:06):
I couldn't agree more.
We have evolved over millenniato live with the bacteria in
our gut and the bacteria on ourskin, and they play a vital role.
Healthy skin has a healthy microbiome,and that microbiome competes with
the bad bacteria and prevents thebad bacteria getting a foothold.
(06:30):
So, if you take an antibiotic and youwipe out all those bugs for a bit, then
sometimes the bad bacteria come backfirst and they then cause problems.
So, using an antibiotic, or in our modernworld with all the antiseptics, as
you say, we live in this very sterileworld as much as we can, we are
(06:51):
causing havoc with our microbiome.
And I'm sure over the next decade ortwo, more will be discussed about the
importance of maintaining a healthygut and a healthy skin microbiome.
You know, we're actually outnumbered.
The number of bacteria in our bodyoutnumber our own cells 10 to 1.
Only 10% of the cellsin your body are you.
(07:13):
90%, or more, are actually bacteria.
They're very small, so they onlyconstitute a few kilograms, but we
have evolved to live with these,they are critical, they're not just
there just riding on us, they'reactually playing critical roles,
as we're beginning to discover.
Absolutely, there's going to be a wholenew, exciting area, in our understanding
of eczema in that, I suspect.
(07:34):
Now, I suspect some of the peoplelistening will be listening because
they have eczema, so we may be sort of,teaching them to suck eggs, when we're
talking about the main symptoms of eczema.But for people who don't have eczema,
the ones I see in my surgery, absolutelytypically it's itch and it's scratch.
(07:55):
Those are the two terms that patientswith eczema always will talk about.
The itch-scratch cycle, and one willget better, and then they will have a
day or two or a week or two, and thenit's back again, we get the flares.
So those are the symptoms that I'mseeing and I'm guessing they're the ones
that you're seeing in clinic as well.
(08:16):
Itch is a horrible symptom isn't it,and atopic eczema is one of the most
itchy skin conditions, and the desireto scratch it is sometimes overwhelming.
Patients will prefer the pain, fromscratching and tearing their skin, to
living with that itch, and unfortunately,as you scratch the skin, you damage it.
(08:39):
Damaged skin is more itchy, and so youcan get into a vicious cycle, that you're
scratching it because it's damaged, andit's damaged because you're scratching it.
So that can cause a flare, and ofcourse, once it becomes inflamed, the
ability of the skin to preserve itselfand to make that barrier is compromised.
So things then get worse.
The broken skin allows bacteria toget through, so it gets infected, and
(09:02):
then you have a flare, and all flaresof eczema have bacteria growing there.
This itch then disturbs sleep,not just for the individual, but
for their entire family, theirhousehold, and that means that they
don't function so well the next day.
It's a huge disturbance there foreverybody, with tiredness, and the
risk of not getting good education orhaving a road accident or whatever.
(09:27):
And of course, the other considerationwe haven't really given much thought
to in the past, is the amount oftime spent, not just with their skin
care regimen, which can be huge,but also accessing health care.
Making appointments to see doctors,collecting their prescriptions,
going to appointments inhospital, having their treatments.
This all takes up time and money, and so,there are enormous consequences to eczema.
(09:51):
Interrupted sleep, though, and interruptedstudy and itch are the main ones.
The other thing, in fact, is, ofcourse, their skin feels uncomfortable.
It feels dry and can be a bit scaly andjust doesn't feel comfortable to touch.
Clothes will stick to it and thingslike that, particularly woollen clothes.
And I think it's also worth mentioning,because there is still this, almost
(10:14):
medieval, myth that some peopledo have, until you sort of correct
them, that eczema is infectious.
It is absolutely,categorically not infectious.
You cannot catch eczema.
But again, as if people with eczema don'thave enough on their plate, every now
and then I will hear about them beingshunned by colleagues at work, or in
(10:39):
social situations if they've got severeeczema because people feel that, somehow,
they're going to catch eczema off them.
It's absolutely awful, but it justfurther diminishes their self-esteem.
People don't want to sit nextto them on the tube or whatever.
Yes, and of course, dry, cracked skinmakes sporting activities more difficult.
(10:59):
The skin tears and things, inthe cold weather, and splits.
Yep, the ramifications are enormous.
Yep.
So, what it looks like.
You and I both know what it looks like.
But typically, we'd be thinking about,red, inflamed, dry, slightly rough
(11:22):
skin, often on the very thin partsof the body, often on places like the
knees, the elbows, around the neck,places that can easily be scratched.
If it's not infected, it tendsto be fairly obvious when you're
looking at it, doesn't it?
Yes, and it's mostly on the face ininfants, around the mouth, but not
(11:48):
right up to the edge of the mouth,onto the cheeks, that's where it's
most severe, but rapidly settles,as you say, into the fronts of the
elbows and the backs of the knees,particularly in white skin actually.
You get different patterns in skinof colour, you can get a reverse
pattern where it's on the fronts ofthe knees and the backs of the elbows.
You can get a follicular patternwhere you just get tiny little
(12:09):
bumps around hair follicles.
It looks trivial, very hard tosee, but intensely itchy and
very severe active eczema there.
So there are differentpatterns in skin of colour.
Where the eczema is affected, it typicallyhas a background redness and looks
cracked with a fine surface crackingto it, maybe a little bit of scaling,
(12:29):
occasionally oozing a bit, and oftenget secondary infections in it, and get
some crust on top of it, like impetigo.
There's a honey-colouredcrust if it's badly infected.
Interestingly, the background skincolour is often quite pale, in eczema.
I'm sure you've seen this.
The face of somebody witheczema, they have pallor.
(12:50):
It affects the circulation ofthe blood vessels in the skin.
Certainly the treatments can as well,steroids can cause a pallor in the skin.
They affect the arteries.
They can cause the arteries to constrict.
So you get a sort of paleness to theskin, as well as the areas looking
a bit redder where it's affected.
Yeah, now, I can't ever rememberdoing tests to diagnose eczema.
(13:15):
It's usually very obviouswhen you see someone.
As you mentioned, it can be alittle trickier if we've got
someone with skin of colour.
But as a general point, andsometimes patients will say,
well, can I be tested for eczema?
Usually there's no reasonat all to test, is there?
(13:35):
No.
The diagnosis is based on a history ofitch and typically, starting in the first
two years of life, this is atopic eczema.
And then, an association withasthma and hay fever, maybe in a
first-degree relative, particularlyin children under four, we look
for relatives with that atopictendency, and then generally dry skin.
(14:00):
And then it's a clinical diagnosis,there's no specific test for it.
Of course, as you mentioned, skin ofcolour can be particularly challenging
because you can't see that rednessvery easily, in skin of colour.
And nor can you see thatpaleness in the skin.
And then they get these very subtlepatterns, which can be very hard,
to know that is what eczema canlook like, so you get these variable
(14:20):
patterns where it looks different.
But as a general point, if you goand see your doctor or a healthcare
professional with eczema, you're likelyto get a diagnosis there and then without
needing to go for any specialised tests.
I'd like to briefly pause today'spodcast, to mention our kind
sponsor AproDerm®, and their rangeof emollients and barrier creams.
(14:43):
Now, as we know,everyone's skin is unique.
In my many years as a GP, it'soften been tricky to find an
emollient that immediately suitedone person and their one condition.
We know it's not as simple as onecondition, one type of emollient.
It's often a case of patients trying anemollient and then going back and forth
with several prescriptions, several visitsto the practice, which is far from ideal.
(15:08):
But fortunately, AproDerm® havedeveloped a genius solution to
simplify the whole process ofselecting the right emollient for you.
Their AproDerm® Emollient Starter Packcontains all four of their emollients
in one pack, each having a uniqueconsistency and level of hydration.
With just one prescription, you havethe opportunity to try each one and find
(15:29):
the one that works best for your skin.
This allows you to choose the one ormore that you prefer and that suits
your lifestyle while saving money,time, and more importantly, fewer
visits to the GP, pharmacist, or nurse.
Sounds like the perfectanswer to me as a GP.
And if you can't make it to yourhealthcare professional, it's available to
buy from your local pharmacy and Amazon.
(15:52):
I've been a big advocate of theAproDerm® range for a while now.
It's such a great range of products,all are suitable from birth and free
from common irritants and sensitisers.
Yeah, and I have to say I love them evenmore now and actually use them myself.
So, if you're affected by a dry skincondition and want to know which emollient
will be the best for you, then do trythe AproDerm® Emollient Starter Pack,
(16:16):
which incidentally, also comes witha handy self-care guide full of tips
on helping you manage your condition,including useful advice on applying
emollients and potential triggers.
It really is a game changer for theworld of dermatology, and as George said
earlier, it's available on prescription orto buy from your local pharmacy or Amazon.
(16:38):
Now at the start, I also mentionedthat patients with eczema often
have repeated flares throughoutthe year and it can really drag
them down when they get better.
They're almost waiting for the next flare.
What are the triggers thatcause people with eczema to
then get a subsequent flare?
(16:58):
They've been running along quitenicely and then suddenly, bang, their
skin is itching, they're scratchingit again, and they're, they're
literally scratching their headsaying, "I wonder what's caused this?"
There are a number of commontriggers, in my experience, and
adherence, you know, actually arethey taking their treatment properly?
Are they using things that dry their skin?
(17:19):
Even stress, stress is aword we use all the time.
But I think, you know, I have seen,and just last week I saw someone,
with purely stress-related eczema.
We could absolutelyclearly link it to that.
These are the big ones that we wouldsee most of the time, aren't they?
Absolutely, yes, certainly stress,yep, and of course, having severe
(17:39):
eczema is pretty stressful, soyou're into a vicious cycle there.
Your sleep's going to be disturbed, and sothe stress is going to be made even worse.
But many people will tell you it's thetime of going through a divorce, or
buying a new house, or doing exams, orwhatever, that eczema is the last thing
they need, and it then becomes even worse.
I suspect sometimes flares could bedriven by exposure to detergents.
(18:03):
So, they had a bubble bath or theywere using some shampoo which then
rinsed over their skin, and we'llcome on to that in management.
So I'm sure detergents, soaps, showergels, shampoos and bubble baths will
all cause the eczema to get worse.
And because once it gets worse, bacteriaget in, and then they drive it as well.
So all flares are infected.
(18:26):
You mentioned not adhering to treatment.
I think that's a big issue, which again,we'll discuss in our next podcast.
But our skin is constantly trying tocope with the world we live in, this
dry world that we live in, and thisworld of detergents and shampoos,
it's constantly challenging the skin.
And then a stressful event comes along andit flares and you're into a vicious cycle.
(18:48):
I hope you can see from thischat that there's a lot more to
eczema than seen at first sight.
And we hope you found ithelpful and interesting.
Roger and I look forward to you joiningus next time in the second part of this
podcast when we'll be talking about thetreatment of eczema, including self-help
tips, and how to prevent it flaring.
We'd also like to thank our sponsor,AproDerm®, for all their help in putting
(19:09):
these Skin Deep podcasts together.
So until the next time,it's goodbye from George.
Goodbye.
And it's goodbye from me.
Goodbye.
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