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Eczema - symptoms, diagnosis and treatment

What are the symptoms of eczema?

In some cases itchy, dry and red skin from eczema can be present all of the time, or may appear or become worse during a flare-up.

Eczema symptoms include:

  • Patches of chronically itchy, dry, thickened skin, usually on the hands, arms, neck, face and legs. In children, the inner creases of the knees, wrists and elbows are often involved.
  • Sores with crusts, caused by scratching.

Seek medical advice if:

  • You develop an otherwise unexplained rash and have a family history of eczema or asthma. You should have a medical diagnosis of the condition.
  • The inflammation does not respond to treatment with emollient lotions and creams. A doctor may suggest prescription medicines.
  • You develop yellowish to light brown crust or pus-filled blisters over existing patches of eczema. This may indicate a bacterial infection that should be treated with an antibiotic.
  • During a flare-up of eczema, you are exposed to anyone with a viral skin disease such as cold sores or genital herpes. Having eczema puts you at increased risk of contracting the viral disorder.
  • You develop numerous small, fluid-filled blisters in the areas of eczema. You may have eczema herpeticum, a rare but potentially serious complication caused by the herpes simplex virus.

How is eczema diagnosed?

To diagnose eczema, your GP will first talk to you about your symptoms and medical history. He or she will also ask about your family's history of rashes and other allergy-related medical conditions, such as asthma and hayfever. While there is no single test to effectively diagnose eczema, a good medical history combined with an examination of your skin is usually adequate.

What are the treatments for eczema?

Good skin care is a key component in controlling eczema. Appropriate care of the skin can often be enough in many milder cases.

In treating eczema, most doctors will start patients on basic therapies. A good moisturiser (in cream, lotion or ointment form) helps conserve the skin's natural moisture and should be applied immediately after showering or bathing and at least one other time each day. It is also a useful technique to apply them little and often and not vigorously rub them in. They should be applied following the line of the hairs on the skin.

Corticosteroid creams and ointments have been used for many years to treat eczema. Your GP may recommend application of over-the-counter hydrocortisone cream in mild cases but will often prescribe a stronger steroid cream when the eczema is more severe. When other measures fail, the doctor may prescribe oral corticosteroid medication; steroids should always be taken with caution and never without medical supervision. Antihistamines are sometimes used to help relieve itching. If strong topical steroids, oral steroids, antihistamines and loads of applications of emollients don’t work, a referral to a dermatologist may be needed.

Newer medicines called topical immunomodulators are available to help treat eczema. These medicines help control inflammation and reduce Newer drugs called topical immunomodulators are available to help treat eczema. These drugs help control inflammation and reduce immune system reactions when applied to the skin. Examples include pimecrolimus and tacrolimus. These drug are thought to be as effective as topical corticosteroids. They are usually considered when other treatments have not been effective.

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