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Faculty of Medical, Clinical and Veterinary Sciences

Skin Problems

Human Skin | Dry Skin | Psoriasis | Eczema | Greasy Skin | Dandruff | Acne | Rosacea | Seborrheic Dermatitis | Skin Cancer | Non-melanoma Skin Cancer | Melanoma | Hereditary Skin Cancer | Sensible sun exposure

Eczema is a generalised name given to a group of non-contagious skin conditions, the most common of which is correctly called atopic dermatitis (AD). There are other, similar skin problems, so proper diagnosis by a qualified medical practitioner is vital to ensure the correct treatment and prevention regime is followed.

It is a inherited disease of the immune system, being closely linked with both hayfever and asthma. Often parents or siblings of an eczema sufferer will be found with one or more of these. It is not infectious and can't be caught from another person.

AD usually starts in infancy and, for the luckier sufferers, can fade late in childhood, but often continues into adulthood. It is thought to affect about ten per cent of people at some point of their lives, affects both sexes and all races equally, although it is more common in developed countries.

The skin becomes dry and itchy, most often around the cheeks, creases in the skin, torso and on arms and legs. The skin becomes broken, through scratching, sometimes leading to infection. It tends to come and go in cycles.

It is believed to flare up when a particular trigger is encountered. The triggers are different for everyone, and finding out which is the main cause is key to controlling the problem. The triggers can be allergy, intolerance or irritant related, or stress events. Dry skin, climate change and infections like sore throats can also have an effect. It is important to remember that everyone is different, so what works for one person may not work at all in the next, or can even make the situation worse.

Preventing Flare Ups

Stress doesn't cause eczema but both mental stress - like worry and psychical stress, such as illness, can trigger flare ups. This can lead to a vicious circle if the skin is in poor condition and the patient is upset about it - this is particularly a problem in children if their peers tease them about it.

Irritants, such as those found in skin care products and household cleaning chemicals, are usually easy to identify and avoid. Always wear cotton-lined rubber gloves when using household cleaners and don't change more than one skin care product at a time. Skin irritants can also be found at work - chemicals, paints, glues and suchlike can cause a flare up.

Allergens can be harder to identify. Pollen, pets, certain foods and house dust mites are all possible culprits. Dermatologists can do a prick test on the skin, where a tiny amount of different potential allergens are introduced to the skin under controlled conditions to check for reaction.


AD can be triggered by a food allergy or intolerance, and although some people can pin-point a food which causes the problem quite easily, others can have more difficulty, as a reaction is not only caused by eating the food, allergies can also be triggered by contact during food preparation. Allergies are best diagnosed by a doctor using the prick test, but some intolerances need restrictive diet to be discovered. Great care should be taken when embarking on an elimination diet, and medical advice should be sought, especially if the subject is a child.

Some people say that it's a good idea to avoid animal fats during a flare up, otherwise a healthy balanced diet to keep you in good health is best.

Self Help Treatment

Prevention of dry skin is very important. For day to day control, most find that use of a good moisturising lotion or cream works well. This is best applied immediately after getting out of the bath or shower - within three minutes ideally.

It is thought that the greasier the cream is, the better it will work, but it is important to find one that feels comfortable on the skin, as it really needs to be applied several times a day. As a general guide, ointments are the most oily, creams next, lotions contain more water than oil, gels have no oil at all - avoid gels that contain alcohol, they dry the skin. Some people find that greasier creams work well on dry eczema and lotions or gels work well on wet and weepy eczema.

Wear loose cotton clothing - avoid wool and synthetic materials. This also applies to bedding. Skin will feel more comfortable if it it's allowed to breathe.

Double rinse all clothes after washing them. Avoid biological washing powders or liquids and fabric softeners.

Beware of mail order 'cures' - several scams have come to light recently with unscrupulous traders selling products labelled as herbal or containing zinc pyrithione (a dandruff treatment) as their active ingredients. In fact these contain strong prescription-only ingredients - sometimes in formulations stronger than would ever be prescribed. Obviously, these are banned as soon as they are discovered. Not all products mail order products are like this, but it is worth doing some background research into any mail order product before buying. Be very suspicious of anything that works in days - this is usually a sign something potent is at work!

Herbal treatments can be effective for some, usually when made for an individual by an experienced herbalist. Bulk manufactured over-the-counter treatments are rarely effective and can cause allergic reactions in some people. It's worth remembering that just because a treatment says it's herbal or natural, it doesn't necessarily mean safe - some of the most toxic substances on Earth are byproducts of plants.

Aromatherapy massage can be helpful, as can anything that helps relieve stress. The oil used helps keep the skin moisturised too. It's worth bearing in mind that the essential oils used can cause an adverse reaction in some.

Wet bandages can be wrapped around the affected area to soothe itching. If the itching is very localised and intense, ice or a cold pack can help (do not apply directly to the skin though, wrap the pack or ice in cotton first.)

Be very careful in the sun. Exposure to sunlight does help eczema in many people, but overdoing it will cause the skin to inflame and it will itch even more. Also take care with the type of sunscreen you use, there may be ingredients in them that can cause flare ups.

Prescribed Treatments

The most common treatment prescribed for eczema flare-ups are corticosteroid1 creams or ointments. These are available in several different strengths prescribed according to how widespread and painful the flare-up is. It is important to follow the instructions carefully and not to overuse these creams as they can cause skin atrophy2 and can also cause a rebound effect (the problem may come back quicker and more vigorously when the treatment is stopped). To help prevent this, most doctors will prescribe what is sometimes called 'pulse therapy' - changing the strength of creams and having frequent rest periods from applications.

For allergy-related eczema, anti-histamines may be prescribed. The older type, over more modern versions, is preferred because the sedative effect helps calm itching, especially at night.

Anti fungal creams and antibiotics may be used to counteract an infection occurring when the skin is broken. This is quite common in eczema sufferers and usually occurs when bacteria or fungus spores, normally present even on healthy skin in small quantities, invade the broken skin, which can lead to even more inflammation, weeping and crusting of the skin, setting off that nasty vicious circle again.

Coal tar creams may be used to counteract thickening of the skin. These must be washed off before exposure to the sun3, as it makes skin photosensitive. Best left to air dry before dressing as it can stain both skin and clothing.

Oral steroids may occasionally be given for very severe outbreaks. These should be used exactly according to the instructions and shouldn't be stopped without consulting a doctor.

UV (ultra violet) light treatment, in the form of sunbeds or lightboxes helps some people, but treatment should only be administered by a professional. In the wrong doses UV can cause more harm than good.

For further help and information, contact The National Eczema Society.

1Hydrocortisone is the best known of these.2Skin atrophy is when the skin thins and stretch marks appear.3Ideally coal tar should be washed off 24 hours before exposure to the sun.

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