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Eczema Guide
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Adult Atopic Eczema

Atopic eczema is discussed in detail and it is an endogenous from of eczema. Most adults with atopic eczema will have had this problem in childhood, but it can occasionally appear for the first time in later life. There may be a history of asthma and hay fever, but these are not essential for making the diagnosis. The main areas of the body that are affected are the hands, neck and face, especially the eyelids. There may be widespread milder eczema and dryness on the torso, and eczema around the wrists, elbows, knees and ankles as in childhood. The nipples are also commonly affected in women.

Atopic eczema is extremely itchy, and this can have a great impact on the suffere's life. Sleep can be disturbed, leading to daytime fatigue, and flare-ups are particularly awkward because they can occur with little warning and may mean taking time off work or disrupting studies.

Atopic eczema usually fluctuates in severity. Sometimes it is possible to identify an external trigger such as a change in the climate or a stressful event which has caused a flare-up, but often there is no obvious reason. The following ere common triggers for adult eczema flares:

  • Exposure to skin irritants, especially on the hands
  • Low humidity/air conditioning
  • Extremes of temperature
  • Sweating
  • Skin infections, especially Staph Qureus
  • Emotional or psychological stress and fatigue
  • Exposure to airborne allergens (house dust mites, animal fur, pollen).

The hands and face are particular trouble zones for adult atopic eczema. This is probably because they are constantly exposed to the outside world and get more than their fair share of contact with allergens and irritant substances.

Atopic hand eczema

Because adults do so much with their hands, eczema at this site is very troublesome, and it is often a chronic (persistent) problem. The skin in atopic eczema is vulnerable to the drying and damaging effects of irritant substances. This can cause particular difficulties in occupations that involve manual work and exposure to irritants such as catering, cleaning and construction. Certain types of work are best avoided by people who have atopic eczema, especially if they have had problems with their hands in childhood. This needs to be considered when older children and adolescents are planning their careers. Even when their hand eczema has cleared, people with atopic eczema have more lines and creases, making the skin look 'old'. This is due to eczema-related dryness of the skin and not because of steroid treatment, as is sometimes suspected.

Another problem with the imperfect skin barrier of atopic eczema is that it allows allergens to penetrate more easily. Certain immediate type allergens can cause particular problems in atopic hand eczema sufferers. These include latex proteins in rubber latex gloves and food protein in meat, fish, fruit and vegetables. Exposure to these allergens can cause immediate reactions with itchy red bumps within minutes, followed later by a worsening of the eczema. The more contact an atopic eczema sufferer has with these sorts of allergens, the more likely it is that they will become allergic to them.

Atopic facial eczema

The facial area, in particular the eyelids, is a common trouble zone for adults with atopic eczema. Because the eyelid skin is thinner than the rest of the body, allergens such as dust mites or pollens can penetrate this area more readily and trigger flares. Adults with atopic eczema that mainly affects exposed skin areas may be more likely to have allergies to airbome allergens such as house dust mites, and may benefit from taking steps to reduce contact with these allergens.

Other substances that come into contact with the eyelid such as cosmetics and toiletries can irritate the skin even more and should be avoided. Mascara and liquid foundation or eye liners can be particularly irritating while eye pencils tend to cause fewer problems. Topical steroids should be used with care around the eyes because the skin here is vulnerable to thinning.


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