15% of the childhood population have Eczema and about a third go onto have it as adults.

That’s a lot of the UK that suffer for eczema and often it’s much more debilitating than just an irritant itch!

There’s a lot of mixed literature out there about eczema so we decided to kick off our Eczema series by interviewing an expert in the field, Dr Simon Meggit.

Dr. Simon Meggit is a Dermatologist at the Royal Victoria Infirmary in Newcastle and has years of eczema experience so we popped in to meet him and asked him to unveil the science behind eczema.

What is Eczema?

Dr.Meggitt: – There’s not a simple answer to that question, eczema is an umbrella term for a variety of different types of dermatitis (inflammation of the skin) such as Irritant Eczema, Atopic Eczema and Contact Dermatitis.

So what is Irritant Eczema?

Dr.Meggitt: – Irritant eczema is inflammation and dryness of the skin and is often caused by over washing or the overuse of things like detergents. Your epidermis (the top layer of the skin) is a 0.01mm barrier between you and your surroundings and essentially stops you from leaking! It is made up of lots of cross linking proteins for structure and lots of fats to help repel water stopping the movement in and out of the skin. What happens in irritant eczema is that you wash away the natural oils of the epidermis until you reach an irritant threshold and skin breaks down into eczema. (No, come back oils and nourish our skin!)

Are there different Irritant thresholds for different people?

Dr.Meggitt : – Yes – so if you have the internal kind of eczema (Atopic Eczema) your irritant threshold is lower so you don’t need as many washes to get to the threshold and break out into eczema. So people with atopic eczema are more likely to get irritant eczema too. Also, if your job involved you using lots of detergent such as soap, alcohol, washing up liquid or shampoo, this will also increase the likelihood of irritant eczema. (That sounds like a good excuse not to do the washing up!)

How good are the current therapies for irritant eczema?

Dr.Meggitt: – You don’t necessarily need therapy for irritant eczema; it’s more about modifying what you’re doing. You can protect yourself from excessive soap and water by washing less or wearing gloves. Sometimes you can’t avoid over-washing though (i.e occupational over-washing) so you need to put that grease back in your skin! The best moisturisers are not the kind people tend to like. The really greasy ones are the ones that work best for eczema! These creams create a layer over the skin which makes the skin sweat and this keeps your skin hydrated because it prevents evaporation of the moisture. Petrochemical products, such as Vaseline, hydrate your skin from underneath in this way and therefore help to combat irritant eczema.

What is Atopic Eczema?

Dr Meggitt : – This type of eczema is often associated with other allergic diseases such as Asthma and Hayfever. Like irritant eczema you get inflammation and dryness in the skin and it appears very much the same. However, the method is very different. The immune cells that are normally circulating in your blood, pile into the skin and cause the inflammation and irritation characteristic of eczema but the reason they do this is still a bit of a mystery.

However, recently the way we understand the causes of Atopic Eczema have changed. We used to think it was an immune problem, so we thought something in your immune system was going wrong and causing the immune cells to move into the skin, but now we think it might be to do with the structure of a persons skin. Lots of people that have Atopic Eczema have mutations in the proteins that link the skin together – the main one being a protein call Filaggrin which aggregates the structural proteins of the epidermis. If you’re missing Filaggrin there are gaps in the epidermis. These gaps in the skin allow bacteria and germs that normally land on your skin and can’t enter, into the body where they can trigger a immune response. This immune response is hypersensitive – i.e it over reacts and results in the production of lots of blood cells that pile into the skin. So the current theory is that Atopic Eczema is caused by problems in skin structure and not problems of the immune system.

What about Contact Eczema/ Contact Dermatitis?

This is another external eczema – your immune system confuses a germ with a molecule (nickel is the commonest) so your immune cells that are usually circulating start piling into the skin and again you get the irritation. It’s a ferocious type of eczema – you get really bad flare ups where you’ve had contact with the molecule. Molecules in cosmetics can also cause contact eczema especially stabilizers and preservatives in cosmetics. Patch testing normally shows us exactly what’s causing it and most of the time once we find this out people stop using the products and the eczema goes.

Is it safe to use steroids for Eczema?

Dr. Simon Meggitt: – A lot safer than you think. Oral steroids are not recommended as usually after a course is finished the eczema bounces back and they have lots of nasty side effects. Normally we use long-term steroid creams. The main side effect of these is thinning of the skin but this only happens if you overuse really strong steroid creams. They use of steroid creams should be regulated to prevent this from happening. Weak or moderate steroid creams almost never cause thinning of skin. There’s a lot of false information that steroids are very harmful – a lot of this is just so pharmaceutical companies can cover their backs! For example hydrocortisone is a weak steroid cream and although it says in the packaging that it can cause skin thinning, I can say with certainty as a dermatologist it does not and this is drug companies covering their backs – they are actually very safe.

We’ve come across oats being used to help eczema – what do you think of this?

Dr. Simon Meggit : – Yes oats are used in some of the creams and some of the molecules help to restore the barrier and there is various evidence supporting their use.

Can food trigger Eczema?

Dr. Simon Meggit : – Only in a minority of cases. You can get rashes from other allergic reactions that can be confused with an eczema rash but in the vast majority of people, food does not trigger Eczema and there is nothing dietary you can do to relieve eczema symptoms.

If you have any more eczema related questions email them to info@beautybythegeeks.com and we’ll get one of our experts to answer them!

Dr. Meggit does some great work for the charity….check it out and please donate if you can spare a penny or two! http://www.nesrf.org.uk/

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