Eczema is common; and getting commoner. It can make life a total misery, we know: - our founder reports he was 16 years old before he woke up in the morning without blood on the sheets from scratching his eczema in his sleep. Despite a lot of medical research and a lot of facts being known, what actually causes eczema is still poorly understood. A lot of different things seem to make the condition worse, so there are things sufferers can do to help themselves, but each of these individual factors may be more or less important in any particular person.
Six important worsening factors are commonly identified in eczema sufferers: drying of the skin, the itch-scratch cycle, local irritants, allergy and infection. Eczema is associated with striking abnormalities in the immunological system of the body, some of which are driven by infection and eczema sufferers sometimes appear to become “allergic” to the bacteria, yeasts and fungi that all of us carry on our skin. These different factors often interact with each other.
Even the non-involved skin of eczema sufferers tends to be drier than average. Further excessive drying causing irritation can be prevented by avoiding too frequent washing, particularly with harsh soaps and by the regular use of moisturising creams.
Allergy is important in some, but by no means all, sufferers. It tends to be more of a problem in babies and young children, and become a less significant factor in adults. Food allergy is quite common in the first two to three years of life, often being grown out of before the age of seven. If you think this might be relevant in your child, it is very important to get proper advice from a health professional about their diet. Some “cows milk substitutes” are not appropriate for young children (warning – goats milk in particular, is not nutritionally suitable for infants. In addition, people with cow’s milk allergy will also react to all other natural milks, except human breast milk).
Rubbing house dust mite allergens into the skin seems the commoner problem later. One controlled clinical trial has shown benefit of allergen barrier bedding covers in a significant proportion of sufferers. The Professor of Dermatology who performed this study tells us that neither allergy skin tests, nor blood tests, are able to predict which patients will benefit.
Oddly, even food allergy does not cause eczema where you can’t scratch. This has been described in people who have had a paralysed arm or leg and in children who have had a plaster cast for a broken bone. This is why, in the past, very tight bandages have sometimes been used to protect the skin. When an acute attack of whole body itching is caused by a particular food, the eczematous rash only develops on those parts open to being scratched.
Another dermatologist has described the difference between eczema and other itchy rashes as “ the others are rashes that itch, eczema is an itch that rashes”. Itching in eczema can be triggered by numerous factors – allergic reactions, overheating in bed at night, irritant chemicals and rough garments next to the skin (wool being the worst offender). The itch of eczema makes you scratch, the scratching then causes acute damage to the skin. Long term continued scratching goes on to cause the hard skin thickening with which many sufferers will be familiar. We all know that injured skin starts to itch as it heals. In eczema, there tends to be a vicious circle – “the itch-scratch cycle” - your skin itches, you injure the skin by scratching, this causes more itching, and so on and on. Anything that interrupts this cycle, helps.
It is impossible to control the urge to scratch a severe itch. Many sufferers scratch in their sleep. One of the roles of simple creams and ointments is simply to lubricate the skin to minimise scratch damage. Another approach is to put a soft fabric between the skin and finger nails. Cotton garments have been favoured for many years, but we think silk is even better. Provided it is polished and not raw silk, it is softer, cooler, more wickable and being “silkier”, slides more easily over the skin.
Most children and adults with eczema will have experienced secondary infection from time to time. This tends to show itself as a flare up with oozing and weeping, often with yellowy crusts. The usual cause is infection with the bacterium staphylococcus aureus – “Staph” (aureus – Latin for golden). This usually needs treating with antibiotics by mouth.
It has been known for some time that eczematous skin is commonly colonised by Staph, even when there are no obvious signs of infection. Recent research indicates that this colonisation is an important factor in maintaining and worsening eczema. Staph produce “Superantigens” which overstimulate the immunological mechanisms of eczema. Most eczema sufferers have very high levels of antibody directed against these Superantigens: antibodies of the same type involved in allergic reactions (immunoglobulin E – IgE).
Once the natural barrier of the skin becomes damaged by the rash and scratching, the scene is set for a vicious circle of secondary colonisation, worsening and spreading of the rash, more scope for infection, and so on. Apart from the general undesirability of overuse of chemical antibiotics, Staph is particularly likely to develop resistance to commonly used antibiotics (MRSA – the hospital “superbug” is a Staph). We are particularly excited by recent evidence the silver-coated textiles can reduce Staph colonisation of eczematous skin and promote healing.
It has been known for many years that silver salts can kill bacteria and fungi, and even viruses. Creams containing silver have been used to prevent infection in burns patients for decades. Metallic silver particles have recently been incorporated in the plastics of indwelling medical devices, such as intravenous and urinary catheters and this has been shown to reduce infection rates. A breakthrough in technology now means that special fibres can be coated with pure metallic silver. These can then be used to make clothing and bandages, which release tiny amounts of silver ions when in contact with the skin. Recently published medical research shows that their use rapidly reduces eczematous skin colonisation with staphylococcus aureus, with consequent improvement in the eczema. We provide a full range of silver textile clothing and bandages for babies, children and adults.