Understanding Eczema: What Is It?
Eczema, also known as dermatitis, is a chronic inflammatory skin condition that affects approximately 1 in 5 children and 1 in 12 adults in the UK. It is characterised by dry, red, itchy, and inflamed skin, which can sometimes become weepy, blistered, or infected. Eczema can significantly impact quality of life, causing discomfort, sleep disturbances, and emotional distress due to its visible nature and persistent symptoms.
There are several types of eczema, with atopic eczema (or atopic dermatitis) being the most common. Other forms include contact dermatitis (allergic or irritant), seborrhoeic dermatitis, and pompholyx eczema, each with distinct triggers and characteristics. While eczema is a long-term condition with no known cure, effective management can significantly alleviate symptoms and improve quality of life.
Causes of Eczema
The exact cause of eczema is not fully understood, but it is believed to result from a combination of genetic, environmental, and immune system factors. Key causes and triggers include:
- Genetics: Eczema often runs in families, particularly alongside other atopic conditions like asthma and hay fever. Children with one parent affected by eczema have a 60% chance of developing it, rising to 80% if both parents are affected.
- Skin Barrier Dysfunction: In eczema, the skin’s natural barrier is impaired, making it more susceptible to irritants, allergens, and infections.
- Environmental Triggers: Common triggers include soaps, detergents, perfumes, synthetic fabrics, pollen, pet dander, dust mites, and certain foods (e.g., dairy, eggs, or nuts).
- Stress and Emotional Factors: Psychological stress can exacerbate symptoms, contributing to flare-ups.
- Climate and Weather: Cold, dry winter air or excessive heat can worsen eczema by drying out the skin.
Identifying and avoiding personal triggers is a critical part of managing eczema, often requiring patch testing or allergy assessments to pinpoint specific allergens.
Eczema Treatment Options in the UK
Eczema treatment in the UK focuses on reducing inflammation, relieving itching, preventing flare-ups, and managing infections. Treatments are tailored to the severity and type of eczema and can be broadly categorised into three approaches: topical treatments, phototherapy, and systemic medications.
1. Topical Treatments
- Emollients: These moisturising creams, lotions, or ointments (e.g., Epaderm, Hydromol) are the cornerstone of eczema management. They hydrate the skin, restore the skin barrier, and reduce itching. Emollients should be applied multiple times daily, even when the skin appears clear, to prevent flare-ups. Bath emollients and soap substitutes are also recommended to avoid irritation from harsh soaps.
- Topical Steroids: Corticosteroid creams or ointments (e.g., hydrocortisone, clobetasol propionate) are used to reduce inflammation during flare-ups. They vary in potency, and dermatologists prescribe the appropriate strength based on the affected area and severity. Short-term use is advised to avoid side effects like skin thinning.
- Topical Calcineurin Inhibitors (TCIs): Non-steroidal options like pimecrolimus (Elidel) and tacrolimus (Protopic) are used for sensitive areas (e.g., face, eyelids) or when steroids are unsuitable. They reduce inflammation and are safe for adults and children over two, though they may cause a temporary burning sensation.
- Antibiotics or Antiseptics: If eczema becomes infected (e.g., with weeping or pus), antibiotics or antiseptic solutions like potassium permanganate may be prescribed.
2. Phototherapy
For moderate to severe eczema not responding to topical treatments, narrowband UVB phototherapy or PUVA (psoralen + UVA) may be recommended. This involves controlled exposure to ultraviolet light to reduce inflammation and itching. Phototherapy is available at specialised NHS clinics, such as Guy’s and St Thomas’ NHS Foundation Trust, which has a dedicated phototherapy suite.
3. Systemic Medications
For severe or widespread eczema, systemic treatments may be necessary, always under the supervision of a consultant dermatologist:
- Oral Corticosteroids: Drugs like prednisolone are used short-term for severe flare-ups.
- Immunosuppressants: Medications such as azathioprine, methotrexate, or ciclosporin are reserved for severe cases, requiring regular monitoring due to potential side effects.
- Biologics: Advanced therapies like dupilumab target specific immune pathways and are used for severe eczema unresponsive to other treatments. These are administered via injection and are available through specialist NHS or private clinics.
4. Lifestyle and Home Remedies
- Avoiding Triggers: Keeping a symptom diary can help identify triggers like certain foods, fabrics, or environmental factors. Patch testing or allergy assessments can confirm allergens.
- Wet Wrapping: This technique, often used for children, involves applying emollients and bandages to hydrate and soothe the skin, reducing itching and aiding sleep.
- Clothing Choices: Wearing loose, cotton clothing and avoiding wool or synthetic fabrics can minimise irritation.
- Bathing Practices: Short, lukewarm baths with emollient-based products and avoiding perfumed soaps can prevent skin drying.
5. Psychological Support
Eczema can take a psychological toll, particularly when severe or visible. NHS trusts like the Royal Free London and Barts Health offer psychodermatology services, combining dermatological and psychological care to address stress, anxiety, or depression that may worsen eczema.
Eczema Treatment Through the NHS
In the UK, eczema treatment typically begins with a general practitioner (GP), who can prescribe emollients, topical steroids, or antihistamines for mild to moderate cases. If symptoms persist or worsen, your GP may refer you to a consultant dermatologist at an NHS hospital or clinic. The referral process can take several weeks to months, depending on local waiting times, with urgent cases prioritised.
NHS dermatology services are available at major hospitals, such as:
- Guy’s and St Thomas’ NHS Foundation Trust (London): Offers a severe eczema clinic with a phototherapy suite and access to clinical research trials. The clinic operates Wednesdays from 8:45 AM to 1:00 PM at the Bermondsey Centre, Guy’s Hospital.
- Imperial College Healthcare NHS Trust (London): Runs eczema clinics at Charing Cross, Hammersmith, and St Mary’s hospitals, offering comprehensive care for adults and children.
- University College London Hospitals (UCLH): Provides specialist clinics for severe eczema, including phototherapy and patch testing at the Mortimer Market Centre.
- Newcastle Hospitals NHS Foundation Trust: Features a nurse-led eczema clinic focusing on education and topical treatment application.
The NHS also supports research, with trusts like Guy’s and St Thomas’ collaborating with King’s College London to trial new treatments. Patients may be invited to participate in clinical studies, which can provide access to cutting-edge therapies.
For urgent cases, such as infected eczema with weeping or pus, contact your GP or NHS 111 for immediate advice. Severe cases may require hospital admission for intensive treatment.
Finding an Eczema Specialist in the UK
For faster or more specialised care, many patients opt for private dermatology clinics, particularly in London, where wait times are shorter, and access to advanced treatments is often immediate. Here’s how to find an eczema specialist in the UK:
NHS Specialists
- Referral Process: Start by consulting your GP, who can refer you to a dermatologist at an NHS hospital. Specify if you prefer a hospital with a dedicated eczema clinic or phototherapy services.
- Key NHS Dermatology Centres:
- Guy’s and St Thomas’ NHS Foundation Trust (Bermondsey Wing, Great Maze Pond, London SE1 9RT): Known for its severe eczema service and research programme.
- Barts Health NHS Trust (The Royal London Hospital): Offers one of the UK’s largest dermatology services, with expertise in eczema, phototherapy, and psychodermatology.
- Chelsea and Westminster Hospital NHS Foundation Trust: Provides phototherapy and specialist clinics for eczema and related conditions.
Private Dermatology Clinics in London
Private clinics offer rapid appointments (often same-day) and access to leading consultants. Costs for an initial consultation typically range from £50 to £495, with follow-ups from £50 to £350.
Finding a Specialist
- Online Platforms: Use websites like Doctorshire or TopDoctors to find verified dermatologists in London or elsewhere in the UK. These platforms allow filtering by location, insurance coverage, and patient reviews.
- Professional Organisations: The British Association of Dermatologists (BAD) provides patient information and a directory of accredited dermatologists.
- Patient Reviews: Check platforms like Doctorshire.com for verified patient feedback to ensure the specialist has experience with eczema.
- Location Considerations: Many private clinics are located on Harley Street, central London, with easy access via tube stations like Oxford Circus or Regent’s Park. Some, like HCA Healthcare UK, have multiple locations (e.g., The Shard, Surrey).
Support Organisations
- National Eczema Society: Offers resources, support groups, and advice on managing eczema.
- Skin Support: Provides psychological support for those with skin conditions.
- British Association of Dermatologists: Offers patient leaflets and information on eczema care.
Eczema is a challenging condition, but with the right treatment and specialist care, it can be effectively managed. In the UK, the NHS provides comprehensive care through GP referrals and specialised dermatology clinics, while private options offer faster access to leading consultants, particularly in London. By combining medical treatments, lifestyle adjustments, and trigger avoidance, patients can significantly reduce symptoms and improve their quality of life. For those seeking a specialist, platforms like Doctorshire, TopDoctors, and the British Association of Dermatologists can help identify experienced dermatologists tailored to your needs.
