Emma Wedgeworth
Consultant Dermatologist
Eczema is a common, chronic inflammatory skin disorder affecting up to 20% of children in the UK and 5% of adults. On the skin, eczema is recognisable as dry, scaly, red, itchy patches. In the last few decades, there has been a two to three-fold increase in the rates of eczema.
The exact reasons for this exponential rise are unclear, but these rises are too quick to be explained by changes in our genetic make-up alone. There may well be factors in our lifestyle that contribute to eczema, such as improved hygiene, dietary changes, modern skincare practices and antibiotic usage.
However, In the last 10 years, great strides have been made in the understanding of eczema. We now know that there are three major factors leading to the development of eczema.
Skin barrier dysfunction
Under normal conditions, our skin should act like a tight, strong barrier against the environment. The skin is akin to a brick wall and the barrier function of the skin is reliant on this structure being intact. If the brick wall structure loses its integrity, the water content of the skin reduces, and the skin dries out, which compromises its ability to act as a barrier.
The barrier function of our skin is determined partly by genetics – some people are more prone to dry skin than others – but is also influenced by environmental conditions such as the weather and what we use on the skin.
Skin immune dysfunction
The skin has a very active immune system, which is there to fight off environmental damage and harmful microorganisms and to repair damage to the skin. We know that, in patients with eczema, this immune system is overactive in certain parts and this leads to the red, itchy inflammation seen in eczema.
Abnormal microbiome
The skin is covered in millions of microorganisms that are – usually – carefully balanced to keep skin healthy. In people with eczema, this balance becomes disrupted, which further drives changes to the skin.
While many people will suffer from mild eczema, we shouldn’t underestimate the impact of this condition on a sufferer. Eczema continues to be a significant health burden and is responsible for disturbed sleep and time off work and school. Fortunately, in the last few years, we have learnt more and more about this condition and have seen exciting new developments in treatment options.
