There are many different types of eczema – common ones include:
- atopic eczema (also called atopic dermatitis)
- discoid eczema
- seborrhoeic eczema
- pompholyx eczema
- contact eczema
The young people we spoke to mainly talked about atopic and discoid eczema.
Dr McPherson talks about some of the most common types of eczema.
Dr McPherson talks about some of the most common types of eczema.
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So the most common type of eczema we see in children and young adults is something called atopic eczema. And that's often something which starts in babies, and it's a very complex disease, but it's mostly to do with a problem initially probably in the barrier of the skin. So, how kind of intact the skin is. And then because of the skin being kind of leaky it loses water, so you can get quite dry skin, and it also means you can develop further problems such as allergy in some cases. So that's by far the most common sort of eczema, which is called atopic eczema. There's a few other types, which some people, you know, can have problems with. So there's one called contact eczema, which is when you're kind of actually allergic to something that goes on the skin. And we tend to see that, sometimes it can be alongside atopic eczema but it can be also in older people or different types. Some certain jobs are at high risk, for example hairdressers, people that are in contact with certain things. And there's two types of contact eczema. One's irritant, where you're just being, you know, exposed to things that irritate the skin. And one's an actual allergy. But they all look very similar, they can all look very similar kind of clinically in terms of the skin being red and dry. And then the other kind of big group of eczema is something called seborrheic eczema. And that's one which really tends to affect the face. So the seborrheic areas are where you produce more sebum, so it tends to the places where you’d otherwise get acne. So forehead, eyebrows, round the nose, and sometimes scalp and back. And that's a different type of eczema which seems to have a kind of yeast, which is on the face and scalp, which can cause a particular type of eczema. Sometimes you see that in babies, but you can also see it in adults. So it's quite common. It's actually, you know, cradle cap that we see in babies is a form of seborrheic eczema as well.
Most people we talked to didn’t name a specific type of eczema. Instead, people usually talked about severity (e.g. from mild to severe) and the different parts of their body affected. Aman only knew what kind of eczema he had when he went to see a dermatologist (a doctor specialising in skin). The treatments are usually the same across the different types of eczema.
Seeing a dermatologist was a “turning point” in terms of information and treatment for Aman.
Seeing a dermatologist was a “turning point” in terms of information and treatment for Aman.
Age at interview: 23
Sex: Male
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And one thing I found especially was with the GPs they’re not always as knowledgeable as you think they are. So, growing up, you just kind of take it as a given that your GP knows everything about every condition. And then, kind of come 14, 15 you start realising well, they’re just prescribing me the same thing over and over again and seemingly expecting a different response. So, if I was going to give any advice that I’d say, go and talk to a dermatologist, because they’ll know exactly what your skin needs and the different types of eczema and will have different types of treatment for it. Whereas, a doctor might only recommend hydrocortisone or one specific treatment. And, so the times when I’ve been to a dermatologist they’ve really kind of [laughs] I’ve said, “Well you know, the doctor told me to use this,” and they’ve basically turned around and said, “Well, you know, that’s not really going to affect it because you’ve got this type of eczema” or “It’s a bit too bad for that kind of cream. It’s not really gonna have an effect”.
Aisha had heard about different types of eczema but felt unsure about whether she had found reliable information about these online.
Aisha had heard about different types of eczema but felt unsure about whether she had found reliable information about these online.
Age at interview: 21
Sex: Female
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I think I've seen a few sort of articles that are very brief as well from like Patient.co.uk and like Mayo Clinic and NHS Choices and WebMD and all these sort of things. But then, on like atopic eczema which is just the general thing, but when it comes to sort of specific branches of atopic eczema there really isn't a lot out there and then you sort of go into the murky world of message boards and forums and it's… you're not too sure sort of how much you can sort of… I don’t know, I think it's that feeling again that, you know, a doctor should know more than you. For instance, so like you're not sort of a bit wary on like, "Well this person said this will work for them and this has made them really ill etc." So, how much can I believe them? But, sort of opposed to like a health professional who obviously is well versed in, you know humans and how much they can live and, you know so you just… it's just a mess [laughs].
Evie chose to see a dermatology specialist about her eczema at a hospital which teaches a lot of medical students.
Evie chose to see a dermatology specialist about her eczema at a hospital which teaches a lot of medical students.
Age at interview: 20
Sex: Female
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So did you say that because it's medical students that are sometimes training in the dermatology unit, that you feel that you're passing on your experience so they can learn from it?
Yeah definitely
Could you say a bit more about that cos that’s really interesting, really important, really interesting.
Yeah, well this is actually most of the reason I did this because I feel like there's not enough out there without actively looking for it.
OK
And so you look at…they’ve got this little handbook of all like these different eczema conditions, and you look for yours, it looks nothing like yours. So you feel like you should like help educate them because if they haven’t got it themselves they…I would assume, well they wouldn’t know how to treat it, but it's a different situation to what they know.
They're just seeing it as all means to an end where we see it as a lifestyle.
Eczema subtype: atopic (allergy-related)
Most eczema is ‘atopic’ (allergy-related), especially in young people, and it is very common in families with a history of asthma or hay fever. Someone who is ‘atopic’ is sensitive to having allergies (when in contact with an ‘allergen’ it causes a person’s immune system to have a big response). Only Laura, Aman and Aisha used the words ‘atopic eczema’ but many people talked about specific triggers and health conditions (like asthma, allergies and hay fever) linked with this type of eczema. Some people had heard that eczema, asthma and allergies were linked but they weren’t sure if this was medically correct. Alice remembers hearing about a link as a child but she hadn’t been told about it or looked it up since.
Dr McPherson explains the links between asthma, allergies, hay fever and eczema.
Dr McPherson explains the links between asthma, allergies, hay fever and eczema.
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So this is something that we know quite a bit more about in the last ten years, really understanding eczema, is- you know, it's a complex condition which is a mixture of your immune response and your skin barrier. So it's both things going on. And we know that in quite a lot of people they have-, they're born with a slight difference in their skin barrier function, and there's a protein called filaggrin, which is quite an important genetic association. If you have mutations in filaggrin, your skin is- your skin barrier function is not the same as someone that doesn't have. So, right from birth you have a slightly leakier skin. So that means two things, that you have this dry skin but it also means that you have this barrier dysfunction. So that means the allergies can- things can enter through the skin and cause problems. So that's, we think now there's a sort of sequential called an atopic march, where you start off with this barrier problem with the eczema. And then due partly to the eczema, you then get exposed to certain things in the environment such as grass, pollens. And that leads to sort of development of hay fever. And in some cases then again, this sort of exposure-, this exposure to allergens through the skin, can then lead to the development of things like asthmas as well. So that's why some of them it's to do with your immune response being overactive, and some of it's to do with your skin barrier being suboptimal. So it's those two things working together which mean you get this whole complex process.
And that's why some of it runs in families. So atopy we know is partly genetic, and some of it is to do with how well you manage your eczema, probably when you're small, and that can reduce your risk we think of going down this pathway.
And there's been an increase in eczema and other allergies over the past few decades, which is more than you would expect if this was just a genetic condition. So we know that it's not just people's genetics, it's a combination of environmental exposure, the way we manage eczema, the way we manage these other allergic conditions alongside, you know, the way your skin is when you're born.
Laura grew up with allergies and asthma, which link to her eczema.
Laura grew up with allergies and asthma, which link to her eczema.
Age at interview: 22
Sex: Female
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As I've been growing up I have begun to sort of see what I am allergic to. And it's not just eczema that like I have allergies with. Like, it brings…it worsens my eczema but it, also I have allergies like mouth reactions and things like that with other food types. So, things like, anything related to sheep – so lanolin, wool and things like that - I know to avoid. And so it's one of those things as a kid you just get told, "Don’t sort of stroke any animals; don’t stroke sheep especially; don’t wear things that are wool; don’t eat lamb," things like that. And also food groups such as like tomatoes and oranges I wouldn’t eat. Dairy, so when I was younger you sort of just know not to, and I guess also your… my Mum was sort of checking whether I was eating things.
Some people believed that they had allergy-based triggers for their eczema and tested these out by ‘trial-and-error’. Some had asked for allergy tests but been told by their doctors that they couldn’t have one done (for more on why this is, see the section on triggers).
Hazel says there are some triggers which make her eczema worse but has never had an allergy test to find out more.
Hazel says there are some triggers which make her eczema worse but has never had an allergy test to find out more.
Age at interview: 21
Sex: Female
Age at diagnosis: 3
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Is there anything else to do with sort of shared accommodation whilst you’ve been at University and like, since you’ve graduated?
I lived in like a really mouldy room two years ago which wasn’t great, and I noticed that that did have quite a big impact on like how everything was with sort of particularly like my hands and my elbows, that was quite severe. But, it got better after I moved out which was good [laughs].
So, have you ever done any allergy tests at all?
No, I haven’t actually. I would be interested in doing that just to know if there's anything that… like I’ve never know if I'm allergic to pets, but I've never had a reaction around pets so I don’t know. Or, like I've never had hay fever or anything like that but I would be interested to know if it's something specific, like dust or mites or something like that, but yeah.
Naomi was unsure about the links between eczema and asthma, but found that there were some shared triggers.
Naomi was unsure about the links between eczema and asthma, but found that there were some shared triggers.
Age at interview: 17
Sex: Female
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But I don’t know if it was linked though. Cos I know a lot of people have…you know if they have eczema, they most likely will have asthma as well, or if they’ve asthma they’ve got a bit of eczema. Like my brother has severe asthma and he only gets patches of eczema, only like yearly. So, I think it is…I think it must be linked.
Yeah
Is it similar, like triggers that you said about pollen and flowers?
Yeah
Is it mm?
Going outside [laughs] makes me go, "No, can't breathe, go inside." You know, walking and…and now it's really weird – my asthma is bad in the winter, it's very bad, a very…when I recently went to my GP, well the nurse, my nurse practitioner, she was like, "You have to go and see the asthma nurse." I haven’t done it yet, that’s really bad, cos she felt…she heard my chest, said, "That’s really, really, you know very inflamed, you should sort it out." And I said, "Oh it's cos it's the weather." When it gets warmer my asthma's fine, though my eczema – it's never fair on me that, you know. Uh times like Spring isn't too bad because it's a mixture, you don’t have weeks of hotness or weeks of freezing temperatures you know. So, it is a nightmare cos you can't win.
After reading about allergies and eczema online, Abid asked his doctor for a test but wasn’t given one in the end.
After reading about allergies and eczema online, Abid asked his doctor for a test but wasn’t given one in the end.
Age at interview: 24
Sex: Male
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I read into it and it was like don’t eat this, this, this. Also you can get your doctor to, to get some kind of like a stickers on your body or something like that and they can test what you’re allergic to and not allergic to and I was like “okay this is cool”.
Straight up went to my doctor said ‘Oh I’d like to be tested for what I’m allergic to’ and ‘Nah sorry we can’t really do that we don’t really have the facilities or I don’t think this would affect your eczema in any particular way’ or you know, these, these kind of like half-hearted jargon filled answers which you’re kind of expected to just kind of be confused and mildly acceptant of. So I got a lot of that and then it was yeah it w-, it was kind of a situation where just deal with it yourself.
Some people described their eczema getting worse because of certain things (irritants), such as the weather/temperature suddenly changing or living in a damp house, and allergies. A few people said that some of their eczema triggers affected people without eczema too, such as skin reactions to metals used in cheap jewellery. Shams said that some of his food allergies have faded away with time but dust still causes his skin to react. See also, ‘Eczema triggers: what can make eczema worse?’.
Cat says that her eczema is unrelated to asthma and hay fever, but there are some triggers (like perfumed bath products) which make her skin flare up.
Cat says that her eczema is unrelated to asthma and hay fever, but there are some triggers (like perfumed bath products) which make her skin flare up.
Age at interview: 24
Sex: Female
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Are there any other health conditions that you have which interact with eczema at all?
No, so I think they were convinced I should have like asthma and hayfever, or… someone in my family should, but no-one does so, sort of the lucky one, or the unlucky one that got it. So, yeah that’s always one of the first questions they… ask as well, sort of hereditary; and yeah I don’t know how you know if you’ve got asthma, but I don’t think I have so, I'm sure I would have found out by now. But yeah so… none of the other ones that normally go with it.
Eczema subtype: discoid
Discoid eczema is a kind of eczema that often looks red and flaky and appears in circular patches or clusters on the skin. It is sometimes confused for another skin condition because it looks different to ‘typical’ eczema. Evie developed some discoid eczema on her legs a few months ago as well as having eczema on other parts of her body, such as her hands and feet. Evie said that she felt more self-conscious about having discoid eczema because it looked different to ‘typical eczema’ and so other people might not understand what it is. The topic of having eczema which is different in some way to what is assumed to be ‘normal’ is also discussed in the ‘Eczema and different areas of skin’ section.
The British Association of Dermatologists websites offers ‘Patient Information Leaflets’ for more detailed information on the types of eczema.
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