Eczema - a global epidemic

Eczema is now a worldwide epidemic. In the UK up to one-fifth of school-age children and one in 12 adults suffer from it.

It is itchy, painful and often unsightly, reduces the quality of life and is one of a group of disorders including allergies and asthma that are becoming increasingly common.

Theories why abound, and range from simple heredity, to food allergies and reactions to common drugs, including vaccinations, antibiotics and paracetamol.

The most recent theory is the so-called 'hygiene hypothesis', which claims that by protecting babies and children from exposure to dirt and germs and by preventing disease from taking its full course in childhood, we are inadvertently destroying the immune system's ability to respond appropriately to infection and other stimuli.

Proponents argue that children who grow up on farms and are exposed to a wide range of germs from an early age, rarely get atopic eczema. Likewise children from big families, who are routinely exposed to childhood diseases, almost never develop the disease.

The known causes of eczema are many and varied, with some types caused by irritants such as chemicals and detergents, allergens such as nickel, or yeast growths. In elderly people, eczema can also be caused by circulatory problems.

But the cause of the most common type, atopic eczema, remains a mystery. Atopic eczema is characterised by people experiencing an excessive immune reaction to normally harmless substances, such as house dust. It affects both children and adults, and associated conditions include asthma and hayfever.

Experts think this type of eczema may be hereditary, because it seems to run in families, but links with environmental factors and stress are also being explored and the following factors have been identified as possible triggers:

Psychological factors - such as stress and anxiety.

Irritants in the home or environment - such as dust mites, animal dander and certain plants.

Foods - especially eggs, peanuts, milk, fish, soy and wheat.

Drugs - ironically, the steroids used to treat eczema can sometimes aggravate the very condition they are meant to treat. Other drugs that can cause flare-ups include antivirals, antihistamines, antiparastics, anaesthetics and anticancer drugs.

Industrial and chemical irritants such as detergents (shampoos, body washes and bubble baths containing sodium lauryl sulphate), biological washing powders and chlorine in swimming pools.

Climate - low altitudes and low humidity worsen symptoms. Central heating and woollen or synthetic clothes can also make itching worse.

Food additives - including a range of commonly used preservatives and colourings.

There is currently no cure for atopic eczema. Conventional treatment focuses on keeping skin moist with emollient creams and ointments and reducing inflammation. This usually involves topical steroid creams, antibiotics and anti-inflammatories.

The problem is that these prescription drugs need careful monitoring and are not ideal for long-term use. Research has shown that prolonged use of steroids, in particular, can cause a range of side effects, including brittle bones, liver and kidney damage, adrenal suppression, eye damage and, ironically, allergic skin conditions.

In addition, they don't always work. A recent US patient satisfaction survey found that a third of parents of children being treated with topical steroids considered the drugs to be ineffective ¿ even when the medications prescribed were moderate to high strength.

That said, the first step in effective treatment of eczema is a correct diagnosis. It is very important to see a general practitioner in the first instance, who may make a referral to a specialist dermatologist for further diagnosis and treatment.

One of the problems with atopic eczema is that every case is different, so what works for one person won't necessarily work for another - and conventional treatments don't always bring relief. In those cases, it's worth trying folk remedies such as milk, yoghurt and even tea bags to relieve itching, and the following alternatives may be worth exploring.

Homeopathic desensitisation - uses minute amounts of common allergens, such as house dust, to calm the immune response.

Essential fatty acids - found in oily fish, evening primrose oil or borage oil - may help reduce symptoms. (Conversely, a high intake of trans fatty acids, found in meat, milk and margarine, may worsen symptoms.)

Oolong tea - evidence continues to mount that tea has many benefits, and Japanese researchers recently found that oolong tea can help reduce eczema symptoms. Oolong tea contains powerful antioxidants called polyphenols and unique flavonoids which may account for its efficacy.

Probiotics - 'friendly' gut bacteria such as lactobacillus acidophilus and bifidobacterium (found in live yoghurt) have been found substantially to reduce the severity of atopic eczema in babies. There is thought to be an important interaction between intestinal microbes and immune function.

Softer water - researchers have found that hard water can make eczema worse. In severe cases, sufferers might consider installing a water softener.

UV light therapy - carefully controlled sun exposure can help reduce symptoms.

Herbs - researchers believe Oregon grape root(Mahonia aquifolium) to be one of the most promising non-drug treatments for eczema and psoriasis.

Massage - soothing contact may be a key to healing. People with skin conditions often miss out on physical contact because other people are either worried about hurting them or afraid the might 'catch' something, yet studies have shown that childhood eczema in particular can be helped by regular massage.