Eczema is very common in children and causes huge misery and upset for them and their families.

Over the past decade progress in the understanding of the pathogenesis of eczema and the publication of a NICE guideline on management have been made but the main cause of treatment failure is still non adherence to the application of topical treatments. Pharmacists are ideally placed to address this

This week Jean Robinson looks at:

  • Skin barrier function and disease
  • Use of emollients
  • Adverse effects of Aqueous cream on skin barrier
  • Adverse effects of olive oil on the skin barrier
  • Use of topical corticosteroids

Atopic eczema (synonym atopic dermatitis) is a chronic inflammatory, relapsing and remitting and itchy skin condition.

It now affects around 20% of children in the UK - most have mild disease but around 15%of sufferers will have moderately severe or severe disease.

Classic symptoms include dry skin, itching, rubbing, scratching, inflammation, infection, fissuring, excoriation and lichenification or thickening.

Itchy children can be very miserable, irritable and fail to thrive. Interrupted sleeps causes problems for the child and the whole family.

Children may also suffer at school due to bullying, absences, poor self-esteem and poor performance.

In healthy skin the stratum corneum (the outer level of the epidermis) is a strong barrier that controls transepidermal water loss and stops the influx of allergens and irritants like infection.

The stratum corneum has been described as a ‘brick wall’ where the ‘bricks’ are corneocytes.

These contain high levels of natural moisturising factor (NMF) that attract water leading to swelling and a smooth physical barrier.

These ‘bricks’ are surrounded by a ‘mortar’ made up of a lipid matrix.

In eczema skin barrier gene mutations predispose to a defective barrier and there are reduced levels of some lipids or ‘mortar’ leaving gaps between the bricks, which allows greater transepidermal water loss and the entry of allergens and irritants like infection.

It is thought that the interplay of genetic and immunological factors with environmental exposures (soaps, detergents) combine to increase skin barrier.

Join us tomorrow as we being to investigate the pharmacist’s role in treating eczema and the use of emollients.