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Eczema

An inflammation of the skin, often causing blisters, scaling and itching.  There are various types of eczema and some forms are more commonly known as dermatitis.  Eczema is occasionally the result of an allergy, but it is often of unknown cause.

Types

Atopic eczema

This is a superficial, chronic inflammation that occurs in people who have an inherited tendency towards allergy.  The condition is commonly seen in babies.  An extremely intensely itch rash appears, often on the face, behind the knees and in the elbow creases.  The skin usually scales and small red pimples can appear.  Infection can occur if the rash is scratched, breaking the skin.

For mild cases, emollients (such as aqueous or petroleum jelly) help to keep the skin soft.  In extreme cases, ointments containing corticosteroid drugs can be used.  Antihistamine drugs can be given to reduce itching.  Excluding certain foods from one’s diet can help to control the condition.  Atopic eczema usually clears up on its own as a child grows older.  Extreme atopic eczema that appears in adults can be treated with immunosuppressant drugs such as oral ciclosporin or topical creams. 

Nummular eczema

This often occurs in adults and the cause is unknown.  It produces round, scaly, itchy patches on the skin that are typical of those of ringworm.  Topical corticosteroids can reduce inflammation, but the eczema is usually persistent.

Hand eczema

This is generally caused by irritant substances such as detergents, but it can occur for no apparent reason.  Itchy blisters appear, often on the palms, and the skin can become cracked and scaly. Hand eczema often improves if emollients are used and if cotton gloves with rubber gloves over them are worn when coming into contact with irritants.  If the eczema is extreme, corticosteroids can be prescribed.

Stasis eczema

This appears in people with varicose veins.  The skin on the legs can become inflamed, irritated and discoloured.  The swelling of the legs can be controlled with compression stockings or bandages.  Corticosteroids ointment can give temporary relief.

 

 

General treatment

To lower irritation, a soothing ointment could be applied to the affected areas; these can then be covered with a dressing to stop scratching.  Absorbent, non irritating materials (such as cotton) should be worn next to the skin; irritants (such as wool, rough synthetics and silk) should be avoided.

 

Edward syndrome

A genetic disorder, also known as trilogy 18 syndrome, that is associated with the presence of a third copy of chromosome 18.  Edward syndrome affects about three times as many girls as boys. 

The characteristics of the syndrome include severe learning difficulties, a low birth weight, low set and malformed ears, hand abnormalities, a small jaw, congenital heart disease, opacities in the cornea, hernias and kidney abnormalities.

Roughly half the babies born with the syndrome do not survive beyond the first week of life.  A very few number of infants live longer than a year.  Those with a family history of the syndrome should consider genetic counselling before attempting to start a family. 

 

Effusion, joint

The accumulation of fluid in the space around a joint, resulting in limitation of movement, pain and tenderness, and swelling.  All joints are enclosed by a capsule lined with a membrane called the synovium.  The synovium usually secretes small amounts of fluid to lubricate the joint.  But if the synovium is inflamed or damaged it produces excessive fluid. 

The inflammation and pain can be relieves by analgesic drugs and nonsteroidal anti-inflammatory drugs and by having injections of corticosteroid drugs.  The swelling often reduces if the affected joint is bandaged firmly, rested, cooled with ice packs and kept elevated.  In some cases, the excess fluid is drawn out of the joint and needle.


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