How to manage eczema – according to a dermatologist
For the one in 10 adults who will develop eczema at some point in their lifetime, and one in five children, life can be pretty miserable.
Eczema is the term for a group of inflammatory skin conditions that causes itchiness, dry skin, rashes, scaly patches, blisters and skin infections.
“It’s one of the most common conditions that we see in general practice, affecting people from all age groups,” says Dr Nisa Aslam, a GP who specialises in skin conditions at The Skin Life Sciences Foundation.
And it’s a problem that often runs in the family. “The majority of people who have eczema will have what we call atopic dermatitis, which is a genetic type of eczema,” says Dr Zainab Laftah, a consultant dermatologist and British Skin foundation spokesman.
As it’s common for the condition to suddenly flare up for the first time in adulthood – even in your 60s or 70s – knowing what it is and how to manage it is essential.
What causes eczema?
In people who suffer from eczema, there is a gene mutation that means their skin barrier function isn’t as intact as someone who doesn’t have that mutation. “Their trans epidermal water loss is much greater and allergens and irritants in the environment like perfumes and dust mites can get into the skin and cause irritation. People with eczema are genetically primed so that their immune system overreacts to the constant environmental triggers,” says Dr Laftah.
Cases of eczema are on the rise, especially among children and teens. “Our modern lifestyle doesn’t help because we have more triggering factors,” says Dr Aslam. Chemicals in exhaust fumes, carpets and memory foam mattresses are thought to be a trigger. “Things like perfumes, detergents, cosmetics, synthetic fabrics and even having hot showers can wreak havoc on the skin barrier. Perhaps that’s why you see more skin conditions compared to maybe 100 years ago.”
Long hot showers have especially been found to be a problem in areas where the water is hard, says Dr Aslam, particularly in winter when flare ups are more common due to changing temperatures and dry air from indoor heating. “If you have a predisposition to eczema, it will make your skin barrier worse,” she says.
The symptoms of eczema
The main symptom is patches of skin that are itchy, in some cases extremely so – 79 per cent of sufferers identify itch as their most burdensome symptom. In fact, a team of Harvard scientists recently identified the bacteria responsible for the urge to scratch and are working on a treatment. Skin will also be dry, cracked and sore. It can affect the body or the face, making sufferers self-conscious. Depending on the type of eczema, blisters or lesions can form, and the skin becomes scaly and flaky. You may even experience oozing or crusting and areas of swollen skin.
A “flare-up” is a phase of eczema that causes one or more acute symptoms or side effects from prolonged itchiness. Common sites for patches to appear are the creases of the skin, especially the areas behind the knees, elbows and other areas that rub against each other. Eczema appears differently in different skin tones; pale skin can become bright red and rashy, whereas darker skin tones can appear pale, grey, ashen or purple.
What can trigger eczema?
Triggers vary from person to person, and include detergents, wool, house dust mites, pet fur, pollen and mould. Some people’s triggers include metals, especially nickel, and others find certain foods can be a trigger, such as cows’ milk, eggs, peanuts, soya or wheat. “An acupuncturist recommended I go dairy-free, and it’s really helped with my eczema,” says Nic Wordsworth, a lifelong sufferer from the condition.
Other triggers are hormonal changes, such as menstruation and pregnancy. Some people find their symptoms are worse when the air is dry or dusty, or when they are stressed, sweaty, too hot or too cold.
What are the different types of eczema?
Atopic dermatitis: The most common form of eczema, it causes the skin to become itchy, dry and cracked. It’s common in small children, but can occur at any age, and children who have family with the condition are more likely to develop it too. People who have asthma and/or hay fever or have family members who do, are more likely to develop atopic dermatitis.
Contact dermatitis: This form of eczema, also called allergic contact dermatitis, is brought on by contact with a particular substance or environmental trigger, such as nickel-containing jewellery, detergents and scratchy wool. Unlike other forms of eczema, it doesn’t run in families and is common in people whose professions involve daily use of chemicals.
Dyshidrotic eczema: Causing blisters on the soles of the feet, palms of the hands and around fingers and toes, this type of eczema is common in families who suffer from another form of eczema. It is most common in young adults and women.
Neurodermatitis: This is a type of eczema (lichen simplex chronicus) that develops into scaly itchy patches when nerves in the skin overreact, and often begins when a person experiences stress, anxiety or depression.
Nummular eczema: This form of eczema, also called nummular dermatitis or discoid eczema, creates small, rounded painful lesions all over the body, especially on arms and legs, and may be a reaction to previously harmless substances like soap. Sufferers may have a history of atopic eczema.
Seborrheic dermatitis: In children this is known as cradle cap and is an inflammatory form of eczema which affects your scalp, face and chest, areas with large numbers of sebaceous glands. It is believed to be an inflammatory reaction related to an overgrowth of normal skin flora. It may be aggravated by illness, stress, tiredness and changes of season.
Stasis dermatitis: Also known as varicose eczema, this causes a skin discoloration on the legs which looks similar to varicose veins. It develops in people with poor blood flow, and if left untreated, can cause leg ulcers to develop.
Who is more likely to get eczema?
Eczema can begin at any time during childhood, adolescence or adulthood. Newborn babies can experience eczema within the first weeks after birth. Young children with eczema can get blisters and skin infections due to scratching. Adult eczema most commonly crops up when someone is in their 20s or over the age of 50.
Menopause can be a time when women experience flare ups, in some cases for the first time. Says Dr Laftah: “When you’re menopausal, your oestrogen levels drop significantly and that affects the hydration of your skin, which is more likely to allow allergens in the environment to get into the skin, causing irritation. Also, your skin is more sensitive to those allergens, and so you’re more likely to have irritant dermatitis”. Often this will occur in people who have a history of hay fever or asthma when they were younger. “It’s likely that they have a genetic predisposition to getting eczema, but never had any issue their entire life.”
Can eczema be prevented?
Eczema is a chronic disease that can last your entire life, with periods of intense flare-ups and months or even years of no symptoms at all. It is not contagious and there is so far no cure, but there are many ways to treat and manage eczema. No matter what your triggers, once identified, the crucial thing is to keep your skin moisturised at all times, as when it dries out you’re more at risk of a flare-up.
“While it’s important to shower every day to reduce the bacterial load on your skin, try to keep that shower relatively short to avoid problems linked to hard water, and be careful not to use fragranced products like shower gels. Even unperfumed soap can dry out the skin, so use a soap substitute, ideally prescribed by the GP,” says Dr Aslam.
In cases of facial eczema, it’s important to use the right beauty products in order to prevent a flare-up. “The inappropriate use of topical skincare products in people that have eczema can significantly exacerbate their condition. Get advice from a medical doctor with experience in the use of topical products and procedures for their condition,” says the beauty scientist and aesthetic surgeon Dr Jonquille Chantrey.
The best eczema treatments
Moisturisers, antihistamines, topical steroid creams and corticosteroids are among the treatments for eczema, and it’s vital to get a diagnosis, especially as eczema is sometimes confused with other skin conditions, like psoriasis. Severe eczema comes with additional complications beyond itchy skin and rashes, and can require treatment in hospital if left untreated. Finding the right treatment for you can be a matter of trial and error.
Other treatments for eczema sufferers include medicated skin tape, such as Fludroxycortide Tape. “This works really well when the skin barrier is damaged, almost as a proxy skin barrier, helping retain moisture and allowing a consistent dose of steroids to enter the skin, unlike ointments and creams that can rub off,” says Dr Aslam.
Phototherapy – also known as light therapy – is another form of treatment available. “On a particular wavelength it activates your own natural immune cells in your skin, causing an anti-inflammatory response, which then reduces your eczema,” says Dr Laftah. And while some people with eczema have to stay out of the sun, others find it can be beneficial (using a mineral-based sunscreen). “Some patients find a little sun exposure helps but you want to minimise the risk of premature skin ageing and skin cancer, so it has to be done in a safe manner, says Dr Aslam.
Your doctor may prescribe an immunosuppressant, to help control or suppress the immune system in order to slow down the symptoms of eczema, or an injectable biologic drug such as Dupixent, that targets a specific area of the immune system and inhibits the inflammatory effects that cause symptoms.
Some aesthetic treatments can be beneficial for cases of facial eczema – particularly injectable skin boosters which contain hyaluronic acid. “Its use is widespread to deliver direct increased skin hydration capacity in cases of eczema where there is skin barrier dysfunction. Anecdotally, many patients suffering from eczema see an improvement of their symptoms and skin quality with this treatment and, certainly, I have observed this in my clinical practice,” says Dr Chantrey.
Are there any long-term effects?
Studies of people living with eczema found that trouble sleeping is one of the most common adverse effects and this can impact your mood, activity levels and mental health. An antihistamine can help ease itchy skin at night. Severe eczema can lead to embarrassment and isolation, which is especially difficult for children who may be bullied or teased. Research suggests people with the condition have higher rates of depression, anxiety and thoughts of suicide. Researchers have also found a higher incidence of heart disease, high blood pressure, stroke and diabetes, although they aren’t sure what the connection is between these conditions and eczema.
As repeated scratching can break open the skin, this can lead to infections like boils, herpes, impetigo and cellulitis. Research suggests a 62 per cent increase in hazard of death in those with severe eczema in the UK population, and it’s vital to get medical treatment such as antivirals and antibiotics right away if you think you have a skin infection.
Are steroid creams safe to use long-term?
Using topical corticosteroid creams to treat eczema is safe, as long as they’re applied as advised by your doctor or dermatologist. People using them for long periods of time can suffer rare severe skin withdrawal symptoms such as redness and a burning sensation, in which case guidance is needed from your doctor before using such products again. It’s advisable to check with them that you have been prescribed the lowest potency of topical corticosteroid needed to effectively treat the skin disorder.
For more information go to eczema.org.
