Your skin, allergies and summer eczema flares
Sometimes medical problems show up at exactly the wrong time, like a stomach bug just before Thanksgiving. This is usually just bad luck, but some conditions are more likely to flare up at the most inconvenient times, like anxiety before public speaking. Eczema can fall into this group too — just when the weather is getting warmer and we are looking forward to shorts and T-shirts, an eczema flare can cause us to feel self-conscious about our skin.
Eczema is an inflammatory condition that often causes itchy, rough skin. It most commonly affects children but can continue into adulthood. Eczema is also referred to as atopic dermatitis, and often runs in families when other family members also have ‘atopic’ conditions including eczema, allergic rhinitis or asthma.
Eczema is a chronic condition that can come and go, but like the other atopy disorders, it is prone to flares during allergy season. Blooming flowers and budding trees may be nice for enjoying nature, but they can be bad for eczema. In my family, we have atopic conditions including eczema and asthma; springtime get togethers can also include an unpleasant trio of itchy skin, sneezing and wheezing among us. This time of year is a good time to review managing eczema.
Before going to medical school, I hadn’t thought much about why skin is important medically. The function of the skin, as it pertains to health, is to establish a barrier between the rest of the body and harmful substances in the environment. For the skin to do its job, it needs to block out irritants without being too affected by them. Essentially, we want “thick skin.” The problem in eczema is that the skin becomes irritated and when this happens, the barrier begins to break down. This leads to even more irritation in a what can be a runaway cycle.
Home treatments and recommendations that are helpful for eczema can also be helpful for skin that is dry and itchy but isn’t eczema. So, what is the difference? Patients with eczema do often have dry, itchy skin, but eczema often shows up as a discrete rash and can be associated with changes in skin pigmentation (lighter, darker or red). Eczema starts in childhood and is a chronic or recurrent condition. It often feels bumpy or scaly and can have a crust. Commonly affected areas include areas where skin folds, like behind the knees, opposite the elbows, or parts of the neck, ankles or wrists. Most patients with eczema have a family history of eczema, asthma or allergic rhinitis. Still, it can be tricky to tell, so the diagnosis should come from a healthcare professional, especially when considering more advanced therapies.
Reestablishing the skin’s protective barrier, or preventing its breakdown in the first place, is an important first step toward skin health. Natural oils on the skin surface are part of this natural, healthy barrier. Hot water can melt the oils away, so people with a history of eczema can start by using warm, not hot, water to shower, bathe and wash their hands. Stringent soaps can have the same effect, so using a gentle soap that preserves more of the skin’s natural oils and limiting soap to the times and places it is necessary can also help to prevent eczema flares and reestablish a healthy skin barrier.
Replacing and supplementing the skin’s natural oils using a skin emollient is also an important strategy for maintaining skin health. I recommend to my patients that they use creams, like Cetaphil or Cervae, or ointments, like Vaseline or Aquaphor, rather than a lotion. Creams and ointments tend to moisturize more effectively than lotions and are a better choice for patients with eczema. Using one of these products right after bathing is a good idea because it is the time when our skin’s natural oils are most depleted.
Avoiding hot water and using a moisturizing cream or ointment is good practice for preventing or aggravating eczema flares but is often not enough to treat a flare of eczema. Since irritation and inflammation are involved in breaking down the skin barrier and perpetuating the cycle of eczema, break that cycle by addressing irritation and inflammation.
This can be done effectively with topical steroids, some of which are available over the counter such as hydrocortisone. The ointment formulations tend to be the best for eczema because they create a better barrier. If over the counter products aren’t working effectively, I will often prescribe patients a higher potency topical steroid.
Topical steroids are usually well tolerated but can have side effects when used incorrectly. For a new flare of eczema, it is reasonable to apply a topical steroid to the affected area twice per day for up to two weeks at a time, but then it is important to stop using it on that area for at least one week. When using topical steroids on a longer-term basis, I recommend applying it twice per day for up to one week and then rest for one week before repeating the cycle if needed. In general, topical steroids shouldn’t be used on the face. Chronic use of topical steroids can lead to a bleaching affect – lightening in color relative to surrounding skin. It can also cause thinning of the skin and easy bruising. Using topical steroids appropriately makes these effects less likely.
When home treatment and conservative therapies fail and the eczema isn’t responding, there are more advanced therapy options. These may come in the form of light therapy, medications, or injection medications. If you or a family member are struggling to control eczema with conservative therapies, try talking with a healthcare professional. The FDA recently approved lowering the approved ages for some injection therapy for eczema. Younger patients may now be eligible for therapy they couldn’t access before.
Remember that newer doesn’t always mean better. Injection therapies can be expensive and carry more risks. A discussion with your healthcare provider can help to explain and understand the risks and benefits of all your options.
We know in our family it can be difficult to cope with the itchy, dry feeling and rashes of eczema just as the sun is out and we’re getting into shorts and swimming again. It’s a condition that many people can manage well with maintaining the skin’s natural barriers and countering flare ups before they worsen, so you can get out there and enjoy the blooms.
Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.
This article originally appeared on Kitsap Sun: Your skin, allergies and summer eczema flares
