The Dermatica perspective on treating eczema

The skin condition we call eczema can range from mild to severe and living with it can be challenging. There is no cure but it can be treated and the risk of flare-ups can be reduced through preventative measures. This is the Dermatica lowdown on this everyday irritation.

What is eczema?

Eczema, also known to skin scientists as atopic dermatitis, is a chronic dry and itchy skin condition that usually begins, and hopefully ends, in childhood but can also develop for the first time in adult skin.

How do I know if I have eczema?

Eczema is typically dry, cracked patches of itchy skin that can be found anywhere on the body, and in all shapes and sizes. 

The most common areas affected, in children, are elbow creases and the backs of knees. In babies, eczema is often on the cheeks and around the ears, though patches can appear on the body too.

Adults tend to have eczema on the hands, eyelids, back and chest. Again, it can be anywhere on the body.

Eczema rash is usually itchy which naturally leads to constant scratching, then irritating and inflaming the skin. This in turn causes the classic itch-scratch cycle causing the skin to thicken through time. This thickened skin is called lichenification. These patches are usually darker in colour than the surrounding skin.

One type of eczema – often mistaken for ringworm – is discoid eczema. As in ‘disc-shaped’. As the name suggests it’s a round patch of dry skin which can appear anywhere on the body. The way to differentiate between this and ringworm is in history (your family history, previous allergies, hay fever, etc) and the number of patches. If there is eczema on other parts of the body, it is likely to be discoid eczema and not ringworm. If there is a single round patch, then ringworm would be considered as a diagnosis. Skin scrapings can be carried out to identify the cause.

What causes eczema?

There is no single cause. Normally several factors are involved:

Genetics: You may be born with skin that is less efficient in maintaining hydration. Skin that struggles to lock in moisture becomes dry and cracked. Simple as that. It’s quite common for eczema to run in families. If one of your parents or siblings suffers from this, you are more likely to develop eczema.

Allergic history: If you have a history of atopic allergies such as asthma and hay fever you are more likely to have eczema. Again, this can run in families. Most children ‘grow out of’ childhood eczema but if there is a family history it is likely to stay into adulthood.

Allergens: Common allergens such as soaps, detergents, house dust mites, pet dander and some foods can trigger eczema or worsen the condition. Many eczema sufferers take allergy tests to try and find the allergen that might be causing the problem. If you take that option, it’s a good idea to keep a detailed diary of allergic experiences to help narrow down the cause. 

Other factors:  Extremes of weather, pollution and hormonal changes can trigger flare-ups or contribute to worsening eczema. 

Stress is also believed to be a factor since in stressful situations the body goes into fight-or-flight mode releasing hormones like adrenaline and cortisol, which may suppress the immune system and cause an inflammatory response in the skin. The National Eczema Association says that “anxiety and stress are common triggers that cause eczema to flare up, which then creates more anxiety and stress, which then leads to more eczema flare-ups.”

Tips to alleviate eczema?

Firstly, there is no ‘cure’. But the good news is it can be treated with a range of medicines but also, with the right care regime and preventative measures, it can often be kept at bay. It’s important to follow some basic rules:

Don’t scratch. Scratching can break the skin, which can lead to infection and make your eczema worse. Try to pat or rub your skin gently if it is irritating you. The key is to break the itch-scratch cycle that is so common, especially among children.

Keep your fingernails short. It’s a simple way to avoid the worst kinds of scratching!

Don’t bathe/shower in hot water. Use warm water instead.

Don’t wear clothing that is likely to irritate your skin. Avoid zips or accessories that might rub against eczema. Stick to natural fabrics such as cotton but be aware that fibres from wool can pull at dry skin.

Avoid potential or known allergens. It’s obvious but bears repeating.

Don’t use soaps and abrasive skincare products. See below.

Avoid stress. If you can break the stress-eczema-stress cycle you remove a potential trigger for flare-ups.

How to manage eczema: The importance of hydration

Eczema is a dry skin condition so it goes without saying that it’s really important to keep your skin hydrated.

Moisturisers:

Moisturisers come in various forms – lotions, gels, creams, ointments. Generally speaking, the oilier the moisturiser the better it will hydrate and therefore the better it will be in combating itchiness. Ointments, for example, usually contain fewer preservatives than creams so are usually less irritating and less allergic but they are oily, which isn’t ideal for some people. This is where lifestyle is a consideration. Because, for any treatment to be effective it has to be compatible with your lifestyle, which is why we would recommend sticking with the moisturiser you use on a regular basis. If you feel comfortable using it, you’re more likely to use it.

Soap substitutes:

Don’t use soaps and abrasive products that will strip your skin of its natural oil. Dry skin will just become drier. Emollients/moisturisers can be used as soap substitutes. Examples include Aproderm, Dermol, Aveeno, Epaderm and Hydromol. Some of these products also come in a form designed to be used in the shower and bath; for example, Oilatum shower or bath gel etc. Most moisturisers can usually be used as soap substitutes – Hydromol or Aproderm ointments are good examples– and although they may not foam up like ‘regular’ shower and bath gels, they will clean just as efficiently without drying the skin.

Steroids:

Steroids also called corticosteroids (not to be confused with anabolic steroids used to enhance performance in athletes) are very effective for the treatment of eczema. They are often prescribed by medical professionals because they reduce inflammation of the skin. Depending on the severity of your eczema you will be prescribed different strengths of steroid until the eczema is under control. When steroids are used correctly, under supervision, the risk of side effects such as thinning of the skin, discolouration and acne will be reduced. 

Steroid sparing creams and ointments (steroid-free):

These are the calcineurin inhibitors: tacrolimus (Protopic) and pimecrolimus (Elidel) ointments. They reduce the immune response and have anti-inflammatory properties. These are used in sensitive areas of the body such as the face and around the eyes. They are very photosensitive and care must be taken to use a good sunblock.

Wet wraps and bandages:

Bandages cover weepy skin and protect the skin from infection and prevent direct scratching.  Using wet wraps also continuously moistens the skin which can be soothing and particularly useful for babies and children with widespread eczema. 

Antihistamines:

Antihistamines are very effective in helping reduce itchiness. One side effect is drowsiness, which might be considered useful when taking the tablets at night by reducing the itch and helping you sleep. Being kept awake by itchy skin can be a source of even greater irritation! However, if you are taking antihistamines during the day, or your occupation requires you to be alert at all times there are plenty of non-sedating options.

Oral steroids:

Oral steroids are used for stubborn, hard to control eczema. They are used in short courses. 

Phototherapy:

If your eczema is widespread, another treatment option is light therapy (UVB) which can reduce the itch and inflammation.

Systemic therapies:

Immunotherapy and biologics may be considered for severe eczema. These should be monitored regularly and managed in specialist dermatology clinics. 

Retinoids:

Oral retinoids are used to treat some types of severe eczema – hand eczema, for example. Although topical retinoids such as tretinoin, adapalene and retinol are great for some types of skin conditions such as pigmentation problems and acne, they can aggravate eczema and rosacea. By increasing skin cell turnover, they cause sloughing of the skin resulting in dryness and flakiness. 

If you have eczema and also want to treat pigment problems, one way to tackle this is to try the lowest concentration of the retinoid creams and use only once or twice a week until your skin becomes more tolerant. Use regular moisturisers to counterbalance the dryness and, when out and about, use a good sunblock and follow these tips for preventing flare-ups… 

Our top 4 rules for avoiding or reducing eczema flare-ups

  1. Arm yourself with soap substitutes, good moisturisers (ones you’re happy to use), sunblock and antihistamines. 
  2. Manage your stress as effectively as possible with strategies that work for you e.g. regular exercise, yoga, Pilates and meditation.
  3. Avoid food and other allergens that you know can worsen your eczema. 
  4. Be mindful of – and try to pre-empt if possible – hormonal changes likely to cause flare-ups.


Cherry Armstrong
Cherry Armstrong
Dr. Cherry Armstrong is a physician with over 20 years' extensive clinical experience in Acute and Family Medicine. Dr. Armstrong was trained at the Royal Free Hospital, School of Medicine, University of London. With 8 years of experience as a Clinical Director commissioning NHS services, she has set up Community Dermatology, Cardiology and MSK Clinics (2008-2016). She was a Clinical Lead for Community Services, including Dermatology, Cancer Services, Adult Mental Health and CAMHS (2008-2016). Dr. Armstrong is Medical Advisor for L'Oreal and regularly gives presentations and teaches at GP and Nurses forums on common Dermatological pathologies in Primary Care.

Dr. Armstrong is a member of the Clinical Advisory Board here at Dermatica
Originally published February 12 2021, updated February 12 2021

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