Did you know that eczema affects over 35 million people in the USA alone? And while it may not be a life-threatening disease, it can seriously impact your quality of life. With key symptoms being excessive itching, redness, and inflammation, knowing how to identify the skin condition and minimize the symptoms can make a huge difference. We covered all of the above, and more, with the help of Dr. Adam Friedmann, consultant dermatologist at Stratum Clinics. We asked him everything from the causes of eczema to the best method of treatment.
What is Eczema?
Dr. Friedmann begins; “Eczema (also known as dermatitis) is a long-term condition that causes inflammation of the skin characterized by redness, swelling, itching and dryness, and cracking of the skin. The most common form of eczema is atopic eczema, which can affect any part of the body but is often found inside the elbows, knees, on the neck, hands, cheeks, and scalp.”
If you’re left questioning whether you have eczema, Dr. Freidmann explains “The key feature of eczema is that it’s itchy. This can be a minor distraction or a major feature that interferes with your life and could prevent sleeping, working, and concentration. In children, it can prevent sleep which causes unhappiness at home. When the condition causes redness and thickening of the skin it can affect one’s appearance and confidence.” Dr. Friedmann adds that in more severe cases, acute eczema can appear, “Red with swelling of the skin, sometimes to the point of tiny blisters or vesicles. It’s often symmetrically distributed. Chronic eczema that has been rubbed repeatedly might be thickened (or lichenified) and darkened.”
It’s helpful to know that you can develop eczema at any time, however, Dr. Friedmann does highlight that, “Eczema is most common in children and can improve over time, although many adults find that they still have flare-ups of eczema during periods of stress. Adult eczema can develop at any stage and is commoner in patients with other atopic conditions.”
What Causes Eczema?
“The cause of atopic eczema is unknown but is associated with a genetic tendency and often multiple minor allergies. Atopy means an association with other ‘atopic’ conditions including asthma and hay fever,” says Dr. Friedmann. He continues to explain that while the exact cause may remain unknown, what’s important to learn are your triggers. “Eczema flare-ups are often triggered by things such as soap, laundry detergent, stress, the weather, and occasionally food allergies.”
Dr. Friedmann tells us there are many different causes for the different types of eczema:
Atopic eczema: “Common in children and related to other allergic conditions such as asthmas and hay fever.”
Allergic contact dermatitis: “Eczema caused by an allergic reaction to something coming in to contact with the skin (such as fragrance or hair dye). This can be identified by means of a patch test.”
Irritant contact eczema: “Eczema caused by a chemical irritating the skin (such as soap or disinfectants).”
Lichen simplex chronicus: “A thickened itchy area caused by repeated rubbing and scratching.”
Nodular prurigo: “Similar to lichen simplex, multiple small itchy areas of thickened inflamed skin.”
Asteototic eczema: “Dermatitis due to dry, cracked skin that occurs with age.”
Drug-induced eczema: “Eczema that might resemble any of the above types, but that is caused by medications.”
Pompholyx/Dishydrotic eczema: “Itchy tiny blisters (or vesicles) occurring under the skin on hands and feet.”
Eczema Rule 1: Try Not to Itch It!
Before we get into our treatment guide, we’ll cover one of the most obvious recommendations: try not to scratch it (we know it’s hard)! While eczema flare-ups may be itchy and uncomfortable, Dr. Friedmann insists you should resist: “Scratching the skin provides immediate short-term relief, but ultimately prolongs the problem by introducing bacteria to the broken skin and causing further infection and inflammation.”
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Unfortunately, Dr. Friedmann confirms that “There’s currently no known cure for eczema, though many articles in the media suggest otherwise.” Instead, “Treatment is focussed on the symptoms and minimizing the triggers.” Learning what triggers a flare-up should be your main priority, as you can then minimize the risk. Some common triggers include stress, sweat, allergies, as well as a change in temperature. The good news is “Often people’s eczema will clear spontaneously over time,” notes Dr. Friedmann.
When it comes to treating and soothing eczema, Dr. Friedman says the key thing is “To fix the skin barrier to keep the water in (stop water loss) and keep the allergens and irritants out.” Therefore, you need to ensure your skin stays hydrated. Dr. Friedmann says, “It goes without saying that you should regularly moisturize to retain the skin’s moisture – when your skin gets too dry, it can easily become scaly or rough which can lead to an eczema flare-up.”
Dr. Friedmann outlines the best plan of action when treating eczema. First, he begins by noting; “The treatment of eczema will depend on the severity. However, in the first instance creams will be recommended to wash with including emollients (moisturizers used daily to stop the skin drying out), soap substitutes, and non-steroid drugs such as Tacrolimus and Pimecrolimus: both of which are available in the UK and have been for years.”
How to Use Steroid Creams to Treat Eczema
One of the most popular treatments for eczema is topical steroids. Dr. Friedmann explains how they can help, “Topical steroids are a valuable tool in the treatment or control of eczema, particularly during a flare-up. They can reduce redness and inflammation and make the skin less itchy and sore, giving it a chance to heal.
However, as steroids are very potent, you need to use them carefully and with a prescription. “Problems arise when steroids are misused: if instructions for the treatment are followed correctly, the skin can recover properly, and eczema will be much easier to manage,” says Dr. Friedmann.
If you’re looking for an alternative to steroids, Dr. Freidmann recommends “Non-steroids such as tacrolimus and pimecrolimus (which will also become available as a tablet at some stage), as they offer a useful alternative to steroid creams without the side effects.”
In-Office Treatments to Help Soothe Eczema
As with most skin conditions, there are some great in-office treatments to help lessen the severity of eczema. Dr. Friedmann told us that, “ Allergy testing is the commonest investigation that if positive, might identify a cause for eczema and allow improvement through avoidance.” Plus, while you’re at the derm’s office, the “Dermatology nurses will often be able to demonstrate how to use creams and moisturizers effectively particularly in children.”
Another form of therapy for eczema is Phototherapy, which Dr. Friedmann explains is “a treatment option that involves precise doses of ultraviolet light being delivered by a medical UV-machine. Phototherapy (ultraviolet light treatment) can be administered in a clinic and might bring about some good control of the disease.”
What to Avoid if You Have Eczema
If you have eczema, Dr. Friedmann says it’s best to “Avoid irritants such as soap, wipes, fragrances and wash with creams such as aqueous cream or Dermol.” Adding, “Make sure you use laundry products that are specifically designed to be kinder to sensitive skin that doesn’t contain any unnecessary ingredients which could irritate skin – no enzymes, dyes, acids or perfumes.”
Another daily thing to avoid is extremely hot water. “When bathing use warm water as hot water can make eczema worse, and keep baths short as the skin can get irritated if kept in the water for too long,” says Dr. Friedmann.
Finally, he tells us, “If you’re a swimmer, it’s important to be careful of chlorine in pools as this can irritate eczema – eczema sufferers should take a shower before going into the pool and moisturize well before getting in. Ensure you shower afterward and moisturize well before getting dressed.”
For more tips on how to treat sensitive skin, read our sensitive skin guide.