We often think of eczema as a childhood condition, but the unfortunate fact is that it can enter our life at any point and stay as long as it likes. The vast majority of cases will become apparent in early childhood, around the age of twelve months, and from there will often follow a remitting (calm period) and relapsing (“flare up”) pattern until the child is school-aged. In severe cases, the flare-ups can be continuous and unrelenting, and they can present with hayfever and other allergies. As many as twenty percent of children will suffer from eczema, and up to ten percent of adults, making this one of the most common genetic diseases we encounter.
So What Is It?
Atopic Eczema (AE) is an inherited condition affecting the skin’s ability to heal itself. It results in chronic dryness, itching, redness and inflammation that can be categorised as mild, moderate or severe. It is not contagious, and frequently resolves by the age of six. It’s not uncommon for it to linger on into adolescence and adulthood, however, and can even disappear for years at a time before returning again. There is no cure for atopic eczema, but the symptoms can be managed to reduce the impact they have on the sufferer. It’s also important to remember that there is a light at the end of the tunnel – with careful management, symptoms can disappear for good.
What Are the Triggers?
We know that environmental factors play a huge role in the frequency and severity of flare-ups, but for each sufferer those triggers are different. For some, cleaning products will induce irritation, and for others it could be a change in the weather. Other common triggers include soaps and detergents, dust mites, surface sprays, pet hair, direct sunlight and even grass. Commonly, perfumed products will irritate the skin very quickly, and should be avoided. There are a large range of hypo-allergic, unperfumed skin products on the market, and they will play a crucial role in keeping the skin soft and moist. Always test sensitivity to new products by applying a small amount to the forearm first.
The best advice out there is to moisturise like mad. Moisturise multiple times a day, particularly after washing and bathing. Patches of eczema are prone to scaling and cracking, so keeping them moist is the first line of defence. Moisturising agents are commonly called emollients, and they should be selected in consultation with a GP or dermatologist. The best ones will be fairly thick and tend to absorb slowly, and can be purchased in cream, lotion and ointment form. Choose cotton clothing when dressing, which will help the skin to breathe and regulate body temperature better than synthetic materials, or wool which can induce itchiness.
Temperature can wreak havoc on sensitive skin, with heat and humidity causing swelling and sweating, and cool temperature inducing dryness. It can be a constant battle to maintain equilibrium, but there are a few ways you can minimise the impact. Staying in an air-conditioned environment during warm periods is common sense, but in those cooler months, when drying and chaffing are the primary issues, a mist humidifier can make all the difference. Showers should be on the slightly cool side, without being cold, with the aim being to retain some moisture. Instead of rubbing with the towel, the skin should be gently patted before moisturiser is applied. In bed, overheating should be avoided. A couple of lighter layers that can be peeled back will control the body temperature much better than a single, heavy doona.
The other nocturnal problem that may arise is sleep-scratching. It’s easy to lose discipline when an unbearable itch stands between you and a good night’s sleep. Cold compresses often provide relief, but the best you can do is keep nails short, and be prepared to sleep with cotton gloves. Children in particular need to be taught the importance of not scratching, and the consequences of infection.
The most enjoyable management tool, if geography is on your side, is swimming in the ocean. The cool, salty water has a wonderfully soothing affect that aids healing.
Eczema is indeed stressful, but stress itself is not a cause of flare-ups. Nor is diet, though certain foods can trigger other allergies. If you’re concerned about lifestyle factors and how they’re affecting you, speak to your GP.
What treatments are available?
For those unable to manage their own symptoms, there are several interventions that you can discuss with a specialist.
- Topical steroids (corticosteroids) are used in instances of moderate to severe flare-ups, and basically have an anti-inflammatory effect. These will be available by prescription from your specialist, and come in varying strengths. They are safe for short-term usage, but relying on them over the long-term can damage the skin by thinning it. The elderly and the very young are particularly at risk, and dosages should always be discussed with a dermatologist. In severe cases, an oral dose may be necessary.
- Anti-histamines can be bought over the counter, though it’s always best to consult a doctor before self-medicating. These are anti-allergy drugs that help to control symptoms like itching, sneezing and wheezing. They can be useful for eczema sufferers who scratch at night or suffer other allergies. Some also induce drowsiness that can assist with sleep.
- Wet dressings can be applied for thick, cracked skin. Find out how to apply them here.
- Ultra-violet radiation therapy (phototherapy) is an option for severe cases of eczema, where quality of life is compromised and other treatment options are unsuccessful. The reason this is a treatment of last resort is the same reason we don’t bake in the sun for hours at a time – the skin is aged by the treatment and results in an increased risk of skin cancer.
The Eczema Association of Australia (EAA) has initiated a Pre-Winter Awareness Campaign through April and May this year in order to raise awareness of eczema and discuss its treatment and management. They are a brilliant source of information on eczema-related health issues, and even have handy School Packs you can download to find out more about managing eczema for day care or school. Check it out!
As always, before embarking on any new treatment regime it’s advisable to consult with your treating specialist. Good luck!