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From one sufferer to another, think of this as your need to know about the pesky skin condition, from what causes a flare-up to how it can be managed
According to Allergy UK, as many as 15 million people live with eczema in the UK alone. But despite its prevalence, many of us are still not quite sure about the best eczema treatment or what causes it.
Eczema varies from person to person – the best eczema creams that soothe one person’s very unfortunate skin may be completely different than what works for another. So to investigate it thoroughly, we asked some of the country’s top dermatologists, skin experts and sufferers of the condition to shed some light.
What is eczema?
“Also called ‘dermatitis,’ eczema is a chronic inflammatory skin condition that can make your skin red, dry and itchy,” says Dr. Walayat Hussain from Bupa Health Clinics. “There are a number of different types of eczema, and the type you have determines which treatment options are best for you.”
Those with eczema have a genetic tendency to it. ‘But that doesn’t mean it will come out,” says Dr Amélie Seghersconsultant dermatologist at The Clinic by Dr Maryam Zamani and author of Eczema: How to Ditch Itches (£11.86 | Amazon). “You have to have the other factors in your life to be present at that time, to make it come out to make it flare.”
Eczema cannot be cured, but with the right creams and treatment plan it can be controlled. ‘I think that’s important for a lot of people to understand, adds Dr. Seghers. “It doesn’t mean that your quality of life will be affected. You can have a completely normal life in almost all cases, for almost all patients with eczema. Some patients have really severe eczema, and it can be difficult, but often it’s because they are not properly treated.’
If you experience uncomfortably hot and rashy skin that then becomes dry and itchy, there’s a good chance it’s eczema, but your doctor will be able to confirm a diagnosis. It can appear pretty much anywhere on the body; it is possible to get eczema on the hands, feet, legs, arms, trunk and eczema on the face.
Although eczema in infants is very common, many will experience symptoms throughout adulthood as well.
Is eczema contagious?
The biggest misconception about eczema is that it is contagious – but it is absolutely not. It is only if the eczema becomes infected and is open and weeps like infection itself can be contagious, Dr. Hussain explains.
Treatment of eczema
There are many different options for managing eczema, and no one-size-fits-all treatment plan. Your doctor may prescribe topical steroid creams, such as hydrocortisone, that can stop inflammation.
Dr. Seghers says the key to controlling your eczema is maintenance treatment, which is your everyday routine gentle skin care routine. Of course, there are treatment plans in place if you have a flare-up, but it’s daily skin care that will keep your skin as strong as possible.
“Those who have a tendency to eczema lose water,” she says. – Which means the skin is dry. You also have a compromised skin barrier that allows things like allergens, pollutants, irritants to penetrate, further irritating it.’ So making sure your skin is as moisturized and hydrated as possible, all the time, is absolutely key. “Because then you’re actually making your skin barrier better, you’re making it stronger, and you’re going to lose less water and put it in a better condition.”
Dr. Beibei Du-Harper, a dermatologist, says it’s also based on the individual. “Eczema treatment should be tailored based on the severity of the condition, its impact on the patient and also the types of treatments they wish to use. For mild to moderate cases of eczema, regular use of a moisturizer is important, and the addition of a prescription cream to treat flare-ups is often helpful to manage things when creams alone don’t work, but in more severe cases, where the eczema is widespread or affects daily life, there are medications that can be taken orally or injected that have been shown to reduce overactive immunity and inflammation in the skin. These types of treatments can be life-changing for those suffering from extremely severe eczema.’
Elise Loubatieres, a content creator who documents her eczema journey on social media is one such person. “For many years, I went through the cycle of treating my eczema with various topical steroids that would clear up my rashes pretty quickly, but they would come back with a vengeance as soon as I stopped using them,” she says. “I decided to stop using topical steroids in October 2020, because I was tired of this cycle and wanted a more long-term solution. Earlier this year, my dermatologist had suggested I start on biologics (powerful drugs that slow or stop damage inflammation), as I was really struggling with my skin and scalp which caused a lot of hair loss and we were worried that with scarring my hair might not grow back. However, this medication does not come without its side effects and taking it would require frequent monitoring and visits in the hospital. But I was so desperate that I welcomed the idea that it might finally help me live a normal life again.’
She adds that this type of treatment plan is incredibly expensive and if you pursue this through the NHS they will explore all other options first.
Knowing your triggers
Knowing what may be causing your eczema flare-ups will be extremely helpful in taking care of your skin.
Triggers can be anything and they are different from person to person. “It could be that a vaccination is causing your flare-ups,” says Dr. Seghers. So before you do one, you increase the amount of moisturizing. It may not stop it completely, but it may give you a much milder reaction. I have known some patients flare up after an insect bite. It itches, so you give it a scratch and it will actually trigger an eczema.
She says it’s common to flare up if you’re unwell, for example if you get a nasty case of the flu, because eczema sufferers tend to have an overreactive immune system. So when you are sick, your eczema can flare up. She recommends putting on more moisturizer when you start to feel sick. “It’s about being prepared,” she says.
Other common triggers in children are teething and drooling, and in adults dust, frequent washing and friction.
One of the biggest triggers, which affects many people, is stress. “Stress is my absolute biggest trigger,” says Loubatieres. “I have such a physical reaction to it, which is usually uncontrollable itching until I damage my skin, mostly unknowingly.”
Are eczema and diet linked?
Many sufferers of medical skin conditions see a reduction in symptoms by carefully monitoring their diet, with dairy and acne being a prime example. So what’s the deal with diet and eczema? “Although changes in your diet cannot cure your eczema, in some cases it can help relieve symptoms and minimize flare-ups,” says Dr Hussain.
“Some cases of eczema are caused by an allergic reaction; the most common sources of allergic reactions from food are milk, eggs, peanuts, fish, soy, wheat, gluten and citrus, so you may find it helpful to try to cut back on some of these foods to see if it helps with your symptoms.
“Otherwise, a simple prick test can help identify exactly what you’re allergic to, so you can avoid those foods. However, it’s important to discuss potential food allergies with your GP, dermatologist or allergy specialist to ensure you get the best advice that are relevant to you and best for your skin.’
However, Dr Seghers is keen to stress that trying to link eczema and diet is difficult. ‘To finding a new food allergy at age 30 is highly unlikely, but what I am saying is that when you have an inflammatory condition, you don’t want to have an inflammatory diet, with lots of processed foods, etc. will make matters worse. You put your body in an inflammatory state, which lowers the threshold for a flare. So in a way I think diet plays a role, but I’m not sure if one type of food causes you to flare up on its own.
She worries that too many people try to make the connection, hoping that cutting out certain foods will suddenly improve their eczema. It’s not that easy, she says. “This sometimes works for small babies and young children. For example, if you discover an intolerance or allergy to milk early in childhood, you can take out the relevant things and see an improvement. But it’s not so common for adults.
If you have an eczema-like rash around the mouth, nose and eyes, it may actually be perioral dermatitis, which requires different treatment options. “Periorificial dermatitis is a common facial skin problem characterized by clusters of itchy or tender small red papules,” explains Dr. Anjali Mahtoconsultant dermatologist and author of The skincare bible.
‘It got this name because the papules appear around the eyes, nostrils, mouth and occasionally the genitals. The more restrictive term, perioral dermatitis, is often used when the eruption is limited to the skin of the lower half of the face, especially around the mouth. Periocular dermatitis can be used to describe a rash affecting the eyelids.’
Your doctor or dermatologist will be able to confirm a diagnosis, so it is important that you make an appointment to confirm.
What causes perioral dermatitis?
“The exact cause of periorificial dermatitis is not fully understood but research has shown that it may be related to epidermal barrier dysfunction, activation of the innate immune system, altered cutaneous microflora or follicular fusiform bacteria,” says Dr. Anjali.
The good news here: “Although it may take several weeks before there is a noticeable improvement, periorificial dermatitis responds well to treatment,” explains Dr. Mahto. “The best way to treat periorificial dermatitis is to stop using all facial creams including topical steroids, cosmetics and sunscreens.
“And consider a slower withdrawal from topical/steroids/facial creams if there is a severe flare-up after steroid discontinuation. I would recommend replacing it with a less potent or less occlusive cream or applying it less frequently until it is no longer needed. If the rash is present , wash your face only with warm water. Use only a non-soap or liquid cleanser when the rash is gone.’