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Eczema advice

Red eczema on elbows
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If you’re experiencing unexplained skin symptoms, it’s a good idea to speak to a pharmacist or doctor. Dry, itchy and scaly skin may be a sign of eczema.

What is eczema?

Eczema is a condition that affects the skin, causing it to become dry, red, itchy and scaly. In more extreme cases, skin affected by eczema can crack, bleed and weep.

Eczema is very common, particularly amongst children. In the UK, one in five children and one in 12 adults live with eczema. In many cases, symptoms improve significantly or disappear entirely with age, however it can be a condition that you live with on a long-term basis.

What causes eczema?

Eczema is not a contagious condition – in other words, you can’t “catch it” from someone who has it, or pass it on yourself.

In most cases, the symptoms of eczema are either caused by underlying factors, such as a genetic susceptibility to dry skin, or by the skin coming into contact with an irritant or allergen. In some cases, it may be a combination of the two.

How and when symptoms arise will depend upon the type of eczema you’re experiencing.

Types of eczema

The most common type of eczema is atopic eczema. This is essentially an allergic condition, caused by the immune system “overreacting” to harmless things in your environment. People with atopic eczema commonly experience other allergic conditions such as hay fever and asthma, and often have family members with allergies.

If you have atopic eczema, you’ll typically experience flare-ups of symptoms after coming into contact with certain triggers. Food allergies are commonly the cause of eczema flare-ups, as are harsh soaps, extreme weather conditions, pollen, and animal fur.

Other types of eczema include:

  • Contact dermatitis – This is where the skin reacts to irritants in the environment, such as harsh chemicals. Contact dermatitis is a common occupational health problem for people who work with irritating substances or materials. If you’ve ever had atopic eczema you will be more susceptible to contact dermatitis.
  • Seborrhoeic dermatitis – This is a type of eczema where symptoms affect areas of the body with numerous sebaceous glands e.g. the face, scalp and chest. One of the key symptoms is dandruff. This type of eczema is thought to be caused by an inflammatory reaction to a specific type of yeast that lives on the skin. Find out more about seborrhoeic dermatitis in our guide here.
  • Discoid eczema – This type of eczema causes circular patches of dry, red and scaly skin to develop. The cause isn’t fully understood, but it can be experienced by people with a history of atopic eczema.
  • Gravitational or varicose eczema - this occurs on your legs when you have poor blood flow.
  • Hand eczema - is one of the most common types of eczema and also referred to as dermatitis - it mainly affects the palms but can also affect other parts of the hand.

Symptoms of atopic eczema

Most people with eczema have the atopic version of the condition. The characteristic symptom of atopic eczema is dry and itchy skin that may also be red, sore and cracked.

Eczema can affect large areas of skin, and most commonly occurs on the hands and fingers, the insides of the elbows, the backs of the knees, and the face and scalp. You will typically have periods where symptoms flare up, followed by periods where symptoms improve.

If your eczema is more severe you might experience:

  • Widespread patches of red, inflamed skin
  • Constant itching
  • Cracking and bleeding
  • Skin infections

An infection can happen if the skin cracks due to extreme dryness or scratching. Signs of an infection include a yellow crust on the skin, fluid oozing from the skin, inflammation and soreness, and generally feeling unwell with a high temperature.

If you think you have a skin infection you should see a doctor as soon as possible. In the meantime, don’t use bandages or cover the eczema.

Treating atopic eczema

In most cases, treatment involves the application of moisturisers, and medicated creams and ointments. Our pharmacy team can help with product recommendations, visit your local store for advice and shop online.

If you have atopic eczema, it’s likely that your daily treatment regime will involve two things:

  • Cleaning and moisturising the skin with emollients
  • Applying topical corticosteroids directly to affected areas

Emollients are cleansers and moisturisers that reduce water loss from the skin and help create a protective barrier. Emollients can come as ointments, which contain a lot of oil and are designed for very dry skin, or creams and lotions, which are tailored towards skin that is less dry.

Emollients should be applied across the skin in a large quantity, even when you’re not experiencing eczema symptoms.

Which emollient is best for me?

Adding an emollient to your skincare routine can help to soothe eczema symptoms. These are in the form of creams to be applied to skin when it is dry, oils which can be used when bathing and washes for showering.

  • E45 emollient wash cream This moisturises and cleans the skin, and does not change the pH balance of dry or itchy skin. It also helps dry skin retain its natural moisture.
  • Dermal 600 bath emollient  Formulated to manage dry skin conditions. This product is a pharmacy medication which means that you will need to answer a few questions when buying online or in pharmacy.
  • Aveeno moisturising  Soothes and relieves dry and itchy skin, suitable for those prone to eczema.

It is recommended that you create a balanced and holistic skincare routine when you have eczema. Using products that are specially designed for eczema prone skin can help to manage your condition. This means when bathing or showering that you wash your skin with products suitable for dry skin, and then afterwards moisturise your skin with specially selected products.

What else can I use to treat eczema?

Topical corticosteroids are medicated creams and ointments that can help to soothe the symptoms of an eczema flare-up. Unlike emollients, they should only be applied to affected areas of skin when you’re experiencing symptoms. The steroids in the cream will help to reduce inflammation and irritation.

Another treatment used by people with eczema is antihistamines. These are usually recommended for people who are experiencing severe itching as a result of their eczema. The treatment works by limiting the effects of the allergic reaction that is causing the flare-up.

Avoiding eczema flare-ups

In addition to making sure you’re using the correct treatments, it’s a good idea to make a plan for avoiding your eczema triggers. These are the allergens and irritants that set off your symptoms.

Common triggers

  • Soaps and detergents
  • Stress
  • Perfume, cosmetics and fragranced products
  • Dusty, damp or mouldy conditions
  • Animal fur, hair or saliva
  • Pollen
  • Sweating
  • Central heating
  • Certain weather conditions (e.g. extreme heat or cold)
  • Food allergies (e.g. peanuts, milk, eggs, wheat)
  • Materials worn next to the skin (e.g. wool)
  • Hormonal changes (e.g. during your period or a pregnancy)
  • Having an infection in the skin

It’s best to try and avoid your triggers altogether, but if you know you might be exposed, make sure you have all the treatment you need to deal with a flare-up.

In addition to avoiding triggers, you should resist the urge to scratch any skin affected by eczema. Scratching can cause damage, worsen your eczema, and make your skin feel even more itchy.

How to avoid your eczema triggers

Get a good night’s sleep

People living with eczema often find the urge to itch is heightened at night and getting to sleep can be difficult. This is largely due to the fact that in the day we are busy and distracted so itching can often be forgotten about. Being hot at night can also irritate skin and increase the impulse to itch.

Try:

  • Keeping the bedroom window open at night
  • Keeping the central heating down to a minimum
  • A light duvet will also be better than a thick one that might cause you to be hot and sweaty and lead to irritation
  • Cotton bedding tends to irritate skin less than other mixed fabrics so if you can try to use cotton sheets and quit covers
  • Having a bath before bed relaxes muscles and may help you drift off to sleep easier but keep the water lukewarm

Watch what you wear

When choosing what to wear there are a few things you should consider. Some clothing can irritate your skin, possibly resulting in a flare up. Fabrics to stay away from include wools and synthetic fabrics such as polyester. Cotton clothing is usually best to limit irritation.

Tight clothing can cause sweating or irritation to the skin which can cause your skin to become delicate and flare-up. Wear comfortable clothing to avoid any irritation.

Washing new clothes before you wear them can also help protect your skin from any possible irritation. Use unscented, sensitive or mild liquid detergents and avoid fabric softeners as they are usually highly perfumed.

Keep a food diary

A food allergy or intolerance can cause eczema symptoms in some people – dairy and wheat produce are some of the more common food allergens. Try keeping a food diary so you can work out if your diet is affecting your eczema. If you have noticed flare ups with certain foods, it’s best to see a dermatologist for advice before cutting things out of your diet.

Free from foods are much more widely available these days and it can be fun experimenting with new recipes.

Minimise stress

Stress can cause eczema to become inflamed so managing this can help you control your eczema. Making sure you get enough sleep and talking with others that live with eczema can be really helpful. Breathing exercises, yoga and meditation techniques are also great for relaxation. Exercise can also help minimise stress levels.

Work out without the flare-ups

Exercise leads to increased sweating which can irritate eczema but it’s important not to let eczema take over, so if you want to exercise don’t let having eczema stop you.

Here are some simple tips to minimize the impact exercise will have:

  • Drink lots of water before, during and after exercise. Those with eczema will have inherently dry skin so it’s important to hydrate yourself when exercising to replace the water that is lost – and that means inside and out
  • Moisturise before and after exercise. You don’t want to use something heavy as that would be counterproductive and trap sweat in. Instead, opt for something light and apply about an hour before working out. You can apply your richer emollient after a cool shower once you have finished your work out.
  • Keep cool by taking regular breaks. Listen to your body and try not to overheat. Cold compression wraps are great for cooling skin down.
  • Opt for a loose fitting cotton t-shirt and loose shorts. Tight fitting clothing may be great for absorbing sweat but it’s not great for eczema. Loose fitting cotton will generally be more comfortable and less irritable.

Manage weather conditions

Eczema reacts badly to rapid changes in temperature as well as extreme hot or cold temperatures. High humidity can lead to symptoms similar to prickly-heat, whilst low humidity may dry the skin out.

Things like central heating in the winter can also be a trigger. The best thing you can do is make sure your home is as comfortable as possible by controlling the heating. Keep it low and wear light cotton sleepwear.

When outside in cold weather, choose leather or cotton gloves to protect your hands from the cold air, remember wool gloves may cause irritation.

Moisturise, moisturise, moisturise

Keeping your skin moisturised often is key to managing your eczema. Moisturise after showering or bathing. Use a plain, unscented moisturiser to keep your skin soft and moisturised.

If this doesn’t work for your skin, try thicker products such as emollients. The difference between normal lotions, creams and emollients is the amount of oil they contain.

Emollients prevent water loss and provide a protective layer on your skin, but often can be greasy as they contain a lot of oil. They come in different forms and can be used directly on your skin, in the bath or as soap. You may have to try a few different emollients to find one that’s right for you.

References

www.eczema.org/what-is-eczema
www.nhs.uk/conditions/discoid-eczema
www.nhs.uk/conditions/atopic-eczema