Eczema, atopic dermatitis, can be a difficult, distressing and emotionally and financially draining condition to have. It is a complex, chronic condition that cannot be completely cured but can be controlled. It is a skin barrier issue and not an allergy issue. The skin barrier which protects us from mechanical injury, UV rays, bacteria, fungus, irritants and allergens is disrupted in eczema. The disruption also leads to increased water loss from our skin, in other words, it’s leaky. It doesn’t keep the outside world out and the inside world in. It causes the skin to be highly sensitive to irritants and environmental allergens. All this triggers inflammation and itch.
The exact cause is unknown but it is thought to be largely hereditary with a strong genetic basis related to filaggrin abnormalities. Filaggrin is responsible for a good skin barrier. the environment also plays a large role in the development of eczema. There’s also an abnormality in the immune system. So you see, there’s no easy answer to the exact cause of eczema.
Eczema presents as patches of extremely dry, red and itchy skin. The itching is usually so unbearable it leads to poor quality sleep which them impacts on the quality of life.
With all that medical language and explanations out the way – now we can talk about what you want to hear – How can you manage eczema! How do we fix this leaky barrier and stop the itch?
Avoid triggers
Potential triggers are allergens like pollen, dust mites and animal dander. Sweating, harsh soaps, cigarette smoke and emotional stress can also trigger eczema. Avoid wearing rough fabrics like denim and wool directly on skin.
Food allergies is not the cause of eczema and eliminating food groups may do more damage than harm. A very small percentage of children may have a co-existing food allergy. Keep a food diary and discuss with your dermatologist if there’s a convincing history of eczema flares associated with food. Testing and dietary changes will be considered when there’s failure to control eczema with appropriate treatment.
Bathing
Use non-soap cleansers that have a neutral or a low pH, hypoallergenic and fragrance free. Aqueous cream is an example of an affordable non-soap cleanser. No bubble-baths! Ever!
Short bath times between 5-10 minutes using lukewarm water. Pat dry and do not rub. Applying moisturiser within 3 minutes of a lukewarm bath/shower increases skin hydration and barrier function. It locks in the moisture.
Moisturisers
Here you get lotions, creams and ointments. Ointments provide better barrier but are unfortunately messy and difficult to use routinely. The key here is to pick an inexpensive moisturiser that is fragrance free. The greasier, the better but pick something that you are willing to use long-term.
Apply the moisturiser twice a day even if you have no eczema at the time. Always apply after swimming or bathing. Pick agents with ceramides and fatty acids as they replace the missing molecules in atopic skin.
That’s a mouthful – what does it mean? Don’t worry, I’ve got you!
Epizone E and Epimax are good affordable moisturisers. If there’s a little more at the bank you can use SBR Repair special cream, Eucerin Ato Control, Bioderma Atoderm Crème, Cetaphil Pro Dry Skin, Avene XeraCalm, La Roche Posay Lipikar AP+m Baume and the new kid on the block Cerave Moisturising Cream. I love the new kid because it comes in big tubs that go a long way without drying up mid-month. There’s probably a lot more on the shelves but these are the ones that I have personal experience with and can vouch for.
The mainstay of treatment for eczema is topical corticosteriods as they suppress the inflammation that occurs in eczema. They are prescription medication and best used under the supervision of a dermatologist, paediatrician and health care providers. A lot of people have steroid phobia as they can have side-effects. When used appropriately with the correct strength of potency, for limited periods the risk of the side-effects is low.
Other treatments include antihistamines to stop the itching that goes with eczema, they also are helpful at night to reduce sleep disturbances. Depending on the severity and response to treatment, your dermatologists may step it up to oral treatments or injected treatments.
Don’t suffer in silence, there’s a lot of ways to control eczema. Contact your dermatologist, soak and smear and you’ll be well on your way to itch-free nights.
