Eczema is the painful, itchy, inflamed rash that one in five kids in Australia are diagnosed with.
Unfortunately, at the time of writing this, eczema doesn’t have a cure, which means there are many eczema sufferers with burning questions about treating, preventing and managing the skin condition.
So, to sort the fact from the fiction we asked Australasian College of Dermatologists fellow, dermatologist Dr Karen Koh, to answer the questions you have about eczema.
What causes eczema to flare up?
Eczema (aka dermatitis) is an inflamed rash, due to a faulty skin barrier and a consequent immune reaction.
Multiple factors can cause eczema to worsen. Sometimes a combination of factors might result in the skin reacting. Most cases of eczema are atopic i.e. a reactive state that is genetically inherited and often includes being prone to asthma and hayfever as well.
Changes in temperature e.g. weather changes – extremes of heat, cold, low or high humidity – could worsen eczema. This might be due to the seasons, but also might be influenced by work environments.
Being unwell or run down with viral/bacterial infections, or stressful life situations.
External factors might affect eczema as well, for example substances that come into contact with the skin to cause irritation or allergy, or oral medications/supplements.
Less commonly, certain foods might cause eczema to worsen, but this is probably only a factor in about 10% of people with eczema.
What foods should I avoid if I have eczema?
No foods should be avoided unless there is an obvious relationship between the food being eaten and development of a rash. It is common to cut out dairy or gluten, but more often than not, these are not an issue.
In small children with obvious eczema sometimes certain foods irritate the skin because they are acidic (citrus, pineapple, strawberries) and often get onto the facial skin and hands when eating them.
Definite allergy to foods making eczema worse is not as common as people might suspect, so cutting out important food groups without testing is not recommended. It is important to consult a GP, or to undergo testing with a dermatologist or immunologist before stopping foods.
Why does eczema itch more at night time?
Most likely this is due to overheating with heavy bedding, quilts and blankets.
I never had eczema before, why do I have it now?
Our skin can definitely change over time. Often as we age, our skin becomes drier. Atopic eczema often develops in infancy or early childhood, but can develop for the first time in adulthood.
If the eczema is a new problem, it is worthwhile also making sure that a contact eczema is investigated. This is a reaction to substances that come into direct contact with the skin. It can be irritation, for example, from just water with excessive handwashing working in a kitchen, or new parents washing hands with a newborn baby, or a true allergy such as reacting to a new perfume, makeup or cleanser applied to the skin, or reacting to jewellery/watch band with a rash.
Are there different types of eczema? For instance, is the eczema on my eyelids same as the eczema on my hands?
Yes, the actual rash is the same thing, but if it occurs in different locations it might be a clue to the cause. Hand and eyelid eczema can be due to contact reactions, but also can occur in atopic eczema. If one location seems to be affected in isolation e.g. eyelids, it is important to rule out substances that are applied to that skin such as eyeshadow, mascara, eye creams, or substances that might get on the eyelids such as airborne sprays.
Are some people more likely to get eczema than others?
Atopic eczema is genetically inherited, and is unfortunately reasonably common. In Australia about 1 in 5 children are diagnosed with eczema. There are some dry skin conditions that might predispose some people to developing eczema.
Is eczema contagious?
Definitely NOT. However, if the eczema gets secondarily infected with bacteria or viruses, those infections, if untreated, could be spread to another person.
Are eczema and psoriasis the same thing?
No. They are different types of skin inflammation, with different genetic and immune reactions. However, in some locations on the skin they can look quite similar. And, in some situations, the treatment is very similar.
Can stress make eczema flare up?
Yes. This is probably due to the immune reactions that occur with stress. People with eczema often notice their skin might flare up with stressful situations, despite their treatment. These stresses can be physical and psychological.
How do I treat eczema?
The main principles behind treating eczema are:
- Repairing the faulty skin barrier that is an inherent problem behind eczema. This is by moisturising the skin regularly and avoiding harsh substances that will dry the skin and damage the skin barrier further e.g. soap/detergents. Moisturising should be a daily habit, whether the skin is itchy/inflamed or not. Keeping showers tepid (hot showers make the skin itchier!) and brief is important, and avoiding taking long baths. Water itself will dry the skin by removing natural oils from the skin surface.
- Reducing the inflammation/redness/itch/swelling with prescribed treatments from the GP/Dermatologist. This might include topical corticosteroids (also known as “steroid” or “cortisone” creams), used in a controlled/supervised regimen. It is important to note that Australian studies have shown that these medications are safe to use and do not cause the side effects that many worry about, if they are used correctly and as directed. Different strengths of steroid cream will be needed for different locations on the skin, and for different severities. For example, a milder cream for thin, delicate skin of the eyelids, compared to the thicker skin of hands/feet. There are also prescription strength NON-steroid treatments that the GP/Dermatologist can give, usually for maintenance of the eczema.
- Being aware of triggers that worsen skin, and avoiding them such as: wearing cool; cotton clothes; not overheating at night with heavy quilt; wearing protective gloves or equipment if external substances are an issue.
- Seeing your doctor if there is a flare not responding to usual treatment. Sometimes this is due to infection that might also need to be treated. Allergies might need to be tested.
Are there any over-the-counter products that might help eczema?
The most important over-the-counter products that help are moisturisers. If the skin is very dry, the thicker the moisturiser, the better. A runny lotion contains more water, that will evaporate and leave less “oil” on the skin to keep it moisturised. Most people with eczema need thicker creams, or even ointments to keep their skin barrier repaired.
If eczema is repeatedly getting infected, the dermatologist might suggest an antiseptic wash or oil to add to the bath water. These should be used according to instructions as using too much can irritate the skin as well.
There is a confusing array of “natural” products and additives in creams/lotions today. Care needs to be taken, as most of these come from plants and can cause allergy. Always test new products on a small area first before using it all over.
Will sunscreen, moisturiser or makeup make my eczema worse?
Sunscreen can and should be used. People with eczema should probably use products that are formulated for “sensitive” skin. Modern sunscreens usually contain a mixture of “physical blockers” that reflect ultra-violet radiation, such as zinc or titanium oxide, and “chemical blockers” that absorb ultra-violet radiation. Keeping to a sunscreen just with a physical blocker is likely to be safer and better tolerated. If there is a reaction to even this sort of sunscreen, it might mean a reaction to another ingredient e.g. preservative or emulsifier (chemicals that make creams smooth).
Any cream, makeup, or sunscreen can contain perfumes, fragrance or preservatives (to prevent your creams going off or growing contaminants) that might cause eczema to react.
Hypoallergenic products often mean they are fragrance free.
The best thing is to test a sample of new product on an area of skin, like the inner arm, before putting it on other more obvious areas.
Also make sure any makeup applicators, sponges and brushes are cleaned regularly to prevent contaminants or infections.