Advice on Managing Eczema

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Benny: Hi DermDoctor. I had problems with atopic dermatitis as a child, but the condition slowly faded away a few years ago. Since moving to Calgary last November, the problem seems to have resurfaced. It's not quite as bad as it used to be in my childhood, but I thought that I was over this already. Can you help?

Dermdoctor: Hi Benny. It's common for atopic dermatitis to go away completely or become less severe at a certain age, although this isn't guaranteed for anybody. Moreover, the atopic tendency for dry and sensitive skin is often not lost. In your case, the change in environment coincides with the return of your symptoms, suggesting a possible causal relationship.

Calgary, being part of the prairies, has very low humidity, and is very cold during the winter. Low temperature and humidity play a major role in draining moisture from the skin, making you more susceptible to rashes, itching, and dryness. While you can't control the climate, taking simple precautions such as moisturizing on a regular basis, avoiding hot baths, harsh soaps, and repeated exposure to irritants, routines that you should already be familiar with, can counteract some of the effects of Calgary's climate.

  • Atopic dermatitis is a common form of eczema that primarily affects children. In many but not all cases, the symptoms disappear or become milder in adult years.
  • A change in environment may improve or worsen symptoms, as environmental factors play a major role in most forms of eczema.
  • Low humidity and low temperatures are the most common causes of drying skin, and worsen eczema symptoms. Winter in most areas therefore more challenging for those that suffer from chronic eczema.
  • Indoor heating also lowers humidity in the air, and this is another reason that winter tends to make eczema worse. A humidifier in the household can help counteract this effect to a certain extent.
  • To restore lost moisture, regular use of moisturizer is recommended. Use thicker moisturizers and remember to apply them after every shower or bath while the skin is still moist.
  • When bathing or showering avoid hot water as it dries out the skin. Do not scrub with a towel, but pat the skin gently to dry, and immediately apply moisturizers.
  • If the symptoms do not improve, visit a dermatologist who can recommend a treatment plan. You want to control flares as quickly as possible before scratching damages the skin.

Noelle: Hello DermDoctor. As a nurse, I need to wash my hands as often as thirty times a day depending on the shift, and it aggravates the eczema on my hands. As leaving the workplace is not a realistic option for me, is there anything else that I can do to deal with my eczema?

Dermdoctor: Hello Noelle. Hand eczema is unfortunately a common problem in hospital nurses for the reasons that you mentioned. I certainly understand that leaving your job is not an option that you can consider right now. My first advice to you is to consult a local dermatologist, and possibly an allergist, if you haven't already done so. Occupational dermatitis is always a challenge to treat, and require ongoing care so you definitely want some professional help.

Proper identification of the irritant or allergen is the first step in treatment, and it seems like you've identified the problem, but you may want to investigate deeper. While frequent hand washing is a very common cause of hand dermatitis, especially in nursing, there may also be other factors involved in a hospital setting such as exposure to disinfectants, harsh soaps, rubber gloves, or other medical substances. Talk to your dermatologist to zero in on all the potential causes.

Secondly, you will need to minimize exposure to the irritants that worsen your condition. Although some factors like hand washing are a necessary part of your job, there may be reasonable workarounds that you can discuss with your employer for other potential irritants, such as changing the soap that you use, or the type of gloves that you wear to suit your needs. When your eczema is particularly bad, you might consider taking some time off to allow your hands to heal. In occupational hand eczema, quite often perfect solutions don't exist, but a bit of effort to minimize exposure in the workplace can go a long ways in managing the problem to a tolerable level.

  • Hand dermatitis is very often chronic, and exacerbated by repeated exposure to irritants and allergens. Occupational factors often play a role in hand eczema, as a disproportionately large number of people that suffer from this condition work in health care, cleaning-related occupations, and metalwork.
  • Consult a dermatologist if you haven't already done so. Occupational dermatitis is always a challenge to control as there is often repeated exposure to irritants or allergens that make treatment an ongoing process.
  • The dermatologist may refer you to an allergist if they suspect that you allergic contact dermatitis may play a role. Latex gloves, common metals, and pollen can often be an allergen that is work-related depending on your occupation.
  • Talk to your dermatologist to zero in on all the potential causes and to discuss which exposures can feasibly be minimized. Not all cases have ideal solutions, and in some extremely severe cases, a change in the work environment or industry may be the only solution.
  • Although some factors may be a necessary part of the job description, more often than not, there are reasonable workarounds for most irritants, such as changing the soap that you use, or the type of gloves that you wear to suit your needs. Proper communication with your employer is a must.
  • Consider taking some time off if eczema becomes severe from overexposure. Allowing time to heal can make your life considerably easier.
  • Treating your hands well off work will also an important factor in how well you recover. Remember to moisturize often, and use the prescribed medication as indicated.

Dario: Hello DermDoctor. My daughter who just turned three last month suffers from severe eczema. She is also allergic to dairy products like milk and eggs, and is on a restricted diet. Are the two conditions related? It pains me to see my daughter like this. Is there any way to rid her of this curse?

Dermdoctor: Hello Dario, I'm sorry to hear about your daughter's situation. As for your question, the connection between food allergies and eczema is a complicated matter. We do know that many forms of eczema are loosely related to sensitivities to environmental irritants and allergens, so the two conditions sometimes go hand in hand. Also, itching and inflammation for any reason, including allergies will often worsen eczema, as the sufferer scratches the skin in response to itching and discomfort, damaging the skin further. In your daughter's case it's important that the food allergy be kept under control, even if the symptoms are not that severe.

It's also important to keep in mind that severe eczema can be trying for both the child and the parent. You need to make sure that you yourself are well rested and in good mental condition, as well as your daughter. Unfortunately eczema is a condition that is chronic, and constant management will be necessary. Consult your dermatologist frequently and work as a team to figure out a lifestyle adjustment that works for your daughter. Remember that allergies and eczema are both challenging to manage, as triggers vary largely from individual to individual. Treatments start from identifying the specific triggers, and this may take awhile as there is an element of trial and error to this. Over time, once you and your dermatologist or perhaps an allergist identify the triggers, lifestyle adjustments and treatment plans can become more effective. It's a long and trying process, but the patience will pay dividends later.

  • Eczema is common in children, especially in the form of atopic dermatitis.
  • Severity can vary widely from individual to individual.
  • Triggers which worsen the symptoms also vary widely, although there are triggers that are more common than others.
  • Sometimes food allergies are related and concurrent with eczema.
  • Atopic dermatitis often runs in families and is related to a tendency for hay fever and asthma. Called the atopic triad, they share hypersensitivity to environmental factors.
  • As parents are directly involved in watching their children suffer, and in the treatment process, severe eczema can exhaust the parent as well as the child. Parents should watch that they are not over-stressed themselves.
  • Consult your dermatologist or paediatrician as appropriate. Depending on their findings, they may recommend a specialist such as an allergist. Think of these doctors as part of a team to help find a management and treatment plan.
  • Eczema is a chronic disease. There is no panacea, and it can take time to find the optimal treatment plan as eczema is complicated.

Sandy: Hello DermDoctor. My son has mild eczema on the hands and the inside of the elbow and knees. It's barely noticeable, but once in awhile it flares up and becomes much worse. My dermatologist recommends the use of topical steroids, but this scares me. Are these medications safe?

Dermdoctor: Hello Sandy. Eczema can episodically become much worse during flare-ups which are triggered by environmental factors like allergies, change in humidity or temperature. Even mild cases like your son's case can cause significant distress during these periods. It is important to note that scratching the skin very quickly makes the condition worse. Scratching damages the skin and causes further itching, which causes the patient to scratch. This negative feedback loop can quickly worsen the skin, leaving it open to infection.

The solution is to quickly and aggressively treat the itch, to prevent scratching and improve the skin in the affected area. Topical steroids are an ideal solution to handling acute flares, as it is extremely powerful and fast acting, and improves the skin condition quickly. While steroids do have unwanted side-effects at higher concentrations, or when used for too long, they are perfectly safe treatments when used as instructed by a dermatologist.

  • Eczema varies widely in severity with most people having mild eczema.
  • Eczema symptoms can quickly worsen in response to a variety of environmental triggers, or even stress. These episodes which happen from time to time are called flare-ups.
  • During flare-ups, itching, redness, rashes, and inflammation can be seen in the affected area.
  • It's important to treat eczema with medication quickly during flare-ups. Itching, one of the most prominent symptoms of eczema is particularly a problem as it induces scratching, which damages the skin further.
  • Topical steroids are usually the go-to medication for treating flares. It is fast acting and its effect is powerful. Although the weakest concentrations are available over the counter, most topical steroids will require a prescription.
  • Topical steroids are safe when used according to your doctor's instructions, but can be dangerous if abused. Use exactly as instructed by your doctor. Do not let others use your medication or use other people's medication.
  • Don't use topical steroids on other parts of your body that it was not intended for. Different areas of the body have different skin thickness, and therefore the effect of the steroids differ depending on where it is applied.

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