Living with Eczema

November is eczema awareness month in Canada. This month, we’re going to focus on living with eczema day to day. Eczema is a chronic condition, meaning that it isn’t going away anytime soon, so you need to find a way to live with eczema.

There are many types of eczema, and a wide range of severities. In terms of symptoms, eczema is characterized by:

  • Dry Skin
  • Itch
  • Inflammation

Itch and inflammation come into play during flare-ups (mini-emergencies when eczema quickly becomes worse), but dryness of the skin is the primary concern on a day to day basis. When the skin loses moisture, the problems of itch, inflammation, and flare-ups become much more likely.


Flare-Ups

Unfortunately, flare-ups are mini-emergencies that those with eczema are familiar with. Some people have flare-ups more often than others, while some people are triggered by certain conditions or substances, almost like an allergy. Treat flare-ups like an emergency--act fast on it, before the itch-scratch cycle starts.

  • Be prepared. Make sure you have treatment (usually corticosteroids) ready. They can be at the house, but if you are travelling for a few days, bring it with you. A few days is plenty of time for the skin to become damaged from itching and scratching.
  • Treat it as soon as possible with medication. Reducing inflammation and itch as fast as possible is important.
  • Don’t forget to moisturize. Moisturizers work well with topical medications and are important for helping the skin retain the necessary water levels.

For many eczema patients, flare-ups are a reality that occur from time to time. The most important principle of eczema is to treat symptoms early and aggressively during an outbreak when the symptoms quickly worsen.

There are some circumstances where conservative treatment is a good option (using treatment only when necessary and then only the minimum strength medication necessary to treat it), but in controlling eczema flares, speed is crucial.

The first priority is to control the itch-scratch cycle. During a flare-up, the urge to scratch can become overwhelming. Scratching, while it provides temporary relief, causes more itching in the medium and long term, as scratching releases histamines worsening the itch, and damages the skin more. This induces itch, which causes scratching, and further damage and itch down the line. This cycle is the reason why eczema flares can very rapidly deteriorate the skin if it’s not put under control quickly and aggressively.1 The problem is that it’s not physiologically practical to tackle the problem at the scratch even though every parent with a child who has eczema tells them to resist scratching -- something they won’t be able to resist as adults.2 The only pragmatic solution is to attack the itch -- the source of the problem -- as efficiently as possible.

Moisturizers: Although moisturizers are not medications, they are required for maintaining healthy skin for people with eczema. With eczema, the barrier function is often deficient, causing the skin to become dry and more sensitive to various antigen. Moisturizers can be and should be used in conjunction with other medications. During flares however, moisturizers alone will rarely be sufficient to quell the itch.

Topical Corticosteroids: Topical corticosteroids are the gold standard for managing eczema flare-ups. They are very fast acting, reducing itch and inflammation significantly. The doctor will prescribe the appropriate strength according to your symptoms, and it’s important that patients use it specifically for what the doctor prescribed.3 Patients shouldn’t be overly concerned about side-effects as long as they are using it as the doctor explained.

Calcineurin Inhibitors: Topical calcineurin inhibitors are another popular option that are used alongside topical steroids. They are immunosuppressants like corticosteroids, and help reduce inflammation and itch.

Due to the chronic (but often not permanent) nature of eczema, treatment and lifestyle management often go hand in hand. The key is to take care of yourself, avoid triggers whenever it’s practical, and to be prepared and have medication on hand to control flare-ups. It’s never a good idea to just “fight through the itch” as this can quickly make the eczema worse, and lengthen recovery time significantly.


1In fact, damaged skin can be the cause of infection.
2Even the most stoic of people cannot resist unconscious scratching that occurs during their sleep. The practical solution is to address the itch at the source as rapidly as possible.
3Location to be treated matters -- skin on the face and genitals are thin compared to the feet and hands so they will absorb a lot more corticosteroids.