Managing Atopic Eczema

Whether you get eczema or not depend on genes; whether you manage it successfully or not depends on you.

Atopic eczema is one of the most common chronic skin conditions, affecting up to 15% of the population, and is becoming even more prevalent in industrialized countries for reasons that are poorly understood. It is a largely hereditary disease that runs in families, and has close connections to other allergy related problems such as hay fever and asthma. As atopic eczema is a tendency that is determined by genetics, there aren't any satisfactory ways to prevent or cure it at this time.

The main symptoms are persistent dry and sensitive skin at the affected sites which largely remain consistent. Itchy rashes may occur during flares, and are commonly found on the hands, scalp, behind the ears, and on the insides of the knees and elbows. As eczema affects close to 1 in 7 people, most people are familiar with eczema, and should know somebody close to them who has eczema. Of those with eczema more than 75% have mild disease which does not inconvenience their daily life. Only a very small proportion of eczema patients have severe symptoms that cause significant distress, such as consistent sleep disturbance. In all cases, symptoms can become considerably worse within a short period of time when the condition is disturbed by an environmental trigger. These episodes are called "flare-ups" and the management and control of these flare-ups are critical in living with eczema.

Fight Dryness with Moisturizers

Persistent dryness of the skin and its lack of protection against factors that drain the skin of moisture are the most problematic symptoms of eczema. Itching, irritation, and inflammation follow from lack of moisture in the skin, and much of the battle in eczema management centers around fighting dryness of the skin. The trouble is that eczema patients have difficulty retaining moisture in their skin, as their skin has a weakened barrier function and will often need external help to keep moisture levels sufficient.

Using moisturizers on a regular basis helps the skin retain moisture in the skin by slowing down natural moisture loss via evaporation, and by drawing moisture from the body towards the top layers of the skin. Moisturizers also serve as a protective layer against dust, dirt, and bacteria, which are all very common on the skin's surface.

  • Moisturizers help repair the skin barrier and protects the skin from irritants like dirt, dust, and bacteria as well as other airborne allergens
  • Thick moisturizers are better at allowing the skin to retain moisture. Petrolatum jelly, one of the most simple moisturizers is a good inexpensive option
  • Moisturizers need to be applied regularly for best effect, and not just during flare-ups
  • After showering or bathing, when the skin is still moist, is the best time for moisturizing as the skin absorbs the compounds best during this time

Eczema Management Needs to be Built into your Lifestyle

Eczema management consists largely of moisturizing regularly, and avoiding environmental factors that trigger flare-ups. Flare-ups cause the skin to dry up in the affected area, and symptoms quickly become worse as a result. When flare-ups occur, even in those with mild eczema, it can cause significant discomfort and frustration. Luckily, eczema flares occur in response to largely predictable environmental triggers, and thus can be prevented or mitigated. While the exact triggers will vary depending on the individual, they tend to be consistent. It is important that patients avoid triggers that worsen their eczema as much as possible.

The most common triggers include:

  • Lower humidity-winter and indoor heating are common culprits that lower humidity and dry out the skin faster. You may also want to think twice about moving to a location that is cold and dry. These types of climates are common in the interior.
  • Lower temperature-winter is a challenge as it combines both low temperature and low humidity. Try to cover up exposed skin when going to out in the cold weather with long sleeves and scarves to protect your skin from the elements.
  • Irritants-soaps, detergents, and overexposure to water (particularly hot water) are common irritants that aggravate eczema
  • Allergens-pollen, dust, dander, nickel, and dairy allergies are known to aggravate eczema
  • Stress-the skin is a part of the immune system and factors that negatively affect the immune system will reflect in your skin's health too

While we have little control over the climate itself, or ubiquitous allergens such as pollen, the goal isn't to completely shut out all irritants but to minimize exposure to a reasonable degree. There are also many other factors like laundry, hand-washing, bathing, and moisturizing habits which are completely within control. These minor decisions add up quickly, and thus routine is critical, especially if you suffer from moderate or severe eczema. Eczema management needs to a built in part of your lifestyle so that the decisions you make are automatic and effortless.

Consider some of these simple and effective changes that you can make without much sacrifice:

  • Wear longer sleeves or scarves to protect your skin, especially during the cold and dry winter
  • Humidifiers can help offset the loss of humidity in the house during the winter
  • Choose mild cleansers or hard milled soaps over harsh bar soaps or disinfectant soaps which tend to be drying
  • To minimize exposure to detergents, launder clothes with less of it and double rinse your clothes to reduce residues
  • Shower and bathe using lukewarm water as hot water quickly drains moisture from the skin
  • Avoid overly long baths, and pat your skin dry gently and avoid vigorous rubbing with a towel to avoid irritation
  • Moisturize immediately after patting the skin with a towel while the skin still feel moist