THE skin, our largest organ, serves as a very important barrier to bacteria, but when it dries out this barrier function is compromised and infection is possible.
Eczema is a dry, inflamed irritation of the skin that appears as a rash. At its most severe it can ooze, crust over and even bleed.
Eczema affects 20% of children and 10% of adults. It runs in families, often occurs in tandem with hay-fever or asthma, and even if a child grows out of it, their skin usually remains sensitive long-term. Certain areas of the body tend to be more prone to flare-up, including the backs of the knees and creases of the elbows, the wrists, neck and face.
While there are several different types of eczema, the most common is one that flares up due to a reaction to something in the environment, perhaps a new washing powder, or the perfume in your shower gel. Other triggers include certain fabrics against the skin, pollen, or even stress.
The itch-scratch cycle that eczema tends to follow is problematic because during a flare-up, the body’s natural reaction to attend to the itch can damage the skin, and gives only temporary relief, leading to further irritation and itch, and so the cycle repeats itself. The key to treatment is breaking that cycle, so the main aim is to keep moisture locked into the skin.
Emollients used generously and frequently are the key to good eczema management. They can be applied directly to the skin as a moisturiser, as well as being used instead of shower gel when washing. There are creams, ointments and lotions to choose from, and less is more in terms of ingredients; anything with too many additives will dry out the skin.
It’s vital to be consistent with emollient use even when the skin is eczema-free, to prevent deterioration. During a flare up, the added use of a steroid-based cream with the guidance of your healthcare provider can address the presenting inflammation and dampen down the immune response. Very severe eczema may be suitable for UV light therapy or tablets to treat the symptoms.
Pat the skin dry after washing rather than rubbing. This will maintain the layer of emollient that has been left on the skin and minimise irritation.
Take extra care in the bath or shower when using emollients as they can make the surface extremely slippy.
You can choose to use a combination of ointments and creams/lotions. Ointments are thicker and may be more user-friendly at night, while creams will rub into the skin better for daytime use. For added absorption of the emollient, wrap the area in cling film and leave for a few hours. The enclosed environment will increase the permeability of the skin to allow the emollient to work its magic!
During a flare-up, if a steroid cream has been prescribed, leave time between using the steroid and emollient to allow for maximum absorption.
Use the concept of a Finger Tip Unit (FTU) as a measuring guide when applying steroid creams — they should only be used sparingly, so the amount of cream that covers from the tip of the finger to the first knuckle joint is all that should be needed to treat one hand for example, or apply 3FTUs to one arm. The bigger the area, the more FTUs will be required. Note that the number of FTUs differs for adults and children.
Aqueous cream is only recommended as a soap substitute and not as a moisturiser applied directly to the skin as it can irritate it.
Choose clothing that is soft, gentle, breathable, and washed in a non-biological powder.
Avoid using conditioner.
Sleep disturbance can be a very real issue during eczema flare-ups. Sedating antihistamines may be prescribed for short term use in these instances. They aid sleep and address the itch.
If swimming in a pool, apply emollient beforehand, and consider applying an extra thick barrier cream to the usual suspect areas of flare-ups. Shower immediately afterwards to stop the chlorine having time to irritate the skin.
Eczema affects 20% of children and 10% of adults. It runs in families, often occurs in tandem with hay-fever or asthma.