Eczema is a condition that causes patches of skin to become inflamed, itchy, red, and cracked. These symptoms can be mild, moderate, or severe, varying from person to person. In some cases, blisters or clear fluid-filled bubbles may appear, adding to the discomfort. Eczema affects up to 15-20% of Canadians at some point in their lives, with ~17% of those being diagnosed with atopic dermatitis - which is considered the most common type. Eczema often follows a relapsing-remitting pattern, which means that symptoms flare up for a period of time and then subside, sometimes disappearing for weeks, months, or years.
Why Does Eczema Happen?
Eczema can be genetic. This is particularly seen in child-onset eczema vs adult-onset eczema, where there tends to be less family history. Eczema often results from immune dysfunction, where immune cells become hypersensitive and release inflammatory cytokines. These are little messengers in the body, and in eczema, these particular ones create inflammation, itching, and improper formation of the skin, This is because the inflammation inhibits the expression of a certain component (filaggrin), which is important for the correct formation and function of the skin barrier. A defective skin barrier results in dryness, and cracks in the skin, causing it to be easier to get infections. One of the most common organisms that infect people with eczema is Staphylococcus aureus, but it is also possible to get infected by other bacteria, viruses, and fungi. The infections cause more inflammation to an already inflamed skin, increase the itch and make it difficult for the skin to repair itself - creating a cycle.
Managing Eczema: Practical Tips
Eczema management is about minimizing triggers, repairing the skin barrier, and reducing inflammation. Here’s how:
Discover and Eliminate Triggers
There is no cure for eczema, but there are ways you can manage it to maintain ‘normal,’ healthy skin. The first thing would be to discover and eliminate your triggers. Since the most common form of eczema is atopic dermatitis, it should come as no surprise that there’s a hypersensitivity/ allergy component. These triggers can include dairy, gluten, eggs, specific nuts, etc. But it’s not just food, it can also be environmental things like dust mites, humid heat, or the dryness that occurs in the fall and winter months. Clinically, I’ve also seen flare-ups occur the week before a patient’s period. Observe your eczema and see if you can find a pattern where you are flaring based on these factors. If you are having difficulty discovering your food triggers, you can do an elimination diet or a Food Sensitivity Test to help you figure it out. Learn more about food triggers here.
Moisturize regularly
Eczema is a skin barrier defect condition. This means it is difficult for the skin to retain moisture since it is irritated, cracked, and dry. The best moisturizers for skin with eczema tend to be non-scented lotions or moisturizers with ceramides. But again, know that everyone is different, and that might not be the case for you. In my case, oat-based lotions worked the best for me and helped to moisturize and soothe my eczema. These moisturizers should be gentle, and devoid of any harsh chemicals. The best time to moisturize your skin is immediately after your shower or wash your hands. Speaking of showers, it’s best to avoid hot showers, especially since your skin is already inflamed, and the additional heat might aggravate it. Lukewarm or cooler showers tend to help decrease the itch sensation, and can also be a great way to help decrease the inflammation acutely.
Manage Stress
Stress is an extremely common trigger. The stress that you experience is communicated to your body and its cells and can result in a flare-up in your eczema. Find effective ways to manage your stress, and to learn to read your body's signs of stress. Meditation, yoga, deep breathing, distraction, exercising, finding healthy outlets, and going out in nature are great ways to help manage stress. Find which ones work for you, and incorporate them into your daily routine. As weird as it might seem, deep breathing when you have the urge to scratch, can cool that area down, and stop you from scratching. Note this practice will have to be used every time you feel the urge to scratch. But doing so also helps you rewire your brain, because people with eczema are hypersensitive to irritants, the slightest irritant can make us feel the need to scratch.
Eat a High-Polyphenol Diet
Eczema causes chronic inflammation locally and systemically, so your body will need extra resources to quell the excess heat. This damage can come in the form of oxidative stress, which leads to more cellular damage. Oxidative damage occurs when there is an imbalance of anti-oxidants and free radicals in your body. Therefore, to protect yourself from chronic inflammation and free radicals, you can increase your intake of polyphenols. Polyphenols come from highly pigmented fruits and vegetables and have a high concentration of antioxidants. You can either incorporate this into your diet, or drink a reds powder drink (similar to a greens powder).
Consider Phototherapy
Lastly, phototherapy - either red LED light or UV therapy. This is a non-invasive way to help decrease the inflammation and itch of your skin. The studies are still fairly new, but promising. The only issue is that it can be quite inconvenient since treatments are recommended every 2 days for at least 3 months. Another issue in Alberta is that these machines are often at dermatologist clinics, which means you need a referral from your medical doctor, since they are the only ones that can refer to dermatologists. That being said, UV therapy has helped me a lot with my eczema, and I do often recommend some sort of phototherapy to my patients.
Ready for Support?
Managing eczema can feel overwhelming, but you don’t have to do it alone. If you’re looking for personalized guidance, book an appointment with Dr. Charmagne today to develop a personalized plan that works for you. Let’s work together to get your skin back on track!
~Dr. Charmagne