Everything You Need to Know About Eczema: Causes, Triggers, and Management Tips

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

Improving Skin Integrity

Fall and winter are notoriously dry in Calgary. You can often hear about how people are experiencing dry hands and eyes, eczema flares, and constantly needing to put lotion on. This is a thing we just accept living in Calgary. However, did you know that you could support your skin, so it doesn’t have to feel the dryness that comes every fall through winter?

There are some healthy oils, and vitamins you can be taking to support your body through the fall and winter to keep them nice and hydrated. I’m sure you’ve heard of fish oil by now, and yes, that is one of the healthy oils I’m talking about. Healthy oils are important for you to be taking regularly during this time (and maybe a month before) to maintain the integrity of your cellular membranes. Cellular membranes are made up of fats, these fat produce a boundary that keeps your organelles where they need to be (inside your cells). This boundary is fluid, and moves. If you eat saturated fats, the fluidity of your cell is disrupted, and it isn’t able to operate like it can when it is able to move as needed. This is where the healthy fats come in: fish oil, olive oil, evening primrose oil, GLA oil, etc. The one I generally recommend is fish oil, along with suggesting you use olive oil in your salad dressings.

So now you have a strong, fluid cell membrane. That’s great! But is it nice and plump and hydrated? This is where making sure you are well-hydrated comes into play. Being well-hydrated keeps your cells working optimally, and allows them to eliminate waste effectively. Imagine working in a cramped factory, where you can hardly move. That is similar to what it would be like working in your cell if you aren’t hydrated. So make sure you are drinking your water, especially during this time. You can check if you are well hydrated by looking at the colour of your urine - is it clear, pale yellow, or dark yellow? The goal is to have pale yellow urine. Note: If you are taking a B Complex, your urine will always be dark yellow.

Moisturizing as soon as you are finished with your shower is a quick and easy way to lock in the hydration. Otherwise, your skin will feel dry afterwards, because the water on your skin is evaporating, stripping your skin of moisture. You can either use a lotion or oil (I like to use olive oil with some lavender essential oil when my skin is really dry).

Lastly, a good B Complex can also help keep the integrity of your skin. The different vitamins do different things, but together, they work together to work on a number of things in your body (I also recommend this to patients for an energy boost). Vitamin B1 can be helpful for irritated, acne prone or dry skin, whereas vitamin B2 can help improve your skin tone (fun fact: this is the vitamin that causes your urine to be neon yellow). Vitamin B3 helps your skin retain moisture and prevent water loss. Vitamin B5 also helps to retain the moisture of your skin, as well as helps to heal wounds. Vitamin B7 (aka biotin) is known to be helpful for your hair, skin and nails. Vitamins B9 and 12 help your red blood cells, which are essential for delivering nutrients and oxygen to your whole body. Remember that B Complexes will turn your urine dark yellow, so if you are dehydrated, understand what your body feels like when it’s hydrated, then start to incorporate a B Complex.

This fall, see for yourself how these can help your skin feel much better and more hydrated. Share below if you have other things you do for yourself to keep your skin hydrated during the fall and winter.

~ Dr. Charmagne

Ways to Improve Dry Skin

Living in Calgary, you think my skin would get use to the dryness, but when winter hits, my skin still has to adjust. The winters are more dry than the summer, at last in the summer, you are drinking more water with the heat there to remind you to drink. The same isn't true for the winter. There is a tendency to drink warm drinks - most of which isn't water - and some of them make you more dehydrated. 

Here are my go to's when winter hits, and my skin needs most moisture:

Drink more water - There is a tendency to drink warmer beverages during the winter, whether it's coffee or hot chocolate. Holding a warm cup also helps you warm your hands - or defrost them from the outside. But they don't hydrate you, so I've been opting for hot water, or hot teas (matcha is my favourite) - these drinks help to hydrate your body throughout the day. Drinking water first thing in the morning can also help hydrate your body and get it ready for the day.

Fish oil - The cells of our bodies are made up of phospholipids, which are made up of lipids (aka fat) - this includes your skin. So the best way to help your cells is by eating healthy fats, so that your body can use that as a building block for your skin and organs. By doing this, the body's ability to retain moisture increases. Barcelos, et al found that omega 3 oils, found in fish oil was able to restore and improve the integrity of the skin.

Using oil as a moisturizer - Oils are fantastic moisturizers! Contrary to popular belief, oil does not clog the skin. Olive oil is able to penetrate the skin, and moisturize from there, but it doesn't provide a barrier. This leaves the top of your skin vulnerable to dryness. Coconut oil is also a fantastic moisturizing oil, but it tends to stay on the top of your skin, and not moisturize the deeper layers like olive oil - the same can be said for avocado oil. The best thing to do is combine your oils, so they can work synergistically to moisturize your all of the layers of your skin. You can also add a few drops of essential oils of your choice (I use lavender, and tea tree) to add some aromatherapy when you moisturize. Try a few oils, and see which ones your skin enjoys, there are a number of amazing oils that are often recommended for the face, you can add some of these oils to your combination as well, but I wouldn't make it the main oil, because it can get quite expensive. Sweet almond oil is also a good choice instead of olive oil. Savy Homemade has a few really nice recipes on making your own body oils.

Milk baths - Use milk with a high fat content, and warm it gently before adding your choice of essential oil(s) (6 drops all of oil all together). Run your bath to the temperature that you want, and pour the milk + essential oils into the tube. Soak for as long as you wish (or the water allows before turning cold), then rinse off in the shower, and apply your choice oil. Milk contains a number of different vitamins and minerals that help the skin heal externally, along with small amounts of lactic acid to gently exfoliate the skin, decrease hyperpigmentation, and decrease acne by balancing the acid mantle. The milk bath helps to hydrate your skin with the fats and proteins found in the milk.

~Dr. Charmagne