About eczema

What is an eczema flare up?

Eczema is a chronic inflammatory skin disease. Chronic inflammatory illnesses are characterised by recurring ‘flares’ or ‘outbreaks of inflammation’ in people who are genetically predisposed to the condition. A trigger can provoke a flare and once the illness has been triggered, it is possible for the flare to continue in the absence of the trigger. Mediators like stress and scratching can keep the circle going.

I like to think of the body as a temple. If your body is a temple, your skin is the wall that protects it. The outer layer of your skin has a classic brick-and-mortar structure. A lot of people with eczema are predisposed to eczema because they are born with poor quality mortar. A poor quality wall will result in two things: water will be lost through the wall, resulting in dry skin; and irritants and other annoying little things such as allergens can penetrate the wall and provoke a reaction or flare.

Most people think of eczema as itchy, red rashes over the elbow folds and back of the knees; however, it can present in many different ways and can be seen anywhere on the body. From the feet to the fingers to the genitals to the nipples to the earlobes to the eyes to the scalp. Really everywhere. Sometimes it is limited to one area on the body and sometimes the rashes are present on the whole body.

What causes it? 

The million dollar question!

Triggers differ across age groups and countries. Food allergens are more common for infants than adults. Drooling and teething can also lead to eczematous rashes in infants. When it comes to toddlers, childhood diseases, environmental allergens and vaccinations are common triggers. In adults and adolescents, stress is a common trigger, as is washing hands too frequently. Sweat and air conditioning can worsen eczema in patients living in hot and humid climates. On the other hand, during cold seasons, low temperatures and wind can cause dry skin and subsequent outbreaks of eczema. Cyclical worsening of eczema in female patients could be secondary to a possible underlying hormonal imbalance, which can require a different treatment strategy. These are all just examples, but if you re interested to know more: in my book I elaborate on each one of them. 

What are a few things someone can do if they are having a flare up? 

Obviously, the best thing is to prevent a flare! Some people know what makes their skin flare, others don’t, it’s not for everyone as easy to find out. Once you know the triggers, it’s best to avoid them but that’s not always possible. For example, change of climate or temperature, you know it’s coming but you can t change it. One thing you can do to help avoiding a bad flare, is increase the frequency of your moisturizing and increase the amount of emollients used and use gentle fragrance free soaps.

When your skin is dry, it is more likely to flare, hence the maintenance treatments with moisturisers in between flares.

The same thing should be done once you skin is flaring, however at that point a cream containing an active ingredient to temper the inflammation should be added in most cases.

Any specific recommendations with regards to coronavirus/frequent hand washing/sanitising?

Too much hand washing can lead to dry, cracked skin as harsh soaps, hot water and rubbing the skin dry strip your own skin’s moisture. The mortar between your bricks becomes poor quality mortar resulting in a fragile, cracked wall with no protective barrier. This opens the door to infections and all other types of misery such as contact dermatitis to certain ingredients in products (e.g. fragrances, preservatives).   Tips to keep your hands well hydrated in Corona Times: use lukewarm water in stead of hot water, blot your hands dry in stead of rubbing them dry and apply daily moisturising cream or ointment immediately after washing your hands. Also, make sure there is no soap left around/under your ring.

Any specific skin care ingredients to use and any to avoid? 

As mentioned above, when the wall of the skin becomes more fragile, ingredients used on the skin penetrate more than usual. Applying products containing certain ingredients such as preservatives and fragrances can then penetrate more compared to skin with a great skin barrier and induce a troublesome lifelong skin condition called contact dermatitis.

Should eczema on the face be treated in a different way to the rest of the body?

The skin on the face is different and more fragile and hence should be treated differently from the rest of the body, especially the skin around the eyes and the neck. This is particularly the case when it comes to active creams but also moisturisers used on the face are slightly different from moisturisers on the body. On the face, especially in the T-zone, lighter moisturisers should be used to prevent clogged pores causing spots.

What do you recommend a typical skin care routine looks like for someone with eczema? 

A gentle skin wash twice a daily and a light moisturiser. Use products for dry skin but avoid too greasy moisturisers as they may clog pores and cause acne.

Any specific recommendations with regards to coronavirus/face mask wearing?

Face mask often cause friction and friction can trigger an eczema flare(and acne!). Make sure your mask is well fit but not too tight. If you are having active eczema on the face, remember your skin barrier is not as protective and bacteria and viruses can enter the skin more easily, hence wash your mask often if you use a reusable mask .

by dr Amélie Seghers, author of ‘Eczema, how to ditch the itch’ , available on Amazon, Barns & Noble and Waterstones.