Eczema: What it is and how to treat it
Breaking out your down-filled parkas and shelling out extra pennies for heavy-duty moisturizers is typical come snowfall – I always have hand cream and lip balm at the ready. But, for some, the start of winter signals something much worse.
Enter eczema, a chronic condition that irritates the skin, leaving it inflamed, red and highly sensitive. For some, it takes a few lifestyle changes to get it under control – an overhaul of your personal care and beauty products or shorter hot showers. But, for more extreme cases, the work of a professional physician is in order.
I’m no doctor, so I called on dermatologist Sam Hanna from Toronto’s Dermatology on Bloor to find out what exactly eczema is, how to treat it and why it gets worse in the winter.
What is eczema?
Eczema is mostly genetic. It’s a type of dermatitis called atopic dermatitis (AD). Dermatitis literally means inflammation of the skin, which messes with the body’s ability to produce the skin’s necessary structural and function proteins. Essentially it strips the skin’s barrier and diminishes its ability to interact normally with the environment.
Hanna explains that this is common in skin folds including the insides of arms, the neck, the backs of the knees, and the wrists. But, in severe cases it can be pretty widespread.
“AD often begins in childhood,” says Hanna. “[It] often improves or resolves through the first two decades of life but 40 per cent of kids with AD may become adults with some persistent manifestations of AD, such as hand dermatitis or nummular dermatitis – so called, ‘winter itch.’”
Why it’s worse in winter
You might find that your skin is itchier and harder to manage in the winter. According to Hanna, this happens because of low humidity in the cold air and hot showers, which strip the skin’s barrier function.
“Heating of our indoor spaces further dries the air and exacerbates the skin barrier breakdown that is the hallmark of eczema. Once that happens, a vicious cycle is set up where the ‘good’ stuff, like natural lubricants and water, get out and ‘bad’ stuff, like bacteria and environmental allergens, can get in.”
This increases the risk of skin infection, as well as the release of inflammatory mediators in the skin, causing itching. Itching leads to scratching, and in turn, more skin breakdown.
Treating eczema
Skin products and medications work together to settle eczema. Hanna suggests staying away from fragrance and preservative-heavy skin products that dry and irritate the skin.
Instead, he recommends a long list of cleanser and moisturizer brands including Cetaphil, Cerave, Aveeno, Avene and La Roche Posay, but cautions that eczema may still flare, especially in the winter.
photo: CeraVe
If that’s the case, your physician can prescribe you anti-inflammatory creams, ointments, gels, foams, liquids or lotions. In severe cases, you may be directed to use strong oral anti-inflammatory medicines.
While tanning beds should be avoided, in some cases, a medically directed UV light therapy that delivers treatment rays can be helpful.
When to moisturize
Moisturize your skin whenever you wash or shower.
“Air drying after bathing or even hand washing ends up resulting in a net water loss from the skin,” claims Hanna.
To help repair the damaged skin barrier and hold newly added water in the skin, he suggests moisturizing with a cream containing ceramides.
“Creams that contain ceramides or increase natural ceramide production in the skin may offer a little better barrier correction.”
Avoid irritants
Approximately one third of people with eczema have related allergens, so make sure to avoid personal irritants to limit flare-ups. It is important to remember that a person’s specific allergy doesn’t mean it’s directly involved in their eczema. When it comes to food, Hanna asserts that “restrictive elimination diets have shown little to no efficacy and may do more harm than good.”
Less is more
When it comes to personal care products, less is more. Fragrance, colours, alcohol and the total number of ingredients in a product should be minimized. Don’t use abrasive pads or brushes and stay away from exfoliators with a gritty texture.
Dryer sheets can also leave irritating fibers in clothes, so Hanna recommends using liquid fabric softeners instead.
He also stresses that supplements and herbal remedies have shown no benefit in treating eczema.
“Plant-based topical therapies can be hard for atopic skin to tolerate.”
Products with words like “natural” or “organic” or “baby” are also red flags as they offer little information that the products will work for those with the condition.
The day to day
Unfortunately, there is no quick fix for eczema, but working with your family doctor or dermatologist will give you the tools to limit the impact eczema has on your day to day life.
Hanna’s advice: “Cleanse gently, moisturize well, use necessary medications and sun protect.”
