On a personal note, I suffered from eczema for many years. At one point in my life almost 80% of my body was affected, and the resulting itching and scratching, sores, irritation, and discomfort were more awful than I can put into words. For years I struggled with medications and a varying assortment of cortisone creams and bar soaps, from Basis to Aveeno, until the day my dermatologist found the right cortisone strength and I started to stay away from topical irritants. Then my skin finally settled down—but the problem didn’t go away until much later in life.
Eczema is a general term representing a range of irritated, rash, inflamed skin problems. It also goes by the name contact dermatitis, atopic dermatitis, irritant dermatitis, and allergic dermatitis. By any name, approximately 10% to 20% of the world population is affected by this chronic, relapsing, and very itchy rash at some point during childhood and into adulthood, although it tends to get better as you get older.
Without question eczema is a difficult, uncomfortable, often painful skin disorder. When you have it, you generally know it by the cracked, abraded, blistered, crusted, weepy, reddened, patchy, dry skin surface, accompanied by persistent, almost unbearable itching and the tendency for everything you touch to make matters worse. A simple act like washing your hands, applying eye makeup, or wearing scratchy material can instigate a flare-up that feels interminable.
Almost anything can trigger eczema, and sometimes nothing at all can precede a bout of oppressive itching, scratching, and rashes. Wool (from clothing to carpets), shampoos, hair dyes, nail polish, jewelry, plants, undergarments (elastic waistbands and spandex bras are special villains), deodorant, tight socks, nylons, pet allergies, excessive heat or air conditioning (which increases dry and itchy skin), bathing too often (which leaches moisture out of the skin), using harsh or mild soaps, hot water, vigorous rubbing or massaging, chlorinated water, salt water, and even sweat (this triggered my eczema almost instantaneously) are all possible offenders. In the world of cosmetics, preservatives, irritants (such as peppermint, menthol, alcohol, camphor, eucalyptus, fragrance, and essential oils), bath salts, bubble bath, scrubs, AHAs, BHA, and loofahs are all potent eczema triggers.
Despite this daunting list, everyone is different, and what irritates your skin might not irritate someone else’s. There is no exact science to discovering what causes your skin to react; rather, it is a process of paying attention to what you come into contact with, seeing what makes things worse for your skin, and then eliminating or avoiding those things at all costs.
Generally, an impaired surface skin barrier condition, such as dry skin or irritated skin, is more prone to the sensation of itching and chapping, so a state-of-the-art skin-care routine as explained in this book is essential for finding a reliable way to deal with the rashes and itching. Gentle cleansers, along with gentle toners and moisturizers loaded with antioxidants and skin-identical ingredients, are essential. It is also important to keep bathing time short, avoid bath salts or bubble baths, use lukewarm to warm water (avoid hot water most of all, and that includes jacuzzis), and avoid bar soaps of any kind (they all contain potential irritants). Using fragrance-free, gentle liquid cleansers that also contain moisturizing agents, and applying and reapplying moisturizers quickly afterward, can help a lot.
Unquestionably, well-formulated moisturizers minimize dryness and are a mainstay in treating mild to chronic eczema. It is believed that regular and frequent use of emollient moisturizers can reduce the amount of topical steroids needed in the maintenance treatment of eczema. The more emollient the cream the better, and when fatty acids are included in the formula it’s particularly helpful. Fatty acids are ingredients such as triglycerides, oleic acid, linoleic acid, evening primrose oil, borage oil, fish oil, flaxseed oil, coconut oil, and palm oil (Source: Skin Pharmacology and Applied Skin Physiology, March 2002, pages 100-104). While using a moisturizer twice daily is considered adequate, it is essential to keep a moisturizer with you at all times so that you can reapply it every time you wash your hands. During the day it is essential that you apply an emollient moisturizer with an SPF 15 or greater that contains UVA-protecting ingredients on exposed areas of your body. In the case of eczema, because of the risk of irritation and skin sensitivity, the UVA-protecting ingredients should be only titanium dioxide and zinc oxide, with no avobenzone or other synthetic sunscreen agents of any kind. Synthetic sunscreen agents have a potential to cause skin irritation, and skin afflicted with eczema is much more prone to reacting to irritants, even those (like AHAs or BHA) that traditionally offer skin more benefits than problems.
For years, topical corticosteroids (cortisone) have been the drug of choice for treating eczema. These products are available in a vast range of strengths and molecular structures that allow for varying skin penetration and potency. The risks associated with prolonged use of a potent corticosteroid are that it may result in skin deterioration and adaptation (that means it stops having an effect on the skin). Because of these risks, newer nonsteroidal treatments for eczema have been formulated and have been approved by the FDA. However, if these newer treatments are not effective for you, concerns about skin breakdown (which happens with any long-term cortisone use) and adaptation should not limit your use of a good, potent steroid. It is still a valid way to get control of the eczema. As much as possible, try to minimize the frequency of cortisone application, using it only as necessary to keep the irritation abated. But don’t cut back too far because there is a point of no return where if you don’t use enough your skin becomes an itchy, rashy mess.