Eczema

What is eczema

Eczema is an itchy, chronic inflammation of the skin that causes it to become red, scaly and dry. The dry skin is then very vulnerable to infection from viruses and bacteria, which increases when the skin is scratched.

Eczema often occurs in infants and children and it can resolve on its own, but not in every case. Eczema can also occur for the first time in adults too. Science really is not sure what causes eczema and while there is no cure for eczema, treatment can reduce symptoms significantly in some people and help prevent further outbreaks.

There are a few different types of eczema

• Atopic eczema – the most common type of eczema, especially in children which displays all the symptoms of eczema and can appear anywhere on the body
• Dyshidriotic eczema – affects the palms of the hands and soles of the feet which usually produces blisters that contain fluid and are surrounded by a red rash; this condition starts before the age of 40
• Nummular (descoid) eczema – red, itchy and inflamed round-shaped lesions form on the arms and legs; most common in older people or those adults with very dry skin
• Seborrhoeic eczema – this is an eczema of the scalp which can affect both babies and adults
  • Adult seborrhoeic eczema – this affects adults and starts with the scalp being affected and then starts to affect the face
  • Infant seborrhoeic eczema – this is also known as cradle cap and is a very common condition affecting babies in their first year of life

Facts about eczema

• Eczema is an inflammation of the skin which causes the skin to get itchy and dry
• The skin has a “red” inflamed appearance where the eczema occurs
• Eczema is derived from the Greek word that means ‘to boil over’
• Eczema is also known as atopic dermatitis
• Eczema affects men and women equally
• It is not just children who develop eczema, adults can develop it too
• It is important to treat eczema when it first occurs, especially if symptoms are mild, to prevent it from getting any worse
• Eczema is not contagious, no matter how severe it is
• Skin that is affected with eczema may be more susceptible to other types of infections
• People with eczema usually have family members who have a history of eczema, or other allergic conditions such as asthma, allergic rhinitis (hay fever) or allergies
• Eczema can affect just a small part of the body and cause relatively mild symptoms (mild eczema) or it can be more widespread, causing more severe and debilitating symptoms
• Use natural, mild (or hypoallergenic) soaps with as little chemicals as possible to avoid drying out and irritating the skin
• Avoid the allergen triggers that may cause eczema – these may be different for each person, but usually harsh chemicals are a problem for eczema sufferers
• Avoid highly perfumed soaps, lotions and skin products as these may irritate the skin and exacerbate eczema symptoms
• Wear clothes made of natural fibres
• Wear gloves when washing dishes, clothes or cleaning
• Use non-perfumed and natural clothes detergents and fabric softeners, as the chemicals in conventional clothes detergents may irritate the skin and cause an exacerbation of symptoms
• Go swimming in the ocean, as seawater, having a high composition of salt is known to alleviate eczema symptoms
• Eczema may not be cured (in most people), but the symptoms can be greatly reduces if a variety of treatment approaches are used concurrently

Symptoms of eczema

General symptoms of eczema

• Blisters – small blisters can form, which ooze a liquid, if the skin is inflamed enough and especially if it has been scratched repeatedly
• Crusty skin – once the blisters form, a crust then forms over them to help them heal
• Itchy skin – this is the main symptoms of eczema, which generally identifies a rash as eczema. The need to scratch the affected areas is very strong
• Lighter or darker skin tone – the eczema affected areas may become lighter or darker than the surrounding skin due to the eczema, as these areas have less pigment (known as lichenification)
• Redness of the skin – the skin with the eczema is more red and inflamed due mainly to the scratching of the affected areas
• Thickening of the skin – this occurs on the skin which has been inflamed for a while, usually due to the repeated scratching of the affected areas

Most common areas of the skin to be affected by eczema

• Ankles
• Behind the knees
• Face
• Feet
• Hands
• Neck
• The inner part of the elbow
• Upper chest
• Wrist

Uncommonly, eczema can also affect the skin around the eyes, including the eyelids. If this area is scratched, it can cause redness and swelling around the eyes and can also sometimes cause patchy loss of eyebrows and lashes.

Causes of eczema

Science has not yet discovered the cause of eczema, but at this stage, it is believed that a malfunctioning immune system may play a big role in initiating eczema symptoms.

There are a number of triggers for precipitating eczema in those who are susceptible to this condition:

Genetics

Research shows that children with a family history of either eczema (or asthma or allergic rhinitis) are also more likely to develop eczema either in childhood or as adults. In addition to this, if there are family members with any of these conditions, it is another factor in likelihood of developing eczema too.

In addition to genetics, it seems that eczema is precipitated by two specific factors:

Allergens

Research suggests that many cases of eczema are caused, at least in part, to an allergic reaction to a substance, which is known as an allergen. Underlying this allergic reaction is a faulty immune system, which does not recognise the allergen as harmless and over-reacts with eczema symptoms. The most common allergens include: food, medication, dust, pets, plants, rubber, nickel.

Irritants

Research suggests that many cases of eczema can also be caused, at least in part, to an irritant that touches the skin. This causes the immune system to over-react and produce eczema symptoms. The most common irritants to the skin that can produce eczema on the skin include: environmental chemicals, laundry powders (or liquids), skin care lotions (or creams), dish washing liquids, laundry softeners, cleaning products.

Prevention of eczema

Non-preventable risk factors

Eczema may be unpreventable in certain circumstances:

• Age – a high proportion of eczema cases seen by doctors are in infants and young children; approximately 65% of all eczema cases occur in infants under the age of one and about 90% of all eczema cases occur in children under the age of five
• Family history – people with other family members who have eczema or other allergic conditions such as asthma or allergic rhinitis are more likely to develop eczema than people with no family history of these conditions. Genetics seems to play a big role in the development of eczema

Preventable risk factors

There may be ways to prevent eczema from occurring or at least reduce occurrence and severity of symptoms:

• Avoid the allergens – people who have eczema due to an allergic reaction to a specific allergen need to identify the allergen and avoid it as much as possible, to prevent recurrence of symptoms
• Avoid the irritants – people who have eczema due to a reaction to a specific irritant need to identify the irritant and avoid it as much as possible, to prevent recurrence of symptoms
• Breastfeed babies – some recent studies suggest that babies which are breast-fed for at least six months after birth are less likely to have babies and children that develop eczema or any type of allergic condition
• Good nutrition – recent research suggests that certain deficiencies in certain nutrients may be a risk factor for the development of eczema. Specifically, the research suggests that deficiency in the omega-3 essential fatty acids can cause eczema to occur and this deficiency starts with the pregnant and lactating mother, who if she is deficient in these nutrients, can risk her child developing eczema as a result
• Inadequate humidity – people living in an environment with a low humidity climate are more likely to be at risk for developing eczema, as the dryness in the air can dry out the skin, leaving it open to developing eczema
• Reduce stress – studies show that stress can aggravate eczema or initiate it in infants, children and adults

Complications of eczema

In general and in most cases, eczema does not pose many complications other than annoying symptoms, but in some cases complications can arise, especially if the eczema is severe, or undiagnosed and untreated for a long time:

• Depression – some people with severe eczema (or scars due to eczema) may not feel comfortable showing their eczema-affected skin in public, especially if it affects their face and other prominent body parts. If the feelings of isolation continue, this can then develop into a low mood and feelings of depression, which need further medical attention. People with severe eczema need to get appropriate treatment in order to reduce their symptoms so that flare-ups of the condition are reduced
• Scar formation – if the eczema rash is scratched too often, this can cause the skin to develop further even inflammation and redness, making the symptoms worse. Subsequent blisters, lumps and nodules that form may develop into scars and these may be permanent
• Skin infection – the eczema affected skin is more susceptible to any type of bacterial infection because in many cases, the skin has cracks, blisters and other openings which the bacteria can enter. Severely affected skin with eczema needs appropriate treatment to prevent this complication

When to see a doctor about eczema

Many cases of eczema start in babies and infants (approximately 65% of all cases), so if your baby has a rash and eczema is suspected, then a doctor should be consulted for a diagnosis and appropriate treatment plan. Children are also quite susceptible to eczema, so any new rash in a child without fever or other visible symptoms should be taken to a doctor for diagnosis.

Adults with any of the symptoms of eczema should visit a doctor in order to diagnose this condition and get advice on an appropriate treatment plan. There are a number of options for treatment, both conventional and alternative and your doctor will advise which options are available and safe for your situation.

Diagnosis of eczema

Initial diagnosis of eczema is through the following tests:

• Medical history of symptoms – the doctor will take notes on the duration and severity of symptoms. The doctor will also ask a series of questions about your personal history and your family history of conditions such as allergic rhinitis, asthma and eczema. The doctor may also ask questions about your exposure to environmental chemicals, cleaning and laundry products and other factors, to determine if this rash is due to an irritant or an allergen, as this is important in a determining treatment plan
• Physical examination – the doctor will review all the areas of the rash on the skin to determine if it is eczema or if the symptoms present another condition

Diagnostic tests

If the doctor suspects that an allergen may be the cause of the eczema, the following test may also be requested:

• Allergy (‘skin prick’) test – this involves pricking the forearm with a very small needle and allowing some of the allergen into the skin. This is done many times with various allergens that the allergy specialist uses (including dust and pet hair brought from home) to determine if an allergy exists to a particular substance. Usually, if an allergy to the substance occurs, it will cause the skin pricked to form a welt, rash or lump. The allergy specialist (or immunologist) will have taken note of each substance used to enable determination of the substances that cause the allergic response

Conventional treatment of eczema

Conventional treatment of eczema involves a combination of avoiding the allergen (or irritant) to prevent flare-ups from occurring in the first place, other lifestyle modifications, together with medication for treating any flare-ups of symptoms. There are also some newer forms of therapy to treat eczema, which are also described.

Prevention – reduce exposure to allergens

• Allergy testing – if it has been determined that the eczema is caused by an allergic reaction to specific allergens.
• Avoid the allergen(s) – it is advisable to avoid any known allergens which can trigger eczema symptoms. Commonly known allergens which should be avoided are: pollen, dust mites and animal dander

Prevention – reduce exposure to irritants

• Avoid the irritant – it is advisable to avoid any of the known irritants which can trigger the eczema symptoms. Commonly known irritants which should be avoided are: certain fabrics (especially wool), perfumes, cosmetics, cleaning products, soap, shampoo, environmental chemicals, cigarette smoke
• Identify the irritant – it is advisable to take note of any worsening of symptoms after application of lotions and creams, or exposure to any environmental chemicals, certain fabrics as well as any other known irritants. This will help to identify the irritants and will enable avoidance of the irritant

Lifestyle modifications

• Avoid having hot baths or showers – very hot water can aggravate the eczema symptoms by creating further inflammation and should be avoided. When eczema symptoms are visible on the skin, have a lukewarm bath or shower and bathe as quickly as possible, as the warm water will dry the skin out further and this can make the symptoms of eczema worse
• Don’t scratch the eczema – avoid scratching or rubbing the eczema lesions/lumps/blisters as this will only make the itchiness worse, will inflame the skin further and will make symptoms worse and possibly spread the eczema over a larger area of the skin
• Moisturise the skin – it is really important to reduce the dryness of the skin, especially after having a bath or shower. Moisturise the skin every day with a gentle, mild moisturiser that is as natural as possible (most organic skin care products contain less chemicals and are less likely to irritate the skin, but try to use one without too many perfumes as that can irritate the skin)
• Protect the skin – in order not to irritate the eczema affected skin, it is advisable to wear light, natural fibres (not wool, unless it is lined) as this can protect the skin from rough material fibres from irritating the skin
• Reduce stress – research suggests that stress can aggravate eczema flare-ups, so it may be beneficial to engage in stress management techniques

Helpful hints for parents of children with eczema

Babies, infants and young children tend to present with most cases of eczema and the following is useful some advice for parents:

• Cut fingernails – always keep the child’s fingernails very short to prevent the child from being able to scratch the eczema lesions too much and make symptoms worse
• Keep the child cool – hot weather, hot baths, hot showers and hot climates will aggravate eczema symptoms, so always bathe the child in lukewarm water (using mild, natural soap, but as little as possible) and cool the child in hot temperatures with a wet facecloth, dabbed gently on the child’s pulse points
• Use natural moisturisers/oils – try to use only natural skin care products on the child, which have less irritant chemicals that may be better tolerated by the child’s skin and not cause further aggravation of symptoms. Consult your doctor on finding the best type of moisturisers and oils for your child

Medication

There are a number of different types of medications used to remedy the different types of symptoms associated with eczema:

• Antibiotics – your doctor may prescribe antibiotics if aggravation of the eczema by scratching has caused a bacterial skin infection or an open sore. Your doctor may prescribe the antibiotics either for a short duration to treat a current infection or for a longer to treat a long-standing infection and to prevent recurrence of infection
• Antihistamines – if the itching symptoms are really severe and unbearable, your doctor may prescribe oral antihistamines tablets to prevent the urge to scratch the skin and worsen the eczema symptoms. Antihistamines can cause drowsiness, so should not be used if you are driving or operating machinery, but can be useful if taken before you go to sleep as they will make you sleepier
• Corticosteroid creams or ointments – your doctor may prescribe corticosteroid cream or ointment, which help to relieve itching and other associated symptoms, such as scaling and thickening of the skin. Some corticosteroid creams are available over-the-counter. Your doctor will advise you which type of creams are the best for your symptoms and will explain all the possible side effects from long-term use of these creams or ointments (which include skin irritation and discolouration, thinning of the skin and possible skin infection)
• Corticosteroid tablets – if the eczema is very severe, your doctor may prescribe corticosteroid tablets to be taken over a short-term. This medication reduces the inflammation in the skin, itchiness and helps to control symptoms to a more manageable level. While corticosteroids are an effective treatment option for very severe eczema, they are not viable over the longer term as they have serious side effects, including loss of calcium from the bones (osteoporosis), more infections, thinning of the skin, cataracts and high blood pressure
• Immunomodulators – these are a newer class of medication which affect the immune system to stop it from causing the inflammatory symptoms, to help maintain normal skin and reduce flare-up of eczema symptoms. These medications can only prescribed by a doctor and are recommended to be only used where other treatments have failed or cannot be tolerated, as there is some concern about potential adverse effects on the immune system if used over a long term. This medication can only be used in children over the age of 12 and in adults
• Medicated wet dressing – if the skin where the eczema lesions occur cracks open, your doctor may prescribe mildly astringent medicated wet dressing, which needs to be changed on a regular basis, to prevent infection

Phytotherapy (light therapy)

Phytotherapy is a newer type of therapy for eczema which involves treatment with ultraviolet light for mild to moderate eczema in children over the age of 12 and in adults. In phytotherapy, the eczema affected skin is exposed to controlled amounts of ultraviolet light for set periods, to reduce symptoms.

Phytochemotherapy (light therapy + chemotherapy)

In some people, phytotherapy alone is ineffective, so it can be combined with Psoralen, which is a type of chemotherapy medication to more effectively treat the eczema. In phytochemotherapy, the treatment is the same as in phytotherapy, except that in this type of therapy, the medication is taken in conjunction with the light therapy, to enable it to work better.

Alternative/complementary treatment of eczema

Most of the lifestyle recommendations which are available in the conventional treatments for eczema are also recommended by alternative/complementary practitioners. In addition to those, there are also some other treatments recommended.

People with eczema who are taking any type of medication need to consult with their doctor before trying any of the treatment options recommended here, as there could be potential for adverse side effects especially in combination with medications.

Herbs

There are a number of excellent herbs which may help to provide relief for symptoms:

• Aloe vera cream – the gel inside the leaves of the aloe vera plant is soothing and cooling, providing instant reduction in inflammation and relief from symptoms, providing potent anti-inflammatory and cooling effects
• Calendula cream – the herb calendula, when made up into a cream is soothing and provides a great reduction in inflammation symptoms over the longer term and in addition to this, it moisturises the skin, reduces dryness and reduces severity of symptoms
• Evening primrose oil – a cream that is made with evening primrose oil as the active ingredient is very effective at reducing the inflammation of eczema and reducing symptoms of itchiness, although it works even better when taken internally
• Tea tree oil cream – this oil of this native Australian tree has potent anti-fungal, anti-bacterial and anti-viral properties, which means it will prevent infection and it also can reduce inflammation as it has cooling properties (especially if in a cream), providing relief of symptoms

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Bioflavonoids – the antioxidant bioflavonoids should be used in conjunction with vitamin C to help reduce symptoms of inflammation associated with eczema, as well as to boost the function of the immune system to prevent future flare-ups
• Vitamin A – numerous studies show that the antioxidant vitamin A is essential for ensuring the skin is healthy and elastic and the mucous membranes are not dried out, which helps to prevent flare-ups of symptoms
• Vitamin B complex – studies show that the B vitamins are necessary for healthy skin and proper circulation in the body. The B vitamins also assists with the proper reproduction of the cells in the body (which is needed in renewing the cells in healing) and assists with providing proper nutrition for the nerves to reduce stress
• Vitamin C – the potent antioxidant vitamin C works to relieve the symptoms of most types of eczema, but especially for dyshidriotic eczema, which responds very well to vitamin C supplementation. Vitamin C provides support for the immune system
• Vitamin D – studies show that vitamin D is beneficial in treating the symptoms of eczema as it helps the skin to heal more quickly from any flare-ups. It can also be useful to use a cream with vitamin D on the skin affected with the eczema
• Vitamin E – the potent antioxidant vitamin E is very beneficial for the skin as it helps to relieve the itching symptoms and helps to moisturise the skin, preventing it form drying out. In addition to this, vitamin E also provides potent support for the immune system. A cream with vitamin E is also beneficial for any type of skin condition, as it helps to reduce dryness, which is a major factor in eczema

Minerals

There are a number of minerals which may help to provide relief for symptoms:

• Magnesium – the mineral magnesium helps to relax the body tissues, which means it may be helpful in reducing the stress and anxiety associated with inflammation and pain of eczema
• Selenium – the potent antioxidant mineral selenium improves elasticity of all layers of the skin and may also assist with healing the skin more quickly from eczema flare-ups
• Zinc – the antioxidant mineral zinc helps the tissues to heal more quickly and it also helps to reduce recurrence of symptoms. In addition to this, studies show that people who have eczema may have a deficiency of zinc, which could be a part of the reason for the recurrence of all the flare-ups

Other nutrients

There are a number of other nutrients which may help to provide relief for symptoms:

• Alpha lipoic acid – the nutrient alpha-lipoic acid is a potent antioxidant, which provides major support for the immune system to help it function better. Studies show that an improperly functioning immune system may be the major reason behind the development of eczema, so supporting the immune system’s function may reduce incidence of flare-ups
• Coenzyme Q10 – studies show that coenzyme Q10 helps to remove toxins from the body and provides support to the immune system to function more effectively
• Evening primrose oil – many studies show that the gamma-linolenic acid (GLA) in evening primrose oil has potent anti-inflammatory properties and seems to assist with alleviating symptoms such as itchiness and redness as well as reducing severity and duration of flare-ups
• Fish oil – the omega-3 essential fatty acids in fish oil have well documented anti-inflammatory properties and studies show that they may be useful for reducing itchiness, redness and inflammation associated with eczema flare-ups
• Glutathione – the amino acid glutathione is potent antioxidant, which provides a big boost to support the immune system to help it function more effectively by normalising it and helping it to react more normally
• Probiotics – it may be beneficial to take probiotics (such as acidophilus) as they help to populate the gastrointestinal system with friendly “good” bacteria and this prevents overgrowth of yeasts and “bad” bacteria in the body, reducing risk of infection in the eczema lesions

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms:

• Eat more fibre – the diet should include plenty of wholegrains and other plant foods to help the colon eliminate toxins more quickly out of the body. Psyllium fibre (in the form of a powder added to foods) is often useful for this function as it is well tolerated by most people. Just make sure to add it a little at first, to get used to eating more fibre
• Eat more oily fish – the diet should include 3 portions of oily fish (salmon, mackerel, sardines or trout) each week. These types of fish contain the highest levels of omega-3 fatty acids, which reduce inflammation and this may assist in reducing eczema symptoms
• Eat more vegetables and fruit – as long as they do not aggravate symptoms, the diet should include 5-7 portions of vegetables and 2-3 servings of fruit each day. Vegetables and fruit are full of antioxidants, vitamins and minerals, plus because they are high in water, they help to keep the body hydrated and this may help to reduce dryness of the skin

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms:

• Apply a cold compress – use plain cotton fabric which has been moistened with cold water to the area on the skin which is inflamed with the eczema. This simple remedy can provide immediate (albeit temporary) relief, but enough to reduce the worst of inflammation and itchiness
• Avoid getting over-heated – high temperatures and sweating can cause an aggravation of symptoms in some people, so try to stay cool, use a cool compress to cool down the body and only touch the affected areas gently, to avoid aggravating the eczema symptoms
• Avoid scented soaps & detergents – perfumed soaps, shampoos, detergents, laundry liquids, softeners, cosmetics and skin care are known to aggravate existing eczema. Always use non-scented, organic soaps, skin care, cosmetics, dishwashing and laundry detergents, as well as cleaning products which are milder on the easily inflamed skin and are less likely to cause a reaction (experimentation will be necessary to find the right soap and detergent). Always read the label and avoid products that have synthetic ingredients, especially perfume and other additives that can cause irritation
• Avoid scratching the itch – by scratching the itchy patch(es) of eczema, it only makes it worse and increases the likelihood of developing worse symptoms and spreading the eczema over more area of the skin. Use one of the methods advised to reduce the symptoms to help avoid scratching the itchiness
• Avoid the allergen(s) – it is advisable to avoid any known allergens which can trigger eczema symptoms. Commonly known allergens which should be avoided are: pollen, dust mites and animal dander
• Avoid the irritant(s) – it is advisable to avoid any of the known irritants which can trigger the eczema symptoms. Commonly known irritants which should be avoided are: certain fabrics (especially wool), perfumes, cosmetics, cleaning products, soap, shampoo, environmental chemicals, cigarette smoke
• Drink more water – drink around 8-10 glasses of water each day as this will help to hydrate the body and tissue and prevent skin from drying out
• Limit exposure to sunshine – limit exposure to strong sunlight, as it can aggravate symptoms. Avoiding sunshine is an excellent way to help reduce inflammation and other symptoms associated with eczema
• Reduce exposure to stress – any type of meditation or calming therapy that will help to reduce stress and anxiety will help to reduce symptoms as stress is known to aggravate symptoms
• Stop smoking – studies show that nicotine can aggravate or even initiate some types of eczema (especially if there is an allergy to cigarettes). Do not smoke and do not be exposed to second-hand smoke from other people

Alternative treatments

• Naturopath – a naturopath can help to identify the source of the allergens or irritants. In addition to this, a naturopath can provide a tailor-made treatment plan with herbs, vitamins and other nutrients to help reduce symptoms

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with eczema

Management of eczema is achieved best by avoiding the allergens/irritants, reducing incidence of flare-ups, reducing symptoms and supporting the immune system to prevent recurrence:

Reduce severity of existing symptoms

• Apply a cool compress – use plain cotton fabric which has been moistened with cold water to the area on the skin which is inflamed with the eczema. This simple remedy can provide a great deal of immediate (albeit temporary) relief, but enough to reduce the worst of inflammation and itchiness
• Avoid having hot baths or showers – very hot water can aggravate the eczema symptoms by creating further inflammation and should be avoided. When eczema symptoms are visible on the skin, have a lukewarm bath or shower and bathe as quickly as possible, as the warm water will dry the skin out further and this can make the symptoms of eczema worse
• Avoid scratching the eczema – by scratching the itchy patch(es) of eczema, it only makes it worse and increases the likelihood of developing worse symptoms and spreading the eczema over more area of the skin. Use one of the methods advised to reduce the symptoms to help avoid scratching the itchiness
• Eat more fish – the diet should include 3 portions of oily fish (salmon, mackerel, sardines or trout) each week. These types of fish contain the highest levels of omega-3 fatty acids, which reduce inflammation and this may assist in reducing eczema symptoms
• Moisturise the skin – it is very important to reduce the dryness of the skin, especially after having a bath or shower. Moisturise the skin every day with a gentle, mild moisturiser that is as natural as possible (most organic skin care products contain less chemicals and are less likely to irritate the skin, but try to use one without too many perfumes as they can irritate the skin)
• Omega-3 fatty acids – many studies show that the omega-3 essential fatty acids DHA and EPA (in fish oil) and the omega-6 essential fatty acid GLA (in evening primrose oil) are very beneficial in helping to reduce the severity and incidence of symptoms in people with eczema. Always discuss supplementation with your doctor before trying it

Support the immune system to reduce flare-ups

• Antioxidant minerals – there are several minerals which have a potent antioxidant and immune boosting function and they also boost the healing process to occur more quickly. The best minerals for this are: selenium and zinc. These minerals enable the immune system to function more effectively and this may prevent and reduce flare-ups and reoccurrence of symptoms. Seek advice from your doctor before trying them
• Antioxidant vitamins – there are several minerals which have a potent potent antioxidant and immune boosting function, plus they may help to prevent the skin from drying out. The vitamins most beneficial are: bioflavonoids, vitamin A, vitamin C, vitamin D, vitamin E. A multivitamin is the best way to provide adequate intake of these vitamins. Seek advice from your doctor before trying them
• Avoid the allergens – it is advisable to avoid the known allergens which can trigger eczema symptoms and cause flare-ups. Avoiding known allergens reduces incidence of flare-ups. Commonly known allergens to be avoided are: pollen, dust mites and animal dander
• Avoid the irritants – avoid the known irritants which can trigger the eczema symptoms and cause flare-ups. Avoiding known irritants reduces incidence of flare-ups. Commonly known irritants to be avoided are: certain fabrics (especially wool), perfumes, cosmetics, cleaning products, soap, shampoo, environmental chemicals, cigarette smoke
• Identify the allergens – it would be most beneficial for the immune system to identify the allergens which cause the eczema in order to avoid them so that the immune system has a break from constantly working to remove them from the body
• Identify the irritants – it would be most beneficial for the immune system to identify the irritants which cause the eczema in order to avoid them so that the immune system has a break from constantly working to remove them from the body
• Other supplements – there are a number of other supplements which have antioxidant properties that boost the function of the immune system or which have other functions to remove toxins from the body that help the function of the immune system. The nutrients most beneficial are: alpha-lipoic acid, co-enzyme Q10, glutamine, probiotics. Seek advice from your doctor before trying them
• Reduce exposure to stress – research suggests that stress can aggravate eczema flare-ups, so it may be beneficial to engage in stress management techniques. This is beneficial in a number of ways, as stress reduction helps to boost the function of the immune system

Caring for someone with eczema

Partner

If you have a partner with eczema, there are a number of useful strategies you can use to help them:

• Avoid using perfumed products – most type of skin care, cosmetics, laundry and cleaning products contain some types of perfumes and other abrasive chemicals, which can irritate sensitive skin prone to eczema. Find non-perfumed, natural alternatives
• Don’t smoke – cigarette smoke is a known irritant to the skin and this could be one of the triggers for causing the eczema. Don’t smoke around your partner as their exposure to your second-hand smoke can be a trigger for their eczema
• Help your partner moisturise – especially if the eczema is on the back or on areas of the skin that are harder to reach, it may be helpful if you can help them with moisturising these areas
• Remove the allergens from the home – once the allergens that trigger the eczema have been identified, ensure they are not in the home to avoid exacerbating your partner’s eczema
• Remove the irritants from the home – once the irritants that trigger the eczema have been identified, ensure they are not in the home to avoid exacerbating your partner’s eczema

Friends and family members

If you have a friend or family member with eczema, there are a number of useful strategies you can use to help them:

• Avoid using perfumed products – most type of skin care, cosmetics, laundry and cleaning products contain some types of perfumes and other abrasive chemicals, which can irritate sensitive skin prone to eczema. Try to ensure you have not just cleaned your home just before your friend or family member is about to arrive and don’t use air fresheners either
• Don’t smoke – cigarette smoke is a known irritant to the skin and this could be one of the triggers for causing the eczema. Don’t smoke around your friend or family member as their exposure to your second-hand smoke can be a trigger for their eczema

Parents

If you have a child with eczema, there are a number of useful strategies you can use to help them:

• Apply a cool compress – use plain cotton fabric which has been moistened with cold water to the area on the skin of your child which is inflamed with the eczema, but do not rub or press hard as this will cause pain. This simple remedy can provide a great deal of immediate (albeit temporary) relief, which is enough to reduce the worst of inflammation and itchiness on your child’s skin. If the child is old enough, you can teach them how to do this too (instead of scratching their skin)
• Avoid using perfumed products – most type of skin care, cosmetics, laundry and cleaning products contain some types of perfumes and other abrasive chemicals, which can irritate sensitive skin prone to eczema. Find non-perfumed, natural alternatives
• Bath and shower in tepid water – ensure you bathe (or shower) your child in tepid water since hot water will dry out the skin and can be painful on active eczema. If your child is old enough, teach them how to use cooler water they take their shower
• Distract the child from scratching – you will need to use a number of strategies to prevent the child from scratching the eczema as that can spread it further
• Don’t smoke – cigarette smoke is a known irritant to the skin and this could be one of the triggers for causing the eczema. Don’t smoke around your child as their exposure to your second-hand smoke can be a trigger for their eczema
• Identify the allergens – there are a number of allergens that can possibly cause the eczema to occur, so work with your child to try to identify these triggers to avoid them. If an allergen is suspected of causing the eczema, discuss your options with your doctor, especially an allergy (skin prick) test, which can confirm allergens
• Identify the irritants – there are a number of irritants that can cause eczema to occur, so try to identify so work with your child to try to identify these triggers to avoid them. Common irritants are soaps, shampoo, detergents, laundry powders/liquids, skin care, cleaning products and perfumes. Try to find more natural, less abrasive and non perfumed alternatives to determine if this makes any difference to your child’s eczema
• Moisturise after bathing – always moisturise your child after a bath (or shower), all over, to help reduce the dryness in the skin and reduce the likelihood of aggravating the eczema. Find a very mild, unperfumed and natural moisturiser that provides adequate emollient moisture for the skin. Older children can be taught to moisturise their own skin in areas that they can reach
• Provide fish in the diet – oily fish (mackerel, salmon, sardines, trout) contain the anti-inflammatory omega-3 essential fatty acids which studies show can be beneficial for reducing symptoms of eczema. Discuss fish oil supplementation with with your doctor
• Use natural, soft fibres – when your child has an active eczema flare-up, ensure they dress with clothes that are natural and are made of soft fibres, such as cotton. Try to avoid any wool or wool mixes as these can irritate the skin, despite being a natural fibre

References

• Alm B, Aberg N, Erdes L, Möllborg P, Pettersson R, Norvenius SG, Goksör E, Wennergren G. Early introduction of fish decreases the risk of eczema in infants. Arch Dis Child. 2009 Jan;94(1):11-5. E
• Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009 Jun;64(6):840-8. Epub 2009 Apr 7
• Andreassi M, Forleo P, Di Lorio A, Masci S, Abate G, Amerio P. Efficacy of gamma-linolenic acid in the treatment of patients with atopic dermatitis. J Int Med Res . 1997;25(5):266-274
• Arck P, Paus R. From the brain-skin connection: the neuroendocrine-immune misalliance of stress and itch. Neuroimmunomodulation. 2006;13(5-6):347-56. Epub 2007 Aug 6
• Bjarnason I, Goolamali SK, Levi AJ, Peters TJ. Intestinal permeability in patients with atopic eczema. Br J Dermatol. 1985 Mar;112(3):291-7
• Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr . 1999;69(6):1086-1107
• Fujita WH, McCormick CL, Parneix-Spake A. An exploratory study to evaluate the efficacy of pimecrolimus cream 1% for the treatment of pityriasis alba. Int J Dermatol. 2007 Jul;46(7):700-5
• Furuhjelm C, Warstedt K, Larsson J, Fredriksson M, Böttcher MF, Fälth-Magnusson K, Duchén K. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy. Acta Paediatr. 2009 Sep;98(9):1461-7. Epub 2009 Jun 1
• Gale CR, Robinson SM, Harvey NC, Javaid MK, Jiang B, Martyn CN, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr. 2008 Jan;62(1):68-77. Epub 2007 Feb 21
• Januchowski R. Evaluation of topical vitamin B(12) for the treatment of childhood eczema. J Altern Complement Med. 2009 Apr;15(4):387-9
• Kremmyda LS, Vlachava M, Noakes PS, Diaper ND, Miles EA, Calder PC. Atopy Risk in Infants and Children in Relation to Early Exposure to Fish, Oily Fish, or Long-Chain Omega-3 Fatty Acids: A Systematic Review. Clin Rev Allergy Immunol. 2009 Dec 9. [Epub ahead of print]
• Morse NL, Clough PM. A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema. Where do we go from here in light of more recent discoveries? Curr Pharm Biotechnol. 2006 Dec;7(6):503-24
• Osiecki H. The Physicans Handbook of Clininical Nutrition, 6th Edition. Bioconcepts Publishing QLD, 2001
• Roelofzen JH, Aben KK, Van der Valk PG, Van Houtum JL, Van de Kerkhof PC, Kiemeney LA. Coal tar in dermatology. J Dermatolog Treat. 2007 Sep 12;1-6
• Sausenthaler S, Koletzko S, Schaaf B, Lehmann I, Borte M, Herbarth O, von Berg A, Wichmann HE, Heinrich J; LISA Study Group. Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age. Am J Clin Nutr. 2007 Feb;85(2):530-7
• Stücker M, Pieck C, Stoerb C, Niedner R, Hartung J, Altmeyer P. Topical vitamin B12–a new therapeutic approach in atopic dermatitis-evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial. Br J Dermatol. 2004 May;150(5):977-83
• Trak-Fellermeier MA, Brasche S, Winkler G, Koletzko B, Heinrich J. Food and fatty acid intake and atopic disease in adults. Eur Respir J. 2004 Apr;23(4):575-82
• Tratter R, Jones A. Better Health Through Natural Healing: How to Get Well Without Drugs or Surgery, 2nd Edition. McGraw Hill, 2001
• Willers SM, Devereux G, Craig LC, McNeill G, Wijga AH, Abou El-Magd W, Turner SW, Helms PJ, Seaton A. Maternal food consumption during pregnancy and asthma, respiratory and atopic symptoms in 5-year-old children. Thorax. 2007 Sep;62(9):772-8. Epub 2007 Mar 27
• Williams HC. Evening primrose oil for atopic dermatitis. BMJ. 2003;327(7428):1358-9
• Yu RJ, Van Scott EJ. Alpha-hydroxyacids and carboxylic acids. J Cosmet Dermatol. 2004 Apr;3(2):76-87

Last reviewed and updated: 14 May 2024