This article was originally published in December 2014, and was updated in June 2016.
What causes eczema?
For many people with eczema, the problem lies in their DNA — a mutation in a gene called filaggrin, says Dr. Joseph Lam, Associate Member of Dermatology and Skin Science at the University of British Columbia in Vancouver. “If you imagine the skin as a brick wall, filaggrin is like the mortar between the bricks. It’s like the body’s natural moisturizer.” If filaggrin is missing, you’re much more likely to have dry, easily irritated skin.
To take the brick wall analogy a step further, says Lam, picture eczema as a fire under the brick wall, if there’s no mortar, the fire blazes through the spaces in the bricks. The skin gets inflamed and extremely itchy, causing dry, red patches that can become scaly, oozy and crusty. And because of the skin’s vulnerability, it’s more susceptible to infection.
While DNA may be the underlying cause of eczema in many cases, there are a number of triggers that can cause a flare-up: overheating, sweating, certain foods, fabrics, stress and contact with particular plants and chemicals. But Lam points out that no one has the same triggers all the time and sometimes there’s no discernible trigger. The patches can show up anywhere on the body, most commonly on the joints of the arms and knees. And it’s a moving target; just as you clear up a blotch on your leg, another shows up on your neck. It’s often hereditary and linked to asthma and allergies. Children may outgrow eczema, but for some, it is a life-long condition.
“Although we can’t ‘cure’ eczema, there are very effective treatments that make it seem like you don’t even have eczema,” says Lam.
Since the skin’s ability to keep moisture in is compromised, it makes sense that proper moisturization is an essential part of the treatment and prevention (see The Moisture Method below).
However, moisturizers alone are usually not enough to put out the inflammation of a flare-up. This is where prescription topical steroids come in (over-the-counter steroid creams are not strong enough, says Lam). There has been a belief that longterm use of topical steroids can thin the skin. However, a 2011 study published in the journal Pediatric Dermatology found no evidence to support that claim. “If used properly, topical steriods are extremely safe,” says Lam. “Any cream or ointment that is used for the eczema should ideally get the area of skin under control within two weeks’ time.” If it doesn’t, another doctor’s visit might be required. If the area becomes infected, antibiotics may be prescribed.
Benadryl is often prescribed to relieve the discomfort of eczema. “Benadryl just treats the itchiness, it doesn’t deal with the source of the inflammation.”
The moisture method
Regular moisturization can in some cases stop or decrease the severity of an eczema flare-up. In fact, bathing and moisturizing are such stalwarts of eczema treatment and management that together they’re called “The Regimen” in dermatology circles. The concept is this: a lukewarm bath allows moisture to enter the skin. But since the barrier is worn down, it needs help to lock in moisture and put out the inflammation. That’s where moisturizers come in. But not all moisturizers are created equal. What should you choose?
“The thicker the moisturizer, the longer it will last on the skin,” says Lam. “Ointments tend to be thicker and last longer and provide more protection than creams. Once you move to a lotion it gets even less thick. You can use a lotion, but you’re going to have to moisturize more frequently than if you use a cream or ointment.”
Make sure you check the label: The fewer ingredients (and therefore fewer potential irritants), the better. And if it lists a scent (also called perfume or fragrance), keep shopping. During a flare-up, the regimen may have to be done two or three times a day, with additional moisturizing in between.
Sometimes just knowing that others also struggle with the far-reaching impact of eczema increases the ability to cope.
• The Eczema Association of Canada offers support groups, information and a list of products reviewed by dermatologists and are free of ingredients known to be irritating to sensitive skin.
• La Roche-Posay, makers of the Lipikar line of products formulated for eczema, has launched 100 Families. Through dermatologist referrals, the initiative supports families dealing with the condition. You can follow the families’ progress and learn more about eczema on their website.
For more on how to treat and prevent eczema click here.