Red, flaky patches. Irritation. Itchy skin. These are all telltale signs of eczema, a skin condition that can pop up year-round but often rears its head in the cold, dry winter months. According to the Canadian Dermatology Association, up to 17 percent of Canadians will suffer from atopic dermatitis (as eczema is also known) at some point in their lives. And while there’s unfortunately no cure, there are ways to soothe the itch and manage flare-ups.
We asked Dr. Kerri Purdy, a Halifax-based dermatologist and president of the Canadian Dermatology Association, and Dr. Carmel Anderson, a dermatologist at Kelowna Skin and Laser Clinic and a clinical assistant professor of dermatology at the University of British Columbia, to answer frequently asked questions about eczema, including what causes it, how to treat it and the best ways to prevent it.
What is eczema and where does it commonly occur?
For starters, there’s more than one type of eczema.
Atopic eczema refers to inflammation of the skin when the immune system reacts to an allergen (either inside or outside of the body) and results in patches of itchy, red and flaky skin. In more extreme cases, skin can appear swollen and blistered.
Infantile eczema refers to atopic eczema in children, which often occurs within the first few months of a baby’s life. Another common type is contact eczema, which happens when skin reacts to contact with an irritating substance and tends to be localized, but can sometimes spread elsewhere on the body over time, according to Anderson. Common contact eczema triggers include harsh soaps, nickel and tea tree oil.
While eczema can arise anywhere on the face and body, Anderson explains that the location of eczema patches can vary. “Infantile eczema tends to occur on the outer areas of the limbs and body, while older children and adolescents often experience eczema in the folds of the arms and legs,” she explains. Adult eczema can appear virtually anywhere, but it’s most often found in the folds of the neck and elbows, behind the knees, as well as on the inner wrists, hands and face.
What causes eczema?
“There is no one ‘cause’ for atopic eczema and there are a lot of theories to explain why it happens,” says Purdy. A genetic predisposition seems to put some people at a higher risk of developing eczema, particularly when they have other conditions such as asthma and hay fever. Ultimately, atopic eczema is thought to be caused by a combination of genetics and specific triggers, while contact eczema is the result of direct exposure to an allergen.
What are common triggers?
Atopic eczema is aggravated by different factors depending on the individual, but common triggers include cold, dry weather, stress, hot water and harsh soaps, says Anderson. In the winter, cold outdoor temperatures and indoor heating make for an irritating combination. “Most people with [atopic] eczema get better in the summer as the temperature and humidity levels tend to be higher, leaving the skin more moist,” says Anderson.
As for contact eczema, Anderson says skin will flare up whenever it’s touched by an irritating substance, regardless of the season.
Should you see a doctor if you suspect you have eczema?
If the eczema is mild and doesn’t compromise your ability to function and enjoy life, you don’t necessarily need to see an MD, says Anderson.
But if the itching is keeping you up at night, if you have blisters or if the affected skin shows any signs of infection, see a doctor as soon as you can.
A family doctor will often be able to treat mild eczema. For more severe cases—or if the condition isn’t responding to treatment—Purdy advises getting a referral to a board-certified dermatologist.
How can I treat eczema?
Treatment varies depending on the type of eczema and how severe the flare-up is.
“For classic atopic eczema, I generally recommend a combination of lifestyle changes [such as minimizing stress, moisturizing regularly and avoiding irritating fabrics], and sometimes prescription medications, which can include topical creams—there are cortisone and non-cortisone options—pills and even injectables,” says Purdy. Anderson says oral antihistamines may also help to relieve itch.
For cases of contact eczema, avoiding the allergen is essential to clear up the irritation and to limit future reactions.
Anderson explains that preventative measures go a long way in limiting breakouts. She also recommends visiting The Eczema Society of Canada for further advice and recommendations. Above all, she says, don’t lose hope.
Should I avoid baths?
Surprisingly, no. “It seems counterintuitive, but I actually recommend more frequent bathing when people have eczema,” says Purdy.
She notes that the water should not be too hot and that the bath doesn’t need to be very long (around 10 to 15 minutes is ideal). Post-soak, apply a cream or topical ointment onto damp skin to seal in moisture.
What over-the-counter skincare products should I use on mild flare-ups?
Both Purdy and Anderson stress the importance of using fragrance-free products, as fragrance is a known irritant.
Opt for a mild soap; in terms of a cream, choose an ointment or salve. “In the case of eczema,” says Anderson, “ointments are more helpful than creams and creams are more helpful than lotions.”
One percent hydrocortisone cream can be also effective in treating mild cases of eczema.
How do you treat eczema in children?
Treatment is similar to that of adults—use mild soap, moisturize the skin frequently and try a cortisone or non-cortisone ointment, as recommended by your child’s dermatologist. “Many children that have eczema will outgrow the flare-ups as they get older, but some people continue to have them throughout their lives,” adds Purdy.
We've rounded up our favourite products to soothe itchy, irritated skin.
CeraVe Moisturizing Cream
This hydrating cream increases skin's ability to attract, hold and properly distribute moisture, and also delivers essential lipids to the deeper levels of the skin to help keep eczema at bay.