Eczema is a very common skin disease which is characterized by dry skin that is flaky, itchy, red, and generally develops bumps or papules on the affected area. It is thought that as much as 30% of the general population in the United States suffers from eczema to some degree. Eczema also spans the entire age spectrum from infants to elderly. It not only interrupts the ability to sleep at night and concentrate during the day, but it also disturbs the individual psychologically by limiting their ability to wear certain clothes and having unsightly, uncomfortable skin. Left untreated, it can result in years of suffering and scarring.
The basic component of eczema is genetic. The gene that causes eczema prevents the body from being able to hold water or moisture within the skin. Triggers such as sun, sweating, cold weather, dry forced air from indoor heating, and allergens will flare the symptoms of eczema. Because eczema is genetic, we can only treat the symptoms; there is no cure. Most people do not know they suffer from eczema. People usually seek medical help because they have a rash which is not resolving. Other people experience a situation where the rash will get better then become worse again. This pattern is frequently seen in eczema.
This article will focus on the triggers and treatment of eczema during the summer. For some, summer is a time of relief from their fight with eczema yet others may continue to struggle. The exposure to sun and water increases the moisture loss in the skin which in turn triggers eczema flares. Higher temperatures and humidity result in the inability of the body to absorb sweat. Sweat is salty and pulls more moisture from the skin as it dries. This dryness triggers a cascade of events leading to dry, itchy, and bumpy papules on the skin.
Caring for eczema in the summer involves bathing, moisturizing, and when necessary, medical intervention. The first step in keeping eczema flares to a minimum is bathing. It is very important to bathe in lukewarm water and avoid hot water. Hot, long showers may feel good at first, but the itching that follows from the histamine release in the skin can quickly leave raw and bleeding areas. Bath or shower time should not exceed 5-10 minutes. Bathing is extremely important to decrease the bacteria on the skin. When skin integrity is broken due to itching, bacteria is transferred into the body which leads to infection.
When bathing, it is best to use a mild, fragrance free moisturizing soap. Do not use soaps that are labeled antibacterial and have a strong smell. These soaps are full of allergens and will over dry the skin. These are often labeled “for sensitive skin” on the packaging. For skin that is already irritated and itchy, baking soda can be added to the bath water to provide some relief. Oatmeal-based bath products (not standard oatmeal) can also be used to provide soothing relief.
After bathing, it is important to replace the water loss to the skin. This is primarily done by applying a moisturizer. The best time to moisturize is within three minutes of bathing. The skin should be patted dry not rubbed and moisturizer should then be applied. Moisturizers fall into three main categories: ointments, creams, and lotions. Ointments are very emollient which means they are effective in hydrating the skin and preventing water loss. Petroleum jelly is very inexpensive and easy to apply, however many people complain that it feels very greasy on their skin. There are other ointments, but petroleum jelly is the only ointment which does not contain water.
Creams are thicker than lotions but not as greasy as ointments. Creams can be an excellent way to moisturize the skin. However, they can be irritating when the skin is inflamed and scratched because creams contain water or alcohol. It may also contain allergens which further irritate the skin.
Lotions are mixtures of oil and water, water being the main ingredient. Lotions do not work well for people with eczema because the water evaporates quickly leaving the skin dry. A lotion on a daily basis may work well if the eczema is very mild. No matter what type of moisturizer is used, it is very important that the product is fragrance-free. Fragrances are known allergens and alcohol is often added to stabilize the fragrance and is very drying to the skin. It is impossible to over moisturize the skin.
Finally, some form of drug therapy may be necessary to control eczema. Antihistamines are often very effective in stopping the itch. By controlling the itch of eczema, the healing process can take place thus avoiding the risk of infection. Benadryl (diphenhydramine) is a highly effective over the counter antihistamine but it causes sleepiness. While this can be very beneficial to help stop the scratch-itch cycle at bedtime, it may not be appropriate for use during the daytime. Non-sedating antihistamines have been found to be less effective in blocking the itch caused from the release of histamine with itching, but are safer to use when being alert is necessary. If Benadryl is not working, consult a dermatology provider since a prescription antihistamine may be needed.
Individuals with moderate to severe eczema will need to be treated with a topical corticosteroid or phototherapy if they are not responding to moisturizers and antihistamines. Topical steroids are the gold standard of care for eczema. Topical steroids are safe if they are prescribed appropriately and used appropriately under the care of a healthcare provider by the individual with eczema. It is when the medication is over used or a provider does not understand how to prescribe this medication that side effects such as thinning of the skin can occur. Seeing a dermatologist or a provider who works in dermatology is important.
Another thing that can be done over the summer is to wear clothes which are cotton to wick the moisture away from the skin. Clothes should always be washed before wearing to remove formaldehydes. Again, it is recommended to use a fragrance free detergent or double rinse the clothing.
Prior to bedtime, a lukewarm bath followed by use of a moisturizer to the affected area, medication to involved areas as prescribed, and an antihistamine will help assure a restful night. By understanding the basic components of eczema and using the techniques described in this article, it is possible to enjoy your summer relatively free of the symptoms from this disease.