Eczema has always been a topic of interest to me partly because my husband has suffered from eczema since childhood himself. Once, the itch and inflammation were so severe, he had to be on low doses of methotrexate (chemotherapy agent and immune system suppressant); and this coupled with the potential side effects of potential liver toxicity was a cause of concern for us. Those living with eczema would know that it is emotionally (and physically) scarring and the scratch-itch cycle is ever continuous. What we have to understand now is that although eczema is not curable, it is definitely controllable.
What is atopic eczema and why does it occur?
Atopic dermatitis/eczema is an immune-mediated hypersensitivity response to an allergen and it is often inherited. This means, when we are in contact with a usually harmless allergen, our immune system gets hyped up and stimulates a cascade of inflammatory response to try to protect our body but in this case it causes more harm than good because it is over-regulated. A study showed that 60% of adults with atopic dermatitis had children with atopic dermatitis. The prevalence in children was higher if both parents are affected; up to 81%.
Age of onset is usually in infancy till childhood, rarely in adulthood and more common in males than in females. Atopic eczema is closely associated with asthma and allergic rhinitis and up to 35% of infants with atopic dermatitis will develop asthma and allergic rhinitis later in life.
What are the symptoms of atopic eczema?
- Dry, flaky skin
- Extreme itchiness
- Skin becomes red and inflamed with papules and plaques
- In severe cases with blisters, weeping skin
- In long-term/chronic patients, if itchiness is not controlled, it will lead to thickening of the skin (lichenification) and hyperpigmentation/ hypopigmentation
- Secondary infection during exacerbation is common because of the disrupted skin barrier, commonly by Staphylococcus Aureus and Herpes Simplex virus
Skin manifestations are most commonly found at the face, neck, elbows, wrists, hands and the back of the knees (flexure areas). It is a constant cycle of itchiness and scratching leading to infection and inflammation with periods of remissions and exacerbations.
What can we do to break the cycle?
Beat the inflammation
- Avoid a high sugar diet, eggs, dairy products, peanuts, soybean, gluten and wheat. These foods are the most common triggers of inflammation. You can even get a sensitivity patch test/blood test done at a clinic by a healthcare professional for more specific details on the cause of your allergy.
- Essential fatty acids such as omega-3 and vitamins and minerals such as vitamin C, vitamin D, vitamin E, zinc, copper and selenium help in skin barrier repair and reduce incidence of flare ups. Bromelain found in pineapples and flavonoid in dark berries help to reduce inflammation.
- Try introducing a variety of raw, organic fresh food that are not processed with no added colourings, flavourings, preservatives or additives. Fresh fruits and vegetables are packed with antioxidants, essential vitamins and minerals to help the body heal.
- Individuals with eczema already have low levels of essential fatty acids so it is important to have a good healthy intake of these essential fatty acids such as avocado, cold water fish and a variety of nuts and seeds.
- Supplement with a good probiotic to regulate gut health and improve immune system. Studies have linked consumption of probiotics, particularly Lactobacillus rhamnosus to preventing atopic dermatitis development and improving severity.
- Drink at least 2 to 3L of water a day to detox the body and get into a good bowel habit.
Read more on 5 natural ways to reduce inflammation.
Take care of the external triggers
- Detox the house from any dust mites and animal dander. Throw out the carpets because they harbour dust and can potentiate a flare up.
- It is equally important to also take notice of the ingredients in the products that you put on your skin because some ingredients can be irritants, such as perfumes.
- Avoid toxic household products.
Repair skin barrier
- Moisturise! Not all moisturizers are the same. There are 3 basic moisturisers available in the market; cream, lotion and ointment. Ointment and creams are the better options because they hold water better. It is recommended to pat the skin dry after a bath (rather than rub) and then apply moisturiser immediately to lock in moisture.
- Use natural skincare products for sensitive skin that contain vitamin E, shea butter hyaluronic acid and ceramide to moisturise and help heal the skin.
- Avoid harsh soaps, hot baths and showers that can strip away the moisture barrier.
- Natural options to use can be aloe vera and virgin coconut oil which have anti-inflammatory and healing properties. Aloe vera has been known for centuries to treat dry, irritated skin. A good option is to put the aloe vera gel in the fridge and use when necessary because the coolness helps to soothe itchiness and keeps redness at bay.
- Stress is the greatest enemy when it comes to itchiness and flare ups. Meditation, yoga and massages have been linked with reducing stress and thus the incidence of flare ups.
- Get sufficient sleep – aim for around 8 hours of uninterrupted sleep. Sleep releases melatonin which has strong anti-inflammatory and anti-cancer properties.
- Some patients find relief during bouts of itchiness from a cold compress with a clean cloth or tepid sponging with cold water. A cold compress should not be left for more than 30 minutes and if need be to be replaced with a new cloth. You could also use a DIY poultice.
- Wear soft loose cotton clothes to prevent humidity and scratching/chafing as the skin is already fragile. Scratching leads to more itchiness and likely infection. Keep nails short and clean.
- Go out in the sun to catch some Vitamin D. The best time to catch the sun especially in our part of the world would be around 8am to 10 am before the sun is at its peak.