Coping with Atopic Dermatitis (Eczema) as an Adult

Eczematous skin tends to be very dry and itchy and this Itching can lead to scratching and rubbing of the skin which can cause thickening of the skin, called lichenification, and the inflammation can lead to darker or lighter patches in the skin called inflammatory pigmentation. Infection is also very common with people with eczema as the skin barrier is already broken so bacterial and viral infections can develop very easily. If you suspect you have an infection of the skin it is important to contact your health care professional for advice to prevent the infection worsening.

Eczema is often seen as ‘just a skin condition’, but for those living with this condition, eczema can impact on all aspects of daily life. Taking care of eczema skin can be time-consuming and expensive. One of the main physical symptoms associated with allergic skin conditions is itch, itch can be very debilitating affecting sleep, concentration and mood and impact on school, work and affect personal relationships.

Breaking the itch scratch cycle

Scratching in eczema damages the skin and can allow bacteria and allergens and irritants to enter the skin making the itch worse. When we scratch we release chemicals in the brain that makes us feel good and want to continue scratching, in eczema, scratching also triggers the release of chemicals in the body called histamine which make the itch worse, this is why we can scratch till we bleed with eczema. Scratching with eczema can become a habit and be very difficult to stop. There are various methods available to help support you to prevent you scratching and causing further damage to the skin. Some of these methods may take practice before they are truly effective.

Tips can include

Keeping your nails short to prevent further damage to the skin, and trying to prevent the skin becoming too hot to cold. You could also try wearing cotton gloves with a layer of emollient underneath to help prevent you from scratching especially at night.

Applying emollient to the affected area often helps reduce the itch, try massaging the itchy area with emollient to reduce the itch sensation, putting the emollient in the fridge (cream or lotions wok best) to cool before applying can be very soothing. The Application of a thick greasy emollient to the area you regularly scratch can also help prevent you scratching as the sensation of the nails clogged with ointment can be off putting for some.

Beware emollients and paraffin based treatments are flammable – while it is essential that you continue to use topical ointments and creams for the treatment for your eczema, you should avoid smoking, naked flames and sources of ignition such as candles, open/ wood burning fires, gas cookers etc when applying topical treatments to yourself or a child.

Antihistamine can help if the itch is triggered by allergy and often a short course of a sedating antihistamine taken at night can help induce a deep sleep and stop you scratching at night and help with sleep.

Pinching not rubbing or scratching the skin when you feel an itch sensation can help prevent you scratching

Try applying an ice pack or cold compress to the area to help soothe the skin

Practicing deep breathing or other relation techniques can also be useful to reduce any built up stress.

Relationships and eczema

Eczema can have a huge impact on family dynamics and relationships. Having eczema can lower your self-confidence and self-esteem and you may feel embarrassed to show your skin or reluctant to mix with others and this can lead to you feeling very alone and isolated. It is important to try to carry on with your normal every day activities as much as possible even when your skin is bad and your mood might be low. Sometimes trying a new hobby or activity can help, other people with eczema often suggest trying relaxation methods such as mindfulness, meditation or deep breathing exercise can help to boast the mood.

If eczema is affecting your emotional wellbeing, it is important to talk about your feelings. There are lots of different types of support available online and through your pharmacist or GP practice. If you have concerns about your mood or general wellbeing, it is important to speak with your healthcare professional who will be able to offer support and advice.

During difficult, busy and stressful times it may seem difficult to maintain any routine, but is essential that you maintain a good skin care routine as this is an important part of managing your eczema to prevent any further worsening of your condition. This regime should include regular emollient therapy, soap substitute, topical treatments and any other medication required to help manage your eczema, some people can find wearing cotton gloves can help to prevent you scratching especially if worn at night.

Skin care – Tips for bathing and showering

• Water on its own can be very drying to the skin, use a soap substitute bath or shower emollient for bathing, avoid the use of perfumed bubble baths or shower gels as these can irritate the skin. Be careful when using emollients in the bath or shower as they can make surfaces slippery.
• Heat is a common trigger for eczema, so ensure the bath or shower is warm but not too hot. Remember to limit the time in the bath or shower to a maximum of 10 – 20 minutes. A hot bath or shower or spending too long in water may trigger the itch /scratch cycle.
• When drying remember to pat rather than rub dry to prevent triggering the itch/ scratch cycle and any further damage to the skin.
• After bathing remember to apply your emollient this helps to trap the moisture and prevent dryness or the skin.

Managing eczema in the home 

Cleaning – dust and detergents including washing up liquid are very irritant to the skin and so it is a good idea to wear waterproof gloves when carrying out any cleaning or messy activities around the home garden to protect the skin. If your hands are covered in emollient or are very sore it may be helpful to wear a pair of cotton gloves underneath the waterproof gloves.

Laundry – washing powders and fabric conditioners can be irritant to the skin – there is no evidence that biological or non – biological powders are any less irritant – but research has found that using only small amounts of washing powder and an extra rinse cycle can help prevent the detergent staying on the clothes.  It is advisable not to use fabric conditioner, this binds to the fibres in clothing to make them soft but also  contains perfumed products to make your washing smell nice both of which can be irritant to the skin

Bedding – use breathable easy care fabrics such as cotton and wash bedding on as high a setting as possible to reduce house dust mite build up

Emollients can stick to clothes and bedding and clog up the washing machine so it always a good idea to put on an empty wash about once a month at a very high temperature  with your usual washing detergent to help prevent a build-up of grease.

Food can be a source of irritation to the skin especially contact with raw foods including fruit and vegetables. Sometimes people can find handling raw food can be irritant to the skin eg peeling potatoes or handling citrus fruit, so you may find wearing waterproof gloves when prepping or chopping food can help.

Common allergens that trigger eczema include house dust mite, pet dander, pollens including grass, tree and weed pollens and mould spores.

House dust mite – the majority of people with eczema will find that they are sensitive to the house dust mite which thrives in warm damp places such as your bedding and living areas. Whilst we cannot eradicate the house dust mite there are measures we can take to reduce the impact on our skin. This includes washing bedding at a high temperature (at least 60˚C) to kill house-dust mites, it is often advised to encase mattresses and pillows and to have easy to clean flooring in the home.

Animals and pets – animals can trigger allergic reactions in some individuals with asthma or allergic rhinitis (pet allergy factsheet) but there is no evidence that animals cause eczema, however the saliva and fur of animals can be seen to irritate or worsen eczema, so it is advisable to avoid having pets in your bedroom, especially on your bed and to prevent them sitting on the sofa or in very close contact if you have eczema.

Pollens  – Plant pollen including tree and grass and weed pollens can be irritant to the skin, especially around the eyes. Pollens are generally more active during the spring and summer months and reactions to pollen typically appear on exposed sites such as the face, arms or legs. If pollen aggravates your skin it is a good idea to apply your emollient as barrier to the skin before going outside,  it is also recommended to avoid drying bedding and clothing outside on days when pollen counts are high and using a rug/ clothing etc to protect exposed skin when sitting down outside, especially on grassy areas.

Mould Spores – Mould can also be a problem, and a warm damp environment encourages mould growth both indoors and outside so It is a good idea to ventilate wet rooms such as the bathroom and kitchen daily to prevent a build-up of mould in the house, put food waste out regularly to prevent a build-up of mould spores, wear gloves when gardening and keep compost heaps covered. Moulds tend to be active in the spring and summer months and less active or dormant in the winter months, however autumn is the mould sporing season so you may find your flare at this time of the year.

For more information visit our Allergy House.

Managing eczema outdoors

Outdoor activities in the sun often can help improve the skin with eczema however it is important to protect the skin from sun damage. Sunscreen should be applied liberally throughout the day. Sunscreen can be applied on top of emollient but you should leave about 30mins-1hr before going out in the sun after applying your emollient to prevent your skin burning.

In winter the cold can be very irritant to the skin as can the drying effect of central heating and lots of layers of warm clothing can also add make you itch. It is important to look after your skin in winter, you may find your skin is dryer and more prone to flaring, often applying a greasier emollient to help manage the dryness is required. It is a good idea to apply a layer of emollient especially to exposed areas such as the face and hands when going out in cold weather to act as a barrier and protect the skin.

Managing eczema and leisure activities

Having eczema shouldn’t prevent you from doing physical activities and exercise. However changes in body temperature and sweat can be irritant to the skin and cause you to become very itchy. Remember to apply your emollient and topical treatments at least 1-2 hrs before exercise to allow time for the emollient to be absorbed into the skin. Wear loose breathable fabrics that are comfortable, not too tight and designed to wick the sweat away from the skin. If possible take regular breaks or reduce the intensity of the exercise if you start to feel uncomfortable or itchy.  Always drink plenty of fluids to keep yourself hydrated before, during and after exercise. The use of cool compression wraps or towels can help to cool the skin after exercise, it is recommended to take a warm not hot shower and try to cool the skin down gradually, this will prevent sudden changes of body temperature which can trigger itch.

Swimming – is one activity that people with eczema tend to avoid both for the physical discomfort of the chlorine on dry skin but also due to the embarrassment of exposing eczematous skin in public.   However with the following tips you should be able to keep swimming with eczema, There are lots of styles of swim wear available and this can make it easier to cover up if you feel uncomfortable exposing your skin, but remember many people feel uncomfortable about their bodies and self-image not just those with eczema, so you are not alone. Chlorine the disinfectant used in swimming pools is known to be very drying and irritate eczematous skin, so applying a thick layer of emollient before you go into the pool and then immediately shower and reapply your emollient after swimming should help to reduce the impact of the chlorine on the skin.

Managing eczema in the workplace

It is helpful to inform your employer of your eczema and any impact that your job or related activates may have on potentially worsening or aggravating your condition.

Employers are usually keen to help you overcome any problems and are usually happy to accommodate any reasonable requests. Employers are usually happy to carry out a risk assessment with you. In some cases your employer may be required or chose to refer you to occupational health for a more details assessment of your requirements to enable you to carry out your job safely.

You may need to request the following to enable you to keep comfortable at work;

• Not being seating in front of a radiator or in direct sunlight if this makes you itchy.
• Allow access to a fan or Opening windows to cool the room, or ensuring windows are closed if pollen or cold air aggravates your skin.
• Providing waterproof gloves to protect the hands, if cotton gloves are to be worn underneath ensure the gloves will fit.
• Where company clothing is provided this should be a breathable fabric such as cotton and not have restrictive cuffs or neck lines where possible.
• Avoid using harsh cleaning detergents especially highly perfumed or aerosol air fresheners in your environment.
• Allow the use of soap substitutes in wash room areas.
• Allocate time to enable you to apply emollient during work time if required.

Unfortunately some jobs are not suitable for people with eczema and can make your eczema worse, especially if you have hand dermatitis. This can include jobs that include handling substances that trigger your eczema and jobs that require frequent hand washing these activities can all aggravate the skin and lead to worsening eczema.  If you find that a break away from work improves your skin than it may be possible you are being exposed to an eczema trigger. In this case it may be worth considering if this is the best environment for you to work in especially if your eczema is severe.

If you have any questions or concerns about being able to manage your eczema it is important to seek advice and speak to a health care professional.

For further information contact

Allergy UK – Helpline

National eczema society – https://eczema.org/

Skin support – http://www.skinsupport.org.uk/

Key messages

1) One of the main physical symptoms associated with allergic skin conditions is itch, itch can be very debilitating affecting sleep, concentration and mood and impact on school, work and affect personal relationships

2) Taking time to relax and de-stress– maybe go for a walk, take a warm not hot bath, read a book, meet up with friends, try a new hobby or sport, if you feel stressed or anxious sometimes meditation, mindfulness or breathing exercises can be helpful.

3) If eczema is affecting your emotional wellbeing, it is important to talk about your feelings. If you have concerns about your mood or general wellbeing, it is important to speak with a healthcare professional who will be able to offer support and advice.