After spending a majority of my life haphazardly applying body lotion (or oil) as I pleased, I discovered a strange, itchy, scaly patch of skin on the right side of my shin. Must be an allergic reaction, I said to myself as I brushed it off since I do test a gazillion things. But after a few weeks when the constant itching and irritation didn't let up, I headed to my dermatologist....I soon discovered I was suffering from eczema, a first in my life.
Apparently, I'm not alone eithermore than three million people suffer from inflammation and red itchy skin because of a number of factors including weather, stress, and genetics. If you have rash-like symptoms that appear on your arms, behind your knees, or on areas of skin exposed to varying environmental factors, you might have eczema (also known as dermatitis).
Those who suffer from the common skin condition know that it does take a bit of trial-and-error to find soothing, hydrating products that calm current (and prevent future) flare-ups. To help expedite your journey, I spoke to three top derms to break down everything you ever wanted to know about eczema including what they recommend you should be using. Seriously, don't let winter dryness get you down, I'm here to help!
What is eczema?
At its core, eczema is a common, non-contagious, dry skin condition which can lead to dry, scaly skin with some redness and itching, though in more severe cases the skin can crack, bleed, and/or crust. It's a chronic inflammatory skin condition involving a disruption of the skin barrier and an unbalance of skin microbiome including the over-proliferation of the staphylococcus bacteria, adds NYC-based board-certified dermatologist, Dr. Marnie Nussbaum.
What are the different types of eczema?
There are different types of dermatitis, including atopic eczema, allergic contact dermatitis, irritant contact dermatitis, and asteatotic (due to very dry skin) eczema. When most people talk about eczema they usually are referring to atopic dermatitis or atopic eczema. Atopic dermatitis is common and tends to run in families along with asthma, hay fever, sinus trouble, and dry skin.
What causes eczema?
Unfortunately, a combination of things ranging from allergens (dust mites, pets, pollens, mold, and dandruff), certain foods (dairy or soy products, eggs, nuts and seeds, as well as wheat), certain fabrics (particularly wool and polyester) and stress levels can increase flare-ups. We still don't know exactly what causes eczema, but researchers believe that it's brought on by a combination of genetics and environmental triggers, adds Mustela's consulting dermatologist, Dr. Latanya Benjamin.
Another important factor is that eczema is generally a hereditary condition. Eczema is 40-50% more likely to occur in children if one parent has a history of the condition, explains Benjamin. This increases to 50-80% if both parents suffer with eczema.
Does eczema get worse in different seasons?
According to board-certified dermatologist, Dr. Sheel Desai Solomon of Preston Dermatology, cold weather and dry air often go hand in hand. Too much dry air can zap your skin of natural moisture. Dryness often leads to itching, which then leads to scratching and inflammation, she explains.
On the other hand, hot weather can also irritate eczema. Heavy perspiration can lead to itchy skin as well as prolonged exposure to water is another eczema- trigger. Water can cause dry skin, which can lead to persistent itching', adds Dr. Solomon.
How can I reduce eczema scarring?
The best way to prevent eczema scarring is to effectively prevent and manage itching in the first place. When the itch is out of control, patients do the most damage. Keeping the skin well moisturized and nails trimmed and smoothed go a long way to reduce the risk of eczema scarring, warns Benjamin.
Nussbaum explains scarring is usually from post-inflammatory hyperpigmentation (PIH) or residual redness from inflammation which may hyper- or hypopigment . The most important thing is to maintain a healthy skin barrier by using a gentle cleanser twice daily and moisturizer twice daily without any harsh ingredients, she shares.
Other key ingredients including vitamin C, niacinamide and aloe vera can assist with evening our skin tone, minimizing inflammation, and boosting collagen production. Oatmeal baths for 30 minutes a day can also help remove dead skin cells, calm inflammation and restore hydration while reducing scarring, shares Nussbaum. But, should the scarring be severe, we [dermatologists] can certainly use laser resurfacing or other types of lasers to lessen the redness and hyper- pigmentation.
Do over-the-counter eczema options exist?
Yes, but remember, there is no cure for eczema now but there are treatments, and more are coming. Depending on the type of eczema and severity, treatments include lifestyle changes, over-the-counter (OTC) remedies, prescription topical, oral and injectable medications, phototherapy and biologic drugs can assist with symptoms. explains Solomon. However, it helps to start with soothing moisturizers, particularly those that contain ceramides, which are naturally occurring lipids (fats) in the skin, that help to maintain normal skin barrier function. More on that below.
What recommendations do you have for over-the-counter creams?
In general, one of the best things you can do for eczema is to find a great moisturizer. Lotions can be a bit drying, as they have a higher water content, so board-certified dermatologist and CEO of Curology, Dr. David Lortscher recommends picking a heavier cream with ceramides or petrolatum.
If your skin is particularly dry or if you're exposed to very cold dry air, you should begin using a thin layer of a heavier moisturizer in the morning to help protect your skin. Moisturizing is the key to improving skin barrier function, resolving symptoms much faster, and reducing relapse with continual treatment.
When should you seek medical attention?
If your skin isn't responding to over-the-counter treatments, there are prescription topicals that your dermatologist can prescribe. Stronger prescription topical steroids are available for short-term use. Protopic (tacrolimus) 0.03% and 0.1% ointment and Elidel (pimecrolimus) 1% cream are calcineurin inhibitors, meaning topical medications that work to inhibit the immune system to reduce inflammation and irritation. Dr. Lortscher typically uses Protopic ointment and Elidel cream to wean patients off topical steroids.
- Eucrisa is a topical, non-steroid treatment. Eucrisa works differently than Protopic and Elidel, targeting an enzyme called phosphodiesterase that helps the body deal with inflammation.
- Dupixent is an injection for individuals who have eczema resistant to topical treatments or who do not have access to topical treatment. Dupixent works by blocking factors that allow white blood cells to communicate inflammation.
Should I use different products for different areas?
Absolutely! According to Nussbaum depending where the eczema is located it should be treated differently. For example, eyelids and sensitive skin areas like underarms, inguinal folds and lips will be treated with a lighter strength corticosteroid than thicker skin like the back or legs, she explains.
The scalp can experience a few different conditions which may look like eczema, however could be a form of seborrheic dermatitis, psoriasis or fungal infection. Therefore always see a dermatologist to help diagnose the condition. Depending on the condition, there are different shampoos, gels and creams containing ingredients such as coal tar, salicylic acid, corticosteroid or selenium sulfide can also effectively treat the scalp.
Lastly, a special note about scrubs:
Although scrubs may be a seemingly obvious fix for sloughing off dead skin, avoid using scrubs on skin with active eczema. A scrub by definition (i.e., exfoliation by means of mechanical abrasion) would likely be really irritating for skin affected by eczema. However, if the granules are soft (almost paste- like), and if the base of the product is heavier and more ointment-like, then water may be trapped in the skin (which is a good thing!), and the hydration may soothe the eczema.