Skin care

Skin care for patients with Eczema

Dry itchy skin is an underlying characteristic of eczema. The dryness makes the skin more sensitive to irritants. The skin of people with eczema also has a reduced water-holding capacity.

These things taken together make daily skin care very important. The three main elements of skin care are as follows:

• Gentle cleansing (bathing)
• Hydration (moisturizing)
• Other measures

Bathing practices

Proper bathing practices for people with eczema are very important.

Daily and short:

• Bathe daily 5-10 minutes in lukewarm water.
• Add emulsifying oil to bathwater.
• Baths are preferred to showers.

Soap:

• Regular soap should normally not be used, unless for the removal of dirt.
• When soap is used, it should be non-drying, mild and unscented.
• Avoid bubble baths, and keep shampoo off of eczema-prone areas, as it can be very harsh as well.

Be gentle:

• After bathing, pat the skin dry with a soft towel.

Moisturizing:

• Apply moisturizers (agents that make skin softer by increasing the amount of water retained) within 3 minutes of gently patting skin dry.
• If skin in a person with eczema is allowed to dry completely without moisturizing, it can crack and the skin barrier is less effective.

Moisturizing

Dry skin is a key feature of eczema. Not only is dry skin more sensitive to irritants, it also has reduced water-holding capacity. That is why hydration through proper bathing techniques and use of moisturizers is an essential component of eczema management.

Two main types of moisturizers

Occlusives, the best moisturizers, provide a layer of oil on the surface of the skin to slow trans-epidermal water loss and thus increase the moisture content of the stratum corneum; they also prevent water loss to the surrounding atmosphere.

Emollients are less effective at providing moisture but are excellent at softening the skin. They smooth out the surface of the skin by filling the spaces with droplets of oil.

Choosing a moisturizer

The appropriate moisturizer can be chosen for the severity of the flare and its location on the body. In most cases, creams and petroleum-based ointments are the moisturizing agents of choice. Conversely, humectants can be painful over excoriated (broken) skin and are generally not recommended for eczema patients.

Other skin care measures

Laundry:

• Use mild detergents; no bleach or softener.
• Double-rinse clothes.
• Wash bedding weekly in hot water to kill dust mites.

Clothing:

• Do not dress in wool or rough fabrics.

Environment:

• Avoid excessive heat or low humidity.

Sleeping:

• Wear cotton gloves.

Nails:

• Keep nails short; it will limit scratching.

Avoidance of triggers

Avoiding certain triggers can help delay the onset of the next flare.

What are triggers anyway?

The skin forms a protective barrier that keeps harmful toxins out and essential body fluids in.

• Irritants

  Irritants:

  include soaps and rough or woolly clothing that leads to skin irritation and worsening of eczema.   destroy this protective barrier.
• Allergens

  Allergens:

  may include certain foods (that a person with eczema is allergic to) as well as inhaled house dust mites, weeds, animal danders and molds.   stimulate an immune response that triggers symptoms of eczema.
• Avoidance of irritants and allergens may alleviate or even prevent eczema.

Irritants

Irritants are a class of triggers that are in your environment. They do not generally stimulate an immune response. Examples of irritants include detergents and surfactants such as soaps and shower gels. These may irritate the epidermal barrier in two ways:

• By reducing skin thickness
• By diminishing the skin’s waterproof barrier

Repeated use of surfactants makes the skin more prone to irritation by other factors.

Allergens

Allergens differ from irritants because they stimulate an immune response. Food allergens include:

• Eggs
• Peanuts
• Soy
• Wheat

Most patients with eczema do not have food allergies. Inhaled allergens, such as the house dust mite

Dust mites:

microscopic organisms that live in house dust; the excretions from which often cause allergic reactions, especially in children., are a common cause of eczema.

Other Eczema triggers

There are many other potential eczema triggers; these include:

• animal dander
• molds
• cigarette smoke

In addition to physical triggers, flares may be initiated by emotional turbulence. High heat and low humidity lead to evaporation of water from the skin, drying it out and exacerbating the problem.

Managing irritants

• Bathe using emollient oil.
• Use mild laundry detergents; avoid bleach.
• Avoid harsh fabrics/elastics in clothing.
• Double-rinse clothing.
• Avoid chlorine or solvents.

Managing allergens

Kill dust mites:

• On soft toys by placing in freezer overnight.
• On bedding by washing at 60?C.
• Dust mites like humid and warm environments; keep house temperature between 17 and 19?C and humidity below 70%.
• Wash curtains/roller blinds regularly.
• Avoid furniture made with dust-collecting materials; leather-and vinyl-covered furniture is best.
• Wash bedding often in hot water.

Scratching

Scratching worsens eczema, causing thickening of the skin and increased markings known as lichenification. This, in turn, makes the itching worse, continuing the cycle. The best way to stop this cycle is to treat the inflammation, helping to reduce the cause of the itch.