Eczema, also known as atopic dermatitis, is a condition that causes dry, itchy, and inflamed skin. Approximately 10% of the U.S population, or 31.6 million people are affected by eczema [3]. It is more likely that people diagnosed at a younger age with greater disease severity and in urban settings are more likely to suffer from prolonged eczema [3]. Fortunately, 80% of children overall are predicted to grow out of their eczema by adolescence or adulthood. The worst symptom of eczema is scratching, which can proliferate skin irritation and disrupt sleep patterns [3]. 6 in 10 adults with eczema suffer from skin pain that may come in the form of a burning feeling, a tingle, or even a sting [3]. This can also be caused by excessive itching.
Mental Health
Stress is a trigger that can make eczema flare or worsen. This happens because stress releases hormones that may suppress the immune system and proliferate skin inflammation, which makes eczema symptoms even worse [4]. Excessive itching can lead to sleeping problems, which may lead to more stress, which can loop back to worsening eczema symptoms. And if that isn’t enough, stress can also slow down the recovery process of your skin. This can be especially potent for eczema patients who suffer from other health problems such as asthma (which is relatively common, as 2 in 10 adults suffering from eczema also have to deal with asthma) [4]. Stress from unrelated health problems can cause further flaring and worsening of eczema. Furthermore, more than 3 in 10 eczema bearers suffer from anxiety and depression [4]. This is in part due to the lack of awareness and negative stereotypes around eczema. Many think that eczema is contagious (which it isn’t) and this can result in negative mental health effects on those who suffer from eczema. Many eczema patients also feel judged when other people look at their skin. Sometimes when people who do not completely understand their skin situations ask questions about it (“What happened to your skin?”) or give recommendations (“Put some lotion on that!”), it can trigger anxiety in eczema patients. This can make eczema patients feel uncomfortable displaying their inflamed skin in public, which can further lower their self-esteem. In fact, it is quite common for eczema patients to only wear long-sleeved shirts and/or long pants in order to hide their skin disease.
General Treatment
A huge part of treatment for eczema includes lifestyle changes. This includes avoiding triggers, which are different for everyone. Common triggers may include certain foods (ex. peanuts), chemicals, synthetic clothing material (ex. nylon), hot water when showering and washing hands, certain detergents and soaps, dryness, and stress [2]. Another important part of treatment is developing a bathing/moisturizing routine [2]. Lastly is the treatment form that usually comes to mind when discussing eczema: over-the-counter and/or prescription medications. It is important that a healthcare provider approves of this before an eczema patient proceeds. While none of these medications can cure eczema, they can help manage symptoms. For example, antihistamines such as Benadryl and Zyrtec can help relieve itching [2]. Pain relievers such as Tylenol and Ibuprofen can help relieve skin pain [2]. In addition, topical hydrocortisone or other steroids may be recommended for a couple of days to help decrease inflammation and irritation [2]. However, it is important to be cautious when using hydrocortisone as it can cause various side effects such as thinning of skin, drying/cracking of skin, increased acne, burning, skin color changing, and itching [2]. Other steroids are also associated with relapses of eczema and can have serious side effects when used long-term. Moreover, prescription topicals (treatment applied on top of the skin) such as PDE4 inhibitors, calcineurin inhibitors, and Janus kinase (JAK) inhibitors can further reduce the inflammation of skin [2]. When all else fails, a healthcare provider may recommend biologics to treat eczema. Biologics, made through genetic engineering, treat inflammation (which can be a result of an overreaction by the immune system) by inhibiting part of the immune system response [2]. Some FDA-approved biologics include Dupixent and Adbry. Immunosuppressants such as JAK inhibitors can also help suppress the immune system [2]. Lately, phototherapy, or light therapy, may be prescribed. This type of treatment usually is done at a healthcare facility. A month or two of treatment with ultraviolet light may be necessary to see reduced eczema symptoms. However, phototherapy has side effects such as early skin aging, increased tenderness of skin, and sunburn [2]. Moreover, it is important to note that getting UV light from sun beds or directly from the sun does not necessarily help eczema due to the harmful component of UV light (which is eliminated in phototherapy) [2].
Using Lotions |
Wet Wrap Therapy |
When patients think about solutions to eczema, an inflammatory rash, perhaps the first thing that comes to mind is to slap some lotion on. While there are many cases where creams are simply not enough to eradicate a patient’s eczema, they can help substantially when used properly. It is likely best to use a combination of flare control creams and moisturizing creams [5]. Flare control creams, which are often topical corticosteroids or topical calcineurin inhibitors (TCIs), are used how they sound: to control eczema flare-ups [5]. Generally, applying a thin layer of flare control cream as soon as the patient notices the return of eczema symptoms (and for the subsequent two days) can do wonders [5]. Simultaneously, it is recommended that patients use moisturizing creams everyday to keep eczema under control. Moisturizing creams are emollients, meaning that they are substances that trap moisture in the skin [5]. These can prevent flare-ups and reduce the urges to itch.
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Another way to reduce the medications needed (and increase medication effectiveness) for treatment is to do wet wrap therapy during difficult eczema flares. It uses clothing or gauze moistened (not soaked) with warm water [6]. This slightly damp dressing is then wrapped where the eczema flare is occurring [6]. For good measure, a dry dressing is wrapped on top of the damp dressing [6]. These dressings are left on for many hours [6]. It is important to consult a healthcare professional before attempting this type of therapy. On average, symptoms ameliorated by 71% in children with severe eczema after undergoing wet wrap therapy [6]. Unlike isolated use of medications, which can lead to a relapse of severe eczema symptoms when stopped, eczema conditions stay in check even a month after being stopped [6].
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Controlling the Itch
Itching can proliferate already existing eczema and can disturb sleep at night. A simple but effective behavioral intervention is to keep fingernails short so that even when the patient can’t resist the urge to itch, less damage is done. In addition, Chida et al. (2007) state that increased stress can lead to increased itching [1]. Therefore, they investigate a handful of techniques that use psychological intervention to help reduce skin irritation [1]. They found evidence to suggest that autogenic training adapted, cognitive-behavioral therapy, dermatological education and cognitive-behavioral therapy, and stress management programs can reduce pruritic sensations and can even reduce the need for steroids [1]. Autogenic training uses systematic exercises focusing on different parts of the body and self-generated statements to induce relaxation in the subject. However, in the study, autogenic training was adapted towards eczema [1]. For example, phrases such as “I do not need to itch” or “the itch dissolves” which reduced the urge to itch. Cognitive-behavioral therapy, a therapy dealing with negative feelings related to atopic dermatitis and/or daily life, remediated anxiety associated with scratching issues [1]. Cognitive-behavioral therapy also proved helpful when paired with dermatological education, which better informed the patients about atopic dermatitis [1]. Moreover, stress management programs, which focused on dealing with stress through the ABC model (awareness, balance, and control), were shown to improve coping for itching and social anxiety (which in turn improves the scratching situation) [1].
Sources
- “Autogenic Training: A Meta-Analysis of Clinical - ProQuest.” www.proquest.com, www.proquest.com/docview/227974087?pq-origsite=gscholar&fromopenview=true&sourcetype=Scholarly%20Journals. Accessed 19 May 2024.
- “Don’t Scratch! What to Do When Your Eczema Itches.” WebMD, www.webmd.com/skin-problems-and-treatments/eczema/ss/slideshow-eczema-itch-dont-scratch. Accessed 19 May 2024.
- “Eczema Stats.” National Eczema Association, nationaleczema.org/research/eczema-facts/#:~:text=31.6%20million%20people%20(10.1%25).
- “Eczema and Stress: What’s the Link? | Pfizer.” www.pfizer.com, www.pfizer.com/news/articles/eczema_and_stress_what_s_the_link#:~:text=However%2C%20research%20highlights%20that%20stress.
- “Other Treatments - Myself | ECO.” www.eczemacareonline.org.uk, www.eczemacareonline.org.uk/en/library/myself/other-treatments-myself. Accessed 19 May 2024.
- “Wet Wrap Therapy for Eczema | Eczema Treatment | Itch Treatment.” National Eczema Association, nationaleczema.org/eczema/treatment/wet-wrap-therapy/.