The terms dermatitis and eczema describe the same itchy, dry skin condition that affects so many of us. Winter particularly plays havoc with the skin with changes in temperature, the cold, low humidity and artificial heating all causing dehydration. This leads to dry skin which is itchy, and scratched irritated skin becomes inflamed and may evolve into dermatitis. The skin can look red with a rash, and sometimes, blisters. Over time the skin builds up and thickens.
The cause of dermatitis is often unknown and can be a combination of irritation, allergies and poor blood flow. Common triggers include food allergies, stress, weather changes and irritants such as woollen clothing, perfumes and chemicals. Excessive contact with water and irritation from soaps and detergents, skin infections, overheating and genetic disposition can also be factors.
There are a number of ways to minimise dry skin and eczema. The key is to find your individual triggers and avoid them, improve the general condition of your skin and specifically treat areas if they become inflamed.
Avoiding the things that irritate your dermatitis is the best way of managing it, but it can be tricky to find out what those triggers are. Keeping a symptom diary and including foods and other possible irritants may uncover some clues. Allergy testing may be helpful if the history is unknown but aren’t very specific with only ~30% of positive results being clinically relevant.
Avoid wool, rather choose 100% cotton, loose fitting clothing against your skin. Sweat can irritate so allow the skin to breath and don’t overheat it with extra covers or electric blankets. Soaps are alkaline and very drying, so a soap substitute is a better option. Avoid scratching if possible and keep your nails short and clean. Oatmeal in the bath can relieve itchiness, see the Aveeno range for this. Immunisation may cause flare ups of dermatitis but isn’t a reason to avoid vaccination, rather to let your doctor know about your dermatitis beforehand.
Common food allergies include dairy, soy, beef, chicken, nuts, oranges, strawberries, wheat, seafood and colours. Food allergy should be considered in people who have reacted previously to a food. Choose a healthy diet with plenty of fruits, vegetables and whole grains. Some studies suggest that probiotics may help relieve the symptoms of eczema in children. Probiotics can be found in foods like yogurt and in some supplements. Omega-3 fatty acids found in fish and fish oil, which help fight inflammation, are also being studied for eczema.
To improve the general condition of your skin, keep it nourished by applying a good moisturiser liberally within a couple of minutes of showering. Take fewer and shorter showers and use lukewarm water rather than hot. Lightly towel dry and apply the moisturiser without rubbing it in. There are many products on the market from thin lotions to water-based creams and greasy ointments. The right one for you will depend on how dry your skin is at the time and personal preference. If you haven’t found skincare that suits your skin, ask about Avène. The range is based on a thermal spring water that has been tested and used for many years to soothe the skin and restore the epidermal barrier in eczema sufferers.
If the skin starts to become red, inflamed or weepy then dermatitis is developing. Moisturiser alone might not be enough, so a topical steroid cream can be used. Mild steroids are available from your pharmacist or check with your doctor if a different product would be suitable for more severe outbreaks. If using a steroid, apply it to all inflamed areas liberally, until the dermatitis has gone and the skin is clear. This often takes 7-14 days. The dermatitis is more likely to recur if not enough steroid is used or stopped too early. Side effects such as skin thinning or growth suppression from using topical corticosteroids for short amounts of time are very rare. The fingertip unit (FTU) is a good guide to know how much cream or ointment to use. One FTU is the distance between the tip of an adult finger and the crease of the first joint and this should cover an area equivalent to the size of the flat of two adult hands with the fingers together. An adult arm would take three FTUs to cover. Drowsy antihistamines may be used to help with disturbed sleep from itchy skin.