Eczema cases have increased due to hand-washing. Here's how to treat it according to a nurse...
THURSDAY 9 APRIL 2020
Dermatologists have noted a stark rise in the number of eczema cases they're seeing – linked to the increased amount of hand washing that's been going on to curb Coronavirus.
Whilst eczema is relatively common, it's easy to confuse with other skin conditions like rosacea, hives and psoriasis. So it's worth making sure you know what you're dealing with in order to treat it most effectively.
To help you determine whether you have eczema, we quizzed Alice Henshaw, nurse prescriber and owner of Harley Street Injectables and Skincycles on everything there is to know about the red, rashy, skin ailment. Then, we asked what can be done to treat it or prevent if from happening in the first place.
What is eczema and what does it look like?
There are a few types of eczema, including severe eczema, atopic dermatitis and atopic eczema. All of which are "a chronic inflammatory autoimmune disease, where the skin barrier can be defective, leading to loss of function which means allergens can sensitise through the skin", says Nurse Alice.
"It is characterised by itchy, non-contagious, inflamed skin that can be present on any part of the body. The appearance of eczema can vary from mild forms, when skin looks dry and flaky, to severe forms, when skin can be extremely irritated and red. The most severe forms of eczema can make your skin crack and ooze."
Here's how to tell the difference between dermatitis and eczema
What causes eczema?
The exact cause of eczema is unknown, but "it's thought to be linked to an overactive response by the body's immune system to an irritant. And it's this response that causes the symptoms of eczema."
"In addition, eczema is commonly found in families with a history of other allergies or asthma. While it's not contagious, eczema is often inherited and infants with parents who have allergies or asthma are at highest risk for development."
Why would hand-washing make eczema worse?
"Proper hand-washing is one of the best ways to prevent spreading viruses but when you have a skin condition, washing your hands often can lead to dry and cracked skin, itchiness, pain and possibly infection," explains Alice. "Hand washing may exacerbate existing conditions such as; allergic contact dermatitis (in which the skin flares up in response to external agents like metals, fragrances or preservatives) or irritant contact dermatitis (caused by a persistent irritation of the skin)," she says.
"Even people with unaffected skin will suffer from drying skin if regularly washed each day. This is because washing hands with warm water and soap makes the natural oils in your skin more soluble and removes them, leaving your skin dry. We notice this even more in winter as the cold, dry air leaches moisture from the wet skin surface. Hand sanitisers cause even more dryness for our skin unless you can find products with added emollients (moisturising elements)," adds Alice.
"Increased hand washing can also lead to greater cracking of the skin allowing environmental and/or microbial allergens to penetrate the skin barrier more easily causing inflammation," Alice explains.
What can we do to prevent eczema from hand-washing?
"I'd advise people wash their hands in cold water, pat dry with a hand-towel and apply a moisturiser after each hand-washing to offset much of the drying effects of hand-washing," advises Alice. Just avoid rubbing hands too hard. "Too much pressure or frequency of rubbing material over the skin will be traumatic to skin integrity and further exacerbate dryness. This can cause cracks which will be more exposed to any bacteria or virus."
"Try patting your hands dry with paper towels until the surface is still a little damp. Then apply a generous dose of moisturiser to the hands including front, palm and fingers. Moisturising maintains healthy skin preventing eczema outbreaks which also provides greater skin strength to resist the rounds of washing. A healthy circle of protection. Just remember to look at the hand cream as some can be very thick and better for over night use than in the day," she says. "If you have space you can carry a pocket tube of moisturiser alongside your hand sanitiser to apply anywhere," she adds.
"This should hopefully prevent eczema break outs. A secondary line of action would be using prescription topical therapy to reduce the inflammation, however this is not as readily available [especially with the current demand on the NHS and the restrictions on safely entering places like pharmacies], therefore I would recommend clients who are sensitive to certain soaps or moisturisers to carry their own tried and tested brands." In general, your best bet is to opt for something fragrance-free as scented hand salves can exacerbate the problem.
How can we keep our selves and our skin safe during coronavirus?
"During this pandemic there are two further considerations," says Alice. "First it is important that people properly clean their hands before applying moisturiser in order to prevent contamination of their products with the virus. Second it is important that people also clean and/or sterilise the outside of the containers they are using to carry around soaps and moisturisers. Otherwise, they run the risk that these tubes may carry the virus on their surfaces."
Could anything else be causing eczema at this time of year?
"Yes," says Alice. "In spring the temperature fluctuations can exacerbate eczema. As can pollen from flowering trees and plants. Those unlucky enough to suffer from hay fever often see their eczema flare up alongside the symptoms of irritation to the pollen," she explains. "Conversely the wider population would normally see a decrease in cases as the warming air and gentler winds ameliorate the drying effects on skin, producing less harsh outbreaks."
But, as it gets better for one person, it might get worse for the next. "Unfortunately there will always be environmental triggers for sections of the population so even in summer when there is warm air, there will be increased sweating, air conditioning and perhaps even chlorine from swimming pools or salty water from the sea. In all circumstances my go to advice is: after carefully washing the skin clean from the irritant, virus or dirt, remember to moisturise and use gentle cleansers and soaps without fragrance."
Is there a cure for eczema?
Unfortunately, there is no miracle cure for eczema.
"Treatment for the condition aims to heal the affected skin and prevent flare-ups of symptoms. Doctors will suggest a plan of treatment based on an individual's age, symptoms, and current state of health," says Alice.
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Eczema usually starts in babies or young children and often, symptoms improve when a child becomes a grown-up. "For some people, eczema goes away over time. For others, it remains a lifelong condition," she adds.
Are there certain triggers that can make eczema worse?
There are certain things that can aggravate eczema, causing flares.
"Everyone’s triggers are different – they can include dry skin, irritants, rough fabrics such as wool, emotional stress, heat, and sweating", says Alice. "When you’re experiencing a flare, you’re more likely to scratch, which can aggravate already irritated skin and make the conditions worse."
Nurse Alice's top tips for treating eczema
- Wear soft, breathable fabrics:Such as cotton, and avoid rough textures like wool.
- Use mild detergents:Avoid bleach and fabric softener on all clothes, towels and bedding.
- Pay attention to your diet:Some foods may trigger the release of T cells that cause inflammation, as well as immunoglobulin-E or IgE, which is an antibody that the body produces in response to a threat. Foods that contribute to inflammation include nuts, milk, and wheat.
- Oatmeal baths:An excellent home remedy, espcially when you combine with dead sea salts and castor oil.
- Use a humidifier:Environmental conditions can exacerbate eczema. Cool temperatures, especially at night while sleeping, help to decrease sweating, which can cause irritation and itch. A humidifier helps prevent drying and should be used in both winter and summer when there is less moisture in the air.
- Try a medicine:If you have moderate to severe eczema, you may need to try a medicine that affects your immune system like methotrexate and azathioprine. Or if nothing else works, you might get a biologic drug called dupilumab (Dupixent). You might also try light therapy (your doctor will call it phototherapy) using ultraviolet light.