Eczema is a common condition that produces itchy, scaly patches on the skin. As well as causing discomfort through itching – which leads to scratching and bleeding – it can be very distressing as it is unsightly.
Your doctor will most probably simply examine your skin and look at your medical history. He or she will ask you when you started getting eczema, what triggers it, whether there’s any history of it in the family. No lab testing is required, although the doctor might conduct some patch testing to rule out other skin diseases or conditions that might go with the eczema. If patients suspect a certain food might be responsible, ask your doctor about identifying potential food allergies.
What causes eczema?
Dr Nasr Al Jafari, medical director and functional medicine specialist at DNA Health and Wellness Clinic in Dubai says: “It’s a condition caused by inflammation and like so many things, it starts in the gut. Seventy percent of our immunity cells are either in the gut environment or in the vicinity, but if there is a disturbance in the gut barrier or an imbalance of bacteria – that is, more bad than good – the immune response will not be regular and a localized reaction can become systemic.
Another name for eczema is atopic dermatitis, and it is allergy-related. It might also be induced by certain drugs and is certainly exacerbated by stress.
It can be extremely incapacitating. The skin is an organ of the body and has several functions, such as temperature control. If that layer is compromised it can leave a person open to infection, irregular temperature and pain.
However, it is perfectly possible to grow out of eczema as the immune system develops and adjusts with age and maturity.
….is not easy. The condition is persistent and it could take months or even years of trial-and-error to find a treatment that works. Even then, flare-ups can still occur.
Medical treatment includes corticosteroid cream or ointment to control the itching and help repair the skin. But overuse can cause side effects, including thinning skin.
Oral corticosteroids might be prescribed to control more severe inflammation but they can’t be used long-term because of potentially serious side effects.
Creams containing drugs called calcineurin inhibitors affect your immune system. Avoid strong sunlight when using them.
If your skin has a bacterial infection or an open sore or cracks, your doctor might prescribe an antibiotic.
The US has approved a new, injectable drug for people with severe eczema who do not respond to other treatments. And the UAE has now allowed CBD, the non-hallucinogenic compound found in the marijuana plant, to be used topically. Jassim Al Nowais, founder of the first company to sell CBD products, persuaded the UAE government to approve its use after finding they were the only thing that helped his exzema.
Non-medical treatments and remedies
• Supplements: Dr Al Jafari says, “I would prescribe high-dose omega-3, curcumin, and quercetin, a plant-based flavonoid. I would also check vitamin D levels.” Quercetin is found in many foods such as onions, green tea, apples, berries, Gingko Biloba, and St John’s wort, among others. Buckwheat tea is rich in quercetin.
• Wet dressings: This involves wrapping the affected area with corticosteroid cream or ointment and wet bandages and is effective for severe cases. The technique requires some expertise, so it’s usually either done by a nurse or you have to learn how to do it at home.
• Light therapy: This is used where topical treatments don’t work or don’t last very long before another flare-up. The simplest form of light therapy or phototherapy involves exposing the skin to natural sunlight. Other forms use artificial ultraviolet A (UVA) and ultraviolet (UVB) light either alone or with medication.
The downside of light therapy is that it can cause premature aging of the skin and increases the risk of skin cancer, which is why it is not often used on young children.
• Behavior modification and relaxation: These can help people who scratch habitually. Instead of scratching, try pressing on the skin. If you really can’t help scratching, cover the itchy area. With children, keep their nails trimmed and have them wear gloves at night
• Moisturize your skin at least twice a day, whether it’s with cream, bath oil, ointments, sprays or a combination. Ointments are better used at bedtime as they are greasier than cream and sting less.
• Bathing is important. Skin conditions like eczema need extra moisture because the outer layer is not working as it should. Use warm water only, don’t scrub and don’t stay in the water for longer than 10 to 15 minutes. Pat yourself dry and apply moisturizer while your skin is still damp – ideally within three minutes of getting out of the water, as this can help seal in the moisture.
• Try sprinkling baking soda, uncooked oatmeal or colloidal oatmeal (finely ground oatmeal, also known as Avena sativa, which has been ground and boiled specifically for bathing )into the water. A 2015 study found that colloidal oatmeal lotion had antioxidant and anti-inflammatory properties.
“Avena cream, which is based on colloidal oatmeal, also works,” says Dr Al Jafari.
• If you want to use soap, choose a mild one that contains no perfume or dye. Many soaps, detergents, and cleansers are alkaline, which can disrupt the acidity of the skin, leaving it more vulnerable to damage and flare-ups. Always rinse off very thoroughly.
• Use gentle, fragrance-free products on your laundry and avoid fabric softener.
• Use a humidifier: hot, dry indoor air can dry out sensitive skin and make the itching and flaking worse.
• Eat the right foods. As eczema is an inflammatory condition, it makes sense to eat anti-inflammatory foods such as fish, leafy greens, beans, lentils, colourful fruits, turmeric and cinnamon.
Inflammatory foods to avoid include dairy, eggs, soy and wheat, although camel’s milk has been shown to be effective. Eliminate some or all of these and keep a food diary to track the results and identify which of them is causing problems.
• Avoid nuts and seeds. “When we do food sensitivity testing, nuts and seeds can come high up on the list of irritants,” says Dr Al Jafari. “When you think about it, the seed is the part of the plant that the plant most wants to protect as that is its means of reproducing, so nature makes it unpalatable and irritating.”
• Wear smooth-textured clothing: Scratchy or rough fabric will irritate your skin more. Make sure you wear appropriate clothing for hot weather or exercise as excessive sweating also increases irritation.
• Look after your emotional health: Stress, anxiety and other emotional disorders can all worsen eczema, so address those issues. If your condition embarrasses you, try talking to a therapist or counsellor or a support group .
Other eczema remedies
• Aloe vera gel: It’s antibacterial, antimicrobial, boosts the immune system and heals wounds. You can buy aloe vera gel or buy an aloe vera plant and use the gel straight from the leaves.
When buying aloe vera gel, use a brand that has the fewest ingredients as preservatives, fragrance, colour and alcohol can all irritate sensitive skin. Alcohol in particular dries the skin and so could make eczema worse. Test a small amount of gel first as it can sting ,but it is generally safe and effective for adults and children.
• Apple Cider Vinegar: Research on this is sparse, but here’s why it can help: skin is naturally acidic but might be less so in people with eczema. Alkaline soaps and cleanser can disrupt the acidity even more, so applying diluted apple cider vinegar could rebalance the skin’s acidity levels. Studies have also found that apple cider vinegar can prevent broken skin from becoming infected.
You can use the vinegar in wet wraps or in the bath but always dilute it, otherwise you could burn yourself.
For a wet wrap, mix one tablespoon of apple cider with one cup of warm water. Apply the solution to cotton or gauze and cover the dressing in clean cotton. Leave on the skin for three hours.
Or add two cups of apple cider vinegar to a warm bath and soak for 15-20 minutes. Rinse thoroughly, pat yourself dry and apply moisturizer immediately.
• Bleach: it might sound weird, not to mention dangerous, but research indicates that the antibacterial and anti-inflammatory properties of bleach can help by killing surface bacteria. Try adding half a cup of bleach to a full bathtub while the water is running – keep the water lukewarm – and soak for 5-10 minutes. Rinse thoroughly with warm water, pat gently to dry off and moisturize immediately.
The fumes from the bleach mean this is not suitable for people with asthma or breathing problems . If you experience redness, irritation or any discomfort, stop immediately.
• Coconut oil: The fatty acids can add moisture to the skin. Virgin coconut oil in particular can improve the health of the skin barrier. Apply it directly to the skin after bathing and several more times during the day and at bedtime for overnight moisturizing.
Extra virgin coconut oil tends to be solid at room temperature but the warmth of the body turns it to liquid.
• Honey: A natural antibacterial and anti-inflammatory agent that’s been used for centuries, studies have shown that when applied to eczema, it can help prevent infections, moisturize the skin and speed up healing. Manuka honey is especially good.
• Tea tree oil: It has antibacterial, anti-inflammatory and healing properties and may help relieve dryness and itching and prevent infections. But as with all essential oils, always dilute it before putting it on your skin. Almond or olive oil makes a good carrier.
• Evening primrose oil contains omega-6 fatty acids and gamma-linoleic acid, which can prevent inflammation. Research on using it for eczema has produced mixed results but even so, many sufferers say it helps, with no side effects.
• Sunflower oil hydrates the skin and protects the outer layer. You can apply it, undiluted, directly on to damp skin after bathing.
• Calendula cream has been used for centuries as a folk remedy for burns, cuts and inflammation and is thought to improve blood flow and fight infection. Research is scarce but some eczema sufferers claim it helps.
Anna Pukas has reported from all over the world as a foreign correspondent for British media. She is now an editor based in Abu Dhabi.