Adults Who Have Eczema

One in eight children have eczema at one time or another as do one in twelve adults. Some of the latter are adults whose eczema has lingered on, while others will have eczema for the first time in adulthood. Some people will have had eczema for the first time as babies or young children and then experience several years of remission only to have the eczema re-appear suddenly and sometimes severely in their adult years.

Since one of the homilies that seems to have attached itself to the condition is “you will grow out of it”, it is small wonder that adults with eczema often become quite desperate, believing that they are stuck with it for life.  This is not necessarily the case. Adult eczema often does recover completely.

Stress

As people get older emotional stress and tension can play a large role in triggering a flare-up of eczema or aggravating the current condition. No one can get rid of stress in their lives, but we can learn how to handle it.

Our bodies are not really equipped to cope with long periods of stress. Centuries ago when we were hunters the body was tuned to quick-action stress. When faced with a threatening situation we either stood our ground and fought or ran. This fight-or-flight response has become part of our psychological and physical make up.

When we prepare for action the brain receives a warning signal. This triggers a chain reaction throughout the body. The adrenal glands secrete adrenalin and this mobilises the body’s defences, preparing it to fight or run. The heart pumps more blood and more oxygen to the muscles. Blood vessels in the skin and stomach constrict to allow more blood to be diverted to the brain. The lungs bring in more oxygen. The body temperature rises and we start to sweat in order to cool down. At this point another hormone, cortisol, is released by the adrenal glands in order to gather energy from other parts of the body to stabilise the situation.

This was very well for primitive man but it does not do much in helping us cope with the kind of stress we are faced with today.

People often think that stress accompanies a person who leads a very busy life, taking on more than he or she can possible do. Yet many people with eczema restrict their lives because they don’t want to be seen in public when their skin looks too awful. Staying at home, feeling bad about yourself, is very stressful thing to do. While eczema should never be ignored or neglected, it is not a good idea to focus on it heavily either. It is embarrassing to be stared at, but better that than become a self-made prisoner.

You do have to adopt a bit of a ‘me first’ attitude and do what you enjoy. It may be that all you need is a practical way of handling a build-up of stress. Do you make time for yourself, or are you at everybody else’s beck and call? Relax by making time to do something that you enjoy, regularly. This can be a hobby, sporting activity or anything else that you like, so long as you do it often enough.

Practical steps

The first step is to get a medical diagnosis of the condition. There are several different types of eczema which share some of the same symptoms like rough scaling, soreness, red spots, dryness, blisters which burst and weep, and constant irritation. Although symptoms may be similar and routine management likewise, there are special treatments that specific skin conditions respond to which your Doctor could prescribe.

Treatment

The byword with eczema treatment is to act promptly. If it suddenly flares up, don’t ignore it. Remember that eczema can become infected. This still does not mean that it becomes infectious: eczema is never infectious.

If the eczema is an on-going condition, get into a daily routine of bathing in tepid water which has had an emollient added to it. Apply a moisturiser at least twice a day and if you are using steroid creams, remember to apply them before moisturiser.

Signs of infected eczema are deterioration in the condition together with weeping and crusting, yellow pus spots and swollen glands. Please go to your Doctor if this happens as you will need special cream and maybe oral antibiotics to treat it.

Keeping eczema at bay

There are a number of ways in which you can cut down the possibility of triggering or aggravating the eczema. Here is a quick checklist:

• Wear cotton next to your skin. Synthetic or woollen clothes and bedding can cause over-heating. Some people can get away with putting woollens over cotton clothes.
• Use soap-substitutes and mild shampoos.
• People with atopic eczema may be allergic to dust, dust mites, grass seeds, pollens, feathers, animal fur and dander.
• Use non-biological soap powders and detergents.
• Use cotton mitts at night to stop you scratching and take antihistamines to curtail the itchiness and to help you sleep.
• Dietary factors are not commonly associated with adult atopic eczema so do not embark on a diet without consultation with your doctor or dietitian.  Food additives are the most likely to cause problems, particularly artificial colourings and preservatives (see the next section).
• Over-heating, frosty weather, low humidity, dry air, central heating, air conditioning and car heaters can all aggravate a dry skin and eczema.
• Get to know your own triggers. What sparks off one person’s eczema doesn’t necessarily trigger another’s.

Diet

Allergic reactions to food are rare with adults with atopic eczema. Eggs can be a problem for some people but it is rare and allergy to milk is even less likely. Along with colourings and preservatives, salicylates may cause problems. These appear widely in our diet, particularly in citrus fruits and apples. They are also included in aspirin tablets. Reactions to additives and salicylates do not seem to be a true allergic response and at present there are no tests available to identify them.

However, you can try and identify adverse reactions to foods by keeping a diary for at least a couple of months. Write down everything you eat and also note the state of your eczema. You may be able to relate the two. A diary may also give you an indication of any excessive amounts of foods that you are consuming. If it turns out that you drink a lot of artificially coloured drinks or eat a lot of heavily preserved and flavoured food, you could well find that switching to a more healthy diet with naturally flavoured wholefoods, could make a difference to your skin condition.

If this is not the case you could try a simple exclusion programme. The first thing to exclude is artificial colourings and preservatives as well as the culprit E numbers. If you are heavy imbiber of apple or orange juice, omit those too. In addition exclude any foods that you suspect may be triggering your eczema. Do this for a month to clear the system. If the eczema is no better, abandon the diet. If it improves, re-introduce the abandoned foods to your diet one at a time, leaving a week before each new food. If the eczema gets worse, exclude that food again.  If the condition stays the same, bring the food back into your diet.

If you are excluding a number of foods, particularly in an on-going diet you must seek the advice of your Doctor or Specialist. It is very important for your physical health and well-being to have a balanced diet. Calcium is very important for adults to ensure healthy bones and so are vitamins and minerals. Rigid dieting can be harmful because, if diets are not well balanced, they can be nutritionally inadequate. Furthermore, rigid dieting can involve a very restrictive life-style which can be very stressful and aggravate the eczema.

Dietary treatment in adults has a very minor part to play in the treatment of atopic eczema. Looking into environmental causes is a much more effective line of action.

Eczema at work

Allergic contact dermatitis and irritant contact dermatitis are two forms of eczema which can be triggered or exacerbated at work. Some jobs are particularly hazardous because they are likely to aggravate the condition and also cause eczema which has been in remission to flare up again. The jobs in this category are catering, engineering, hairdressing, animal handling, domestic work, nursing, work with cement and the armed forces.

It is sometimes possible to reduce the risks by wearing a barrier cream and protective clothing. If you are having skin problems and you think it may be triggered by something at work, it is worth checking it out with a Dermatologist to try and identify what the culprit is.

Social and sexual problems

One of the main problems of eczema socially is that there are still many members of the population who think it may be contagious, infectious or unhygienic. Many people with eczema on their hands get embarrassed because they see people staring at them. If you can’t say it outright, try and slip into the conversation that you have eczema and that it is neither infectious nor contagious and certainly not unhygienic. You may like to make a joke about how often you have to bathe and how scrupulous you have to be with your laundry and house cleaning. A joke that’s not really joke is a very powerful way of getting a message across! If you have eczema on your hands you may find wearing cotton mittens helpful in this respect.

Don’t stay away from life or wait until your eczema disappears before you enter it. Friendships are very important to all of us and the person with eczema is no different. You don’t have to be the life and soul of the party or go to parties at all if you don’t like them. Better to find interests and activities that you enjoy and try and forget about the eczema. This way you can meet kindred spirits, most of whom will be far more interested in you than in your skin condition.

Within a sexual partnership eczema can cause physical problems which then go on to have an emotional effect. If the skin is hot, itchy and sore the person may not be able to bear being touched. The genital area may be affected. Eczema in this area can be severe, making intercourse painful if not out of the question. There are many possible triggers:

• Vaginal deodorants
• Contraceptives including rubber sheaths, caps and spermicidal jellies and creams.
• Sanitary towels and tampons.
• Talcum powder, perfumed soaps and bubble bath.
• Nylon underwear. (Stick to cotton).
• Very tight clothing and clothing that rubs.
• Rough toilet paper.

Don’t try and treat it yourself and don’t put steroids on this sensitive area of your body. It may not be eczema that you have. It may be thrush (candida) which requires different treatment. So go to the doctor and get the condition both diagnosed and treated.

If the condition is in the genital area you may have to accept that for a period you may not be able to have sexual intercourse. But this does not mean that you cannot have a sexual relationship. If the woman has the condition she can lie with her partner and caress him to orgasm. It may be that the touching may not be able to be reciprocal but at least the sexual door is not closed. Equally, if the man has eczema and cannot have penetrative sex, he too can pleasure his partner and be pleasured by her without penetration taking place. This is very similar to the sexual enjoyment that many couples give each other after birth of a baby when sex is also limited.

The most important aspect is to literally keep in touch and to be affectionate to each other. People with eczema need to feel loved and not rejected. But equally, they need to recognise that the condition can make them irritable and this is communicated to the partner who may not always shrug it off or put it down to the condition and may, instead, feel rejected themselves.  In many ways it is up to the partner with eczema to take the sexual initiative. You know what you can do and what you can’t do as well as what hurts and what doesn’t. Your partner may be nervous of approaching you because he or she does not want to give you any more physical pain than you have already. Equally, he or she may feel the approach will be met with rejection and you don’t have to have eczema to fear that.

Kissing, cuddling and holding hands are all loving gestures which make the other person feel wanted and desired. Obviously if the whole body is affected, it could become a very isolating experience – for both the person with eczema and his or her partner. Try and stay in touch on an emotional and feeling level. Talk about how you feel and listen in to your partner’s feelings. In the same way as you reverse the dry skin situation with the regular application of creams, reverse the isolation experience by getting to know the people who love and care about you.

Try and separate the person from the condition. You are a person: your partner is a person. Eczema is a condition so that is the odd one out. With any chronic condition the person with the illness and the illness itself get locked into a relationship and everyone else is kept outside. Eczema can take over your body and make you feel hot, itchy, sore, tired, irritable, dirty, unlovable and unloved. Well, the condition may be on your body, but don’t give it house room in your mind. Stay connected to the outside world and particularly to your loved ones.

If you are finding it hard to cope with your emotional life and your love life, it might be worth going to see a counsellor. There are sex therapists who are also trained counsellors. Your local Council can be helpful in providing Counsellor information, or ask your GP. Alternatively you may like to try and treat the eczema in this part of your body through hypnotherapy.

Pregnancy

Since eczema is such an individual illness, it varies from person to person as to when it will flare up and when it will remit. A study reported in the British Journal of Dermatology in 1991 found that 52 percent of women experienced an adverse effect on their eczema during pregnancy, usually starting in the first 20 weeks. For 24 percent of women in this study the eczema improved during pregnancy. It was a small study and may not be representative of the population as a whole.

Some people suddenly develop eczema during pregnancy. Others find it flares up then while the more fortunate experience remission during this time. At present whys and wherefores are not known except for the fact that an upheaval of hormones makes a difference to the skin. What we do know is that you need to be careful with treatment during this time. So please keep in regular contact with your doctor.

Topical steroids are generally considered to be safe in eczema treatment provided they are used in limited quantities and under a doctor’s supervision. Studies on animals have shown that topical corticosteroids on pregnant animals can cause abnormalities to foetal development. These include cleft palate and intra-uterine growth retardation. There is a very small risk of similar effects on the human foetus.

If you possibly can, try and stick to emollients and bandaging to treat the condition. Bandages impregnated with ichthammol or coal tar pastes can be helpful. Phenergan, which has a long record of safety, may also be prescribed to help counteract the itchiness.

Obviously herbal remedies like Chinese medicine are not allowed during pregnancy, but you could try relaxation and meditation techniques to try and cope with stress.

Investigate environmental triggers, such as the ones listed earlier on to try and combat the condition at this time. Diet should never be contemplated without guidance of a dietitian during pregnancy.

Some mothers with a history of atopy in the family or who already have an eczematous child, may wonder if they should avoid common dietary triggers like eggs and cow’s milk during pregnancy. There is some evidence that some babies may become sensitised to these products before birth and this may take place in the womb. But there are no conclusive findings at present.  Please don’t embark on any diets cutting out these important foods without qualified and expert medical help. A healthy diet with plenty of essential vitamins and minerals and a minimum of junk food is good news for any foetus and a good start in life for any baby.

Will your child have eczema?

The predisposition to eczema is an extended family situation. Even if neither parents have the condition, but a grandparent, aunt, cousin or nephew have one of the atopic conditions, there is a possibility that a child of that family will get eczema. Atopy affects one in three people. That puts a lot of people in the target area.

But what is the situation if you, as a parent, have one of the atopic diseases (eczema, asthma or hayfever)? In his book, Your Child with Eczema, Dr David Atherton explains:

If one parent has or has had one of these conditions, the child’s risk of developing atopic eczema will be about double that of a child whose parents have never had any of these. If both parents have or have had any atopic disease, the risk of eczema in their child is doubled again. Having a brother or sister as well as one parent with atopic disease does not appear to increase the risk any further. If parents, or brothers or sisters have a history of eczema itself, rather than just asthma or hayfever, then the risk is increased even further.

But bear in mind something else: you don’t inherit eczema, you inherit a predisposition to it. Whether the eczema actually develops and whether or not it appears in a mild or severe form is thought to  be determined as much by environmental factors as inheritance. A parent with eczema who knows about triggers in the shape of dust mites, pets, pollen, laundry products, foodstuffs and so on is going to be well equipped to help keep the condition buried in the genes rather than running riot on the skin. An eczematous parent who knows about routine treatment and understands the psychological issues involved with eczema, should it appear, is far more likely to be able to keep it under control than someone for whom the condition appears in shock-horror form out of the blue.

Cosmetics

Cosmetics can make a big difference to how you look and go a long way to boost your confidence. However, people with eczema do have to be careful about what they use on their skins as they can have allergic reactions to some of the ingredients.

Perfumes and preservatives are two common allergens and some eczema people are allergic to lanolin.

Perfume

Many different ingredients are included to create a perfume and each of these constituents can cause an allergic reaction. Allergy is seldom confined to a single brand of perfume.  You may need to avoid any product containing perfume. Some people with eczema can tolerate perfume if it is dabbed on their clothing but others cannot. Obviously if you are sensitive to perfumes it is best to go for products that do not include them. Hypoallergenic products do not include perfume and although with these products the risk of allergy and sensitivity is reduced, it is not removed altogether.

Preservatives

Preservatives are used to stop products ‘going off’. Some products include more than one preservative. If you are using a product that is preservative-free check carefully the sell-by date (if provided) as bacterial and fungal contamination will start within days or weeks of opening. Also some of these products contain alcohol which limits the growth of bacteria but is not good for eczematous skin because it is drying.

Labelling

There is no legal requirement at present to provide product information. Sometimes manufacturers choose to include only an incomplete list of ingredients or no information at all.  Manufacturers who provide full ingredient labelling provide a real service to people who need to have this information.

Some products that are labelled ‘natural’, ‘organic’ or ‘herbal’ may not be suitable for eczematous skin as they may contain common allergens. Organic ingredients can produce sensitivity and these products may include preservatives and perfume unless they say otherwise. ‘Natural’ does not mean safe.

Patch testing

If you don’t know the ingredients of a cosmetic or have never tried it before, a good way to find out whether or not it agrees with you is by means of a home patch test (not to be confused with the clinical patch testing). Test it on a two-inch square of skin on the upper outer arm for several days. Most manufacturers now provide samples or allow the assistant to test some on you. Explain to the assistant that you have a sensitive skin and you need to try before you buy. Always try this test on any product that you have been using but is now being sold in a ‘new and improved’ version. It may not be an improvement for you!  Sometimes the reaction to a patch test can be very strong, so use tiny amounts and don’t do it the day before you have an important engagement.

If you do react to a cosmetic it may be worth finding out what the ingredient is that is causing the trouble. Ask your GP to refer you to your local dermatologist for allergy testing. Keep the product that seems to have caused the problem. When the dermatologist has identified the ingredient that is causing the allergy you can write to the manufacturer for advice on their products.

Cleansing and Moisturising

Cleansers work by absorbing grease, dirt and make-up. A gentle cleanser or cleansing bar may work well for your skin. Avoid soap as it dries the skin. A soap-substitute is a much better choice. If you want to tone the skin after cleansing, choose a toner that is alcohol-free.

Emollients are a very important part of good skin care for anyone with eczema, or you may prefer to try moisturisers. If in doubt about their suitability, try the patch tests.

Lanolin, which is a fat derived from sheep’s wool, is used in many cosmetics because of its moisturising properties. Some people with eczema are allergic to it. If you are, avoid all products that contain lanolin or wool alcohol.

General toiletries

Deodorants and antiperspirants cannot be tolerated by many people with eczema. Many antiperspirants contain alcohol and perfume and can cause an irritant reaction.

Many people with eczema also cannot use talcum powder as it is often highly perfumed and is quite drying to the skin.

Hair removal products are not very well tolerated by people with eczema. Hot wax treatments are unsuitable because eczematous skin is very easily irritated. Bleaching is not recommended and hair removal creams often cause irritation. The best method is dry shaving, or, if you prefer, a wet shave using a soap-substitute, and apply emollient afterwards.

Make-up

Foundation creams can present a problem to some people with eczema. Irritation is more likely to be the problem than allergy: some also contain sunscreens which you may find you are sensitive to.

Lipsticks often contain lanolin, perfume and antioxidants all of which may cause problems.

The dyes in eye make-up don’t usually cause irritation or allergy, but the brushes or pads to apply them may give you a problem.

Nail varnish and enamel are usually no problem on the fingers themselves but they can affect any area of skin they come into contact with, particularly any part of your body that has eczema which you scratch.

Camouflage

You may like to try camouflage make-up if the eczema persists or where there is flushed skin or broken veins. Almay, Avon, Clinique and Max Factor make camouflage creams. Some of these are waterproof which is useful if you are swimming; some include sunscreens. They are available in a wide variety of skin tones and can be used by men, women and children of all races. Other camouflage creams are available – check with your Pharmacy.

Shaving (for men)

It is best to avoid shaving foam, astringents and after-shave as they usually contain perfume and sometimes alcohol and can aggravate the eczema.  Dry shaving is usually the best, and you should always apply emollient after shaving.  If you prefer to wet shave use aqueous cream, a soft emollient cream or bath oil in place of soap or shaving foam.

Hairdressing

Many hair products can produce allergic reactions, particularly permanent dyes which can even affect people who have been dyeing their hair for many years. The contact dermatitis which follows produces itching and weeping of the forehead, neck and behind the ears. Where there is severe reaction, not only is the entire face involved but the problem can spread to the shoulders and the rest of the body. It is very important to follow the manufacturer’s advice to any permanent dye. If you have had an allergic reaction with a dye, never use it again.

Perfumes and preservatives are usually included in gels, mousses, sprays, conditioners and so on and these can produce allergic reactions on the face, scalp, neck and ears. If you are using any of these products protect the hands with gloves. You can use the thin disposable polythene gloves or the protective PVC ones with cotton inners. To be absolutely safe avoid perming, straightening, bleaching, dyeing, hot-brushing, heated rollers, curling tongs and hot-oil treatment.

Swimming and sunbathing

Chlorine can irritate the eczema, but so long as you apply an emollient before you enter the water to act as a barrier, remember to shower as soon as you come out and re-apply the emollient or other moisturisers to stop the skin becoming dry, the enjoyment of swimming should more than compensate for some of the more negative aspects.

As for sunbathing, you may find that sunlight improves the condition or you could find that it makes it worse. Obviously if the sun makes the eczema worse you will stay out of it, but even if it improves the skin, you must protect it from over-exposure to ultraviolet rays.

• Remember exposure to the harmful rays of the sun is greatest when the sun is high in the sky, between 11am and 3pm. Try and limit the amount of time you spend out of doors at this time and, if you are out, stay in the shade as much as possible.
• Loose, long-sleeved cotton tops and trousers will protect you from the harmful rays as will a sun hat (particularly if it has a wide brim).
• Always use a sunscreen.  The higher the SPF (Sun Protection Factor) the more protection is given. If your skin burns easily you should use a product with an SPF factor of 15 or more.  People with darker skin that tans easily and rarely burns can usually get away with an SPF factor of around 10.

If your eczema gets worse in sunlight use a cream of SPF 15 or more, regardless of your skin type. You should re-apply the sunscreen every two hours. If you are swimming choose a water-resistant one, but still re-apply frequently.

Sunburn is due, in the main, to ultraviolet rays and these penetrate into water and are also reflected off sand. Radiation mostly comes from the blue sky and not from the sun so even if you are sitting under a parasol, you could be vulnerable.

If the skin has been over-exposed to the sun and burning has occurred, bathe in a tepid bath with plenty of bath oils added and apply emollient. After-sun lotions are probably best avoided as many contain antihistamines and may cause an allergic reaction.

High risk factors

People with eczema are more vulnerable to catching other people’s skin infections. Usually these present no special problems with the exception of the following three:

• Cold sores (herpes simplex): These are very contagious and can lead to a very serious, even fatal, viral illness known as eczema herpeticum. It is essential that you avoid all mouth-to-skin contact with anyone with a cold sore. If you fancy someone and they have a cold sore, please wait until it goes before you get physically involved. Also be careful about sharing cups that haven’t been washed, and so on. You do really need to be scrupulously hygienic under these circumstances.  If your eczema suddenly spreads, is infected and you have a temperature, check immediately with your doctor that it is not eczema herpeticum.
• Impetigo: this is a contagious, pustular skin disease which can lead to the development of infected eczema.
• HIV (the AIDS virus): This virus can be transmitted through eczema and broken skin. The known risks for acquiring HIV are by unprotected penetrative sexual contact (vaginal or anal intercourse) with an infected person. You can also become infected through sharing blood-contaminated equipment (needles, syringes and so on) with an infected person, or transfusion of unscreened infected blood or blood products. The virus can also spread from an infected mother to the foetus or newborn infant across the placenta, during delivery or by breast milk.  Body fluids that carry significant amounts of HIV with a potential for transmission are blood, semen, female genital secretions and breast milk. Saliva, urine, faeces, sweat, vomit and nasal secretions do not present significant risk unless they are visibly contaminated with blood.

Normally skin is a very good defence against HIV and other infective agents. But people with active, weeping eczema or eczema with skin cracks should either avoid contact with HIV-infected body fluids or ensure that additional protection is present where contact with HIV-infected body fluids is likely.

The main part of the body at risk will be the hands, so latex gloves would provide a suitable barrier in situations where contact is likely (for example, during contact with bleeding sites on potentially infected persons, or during mutual masturbation). Small areas could be covered with plastic-type dressings for the duration of contact. Infected persons should use condom to reduce further any exposure to semen or genital secretions.

If you are uncertain what to do or what level of risk applies, you should discuss the matter with your doctor. Health care workers with extensive active eczema should seek professional guidance on possible re-allocation to duties not involving patient contact until the skin is healed.

It is not the policy of the Eczema Association of Australasia Inc to recommend or endorse any product or treatment.
It is part of the role of the Association to provide information on a wide range of products and treatments to keep those involved with eczema as fully informed as possible as to all options available. For medical advice, consult your health professional.