Health: itching for relief

Living with eczema can be hard on the body and mind

Many of us think of eczema as a childhood problem, but it affects around one in 12 adults, too – and new research shows the skin condition can have a serious impact on mental health. It seems that for many people, the typical symptoms of eczema – dry, red, itchy skin and an intense urge to scratch – go hand in hand with sleeplessness, anxiety and depression.

“While most people have heard about eczema, very few appreciate just how tough it can be,” says Andrew Proctor, chief executive of the National Eczema Society. “Relentless itchiness is one of the most challenging aspects of eczema. It’s difficult to focus on tasks or activities when the urge to scratch is overwhelming.

“Eczema can make you feel selfconscious about your appearance, too, especially when it’s on the face or hands. It can affect your family life, relationships, leisure, holidays, and all sorts of day-to-day activities.”

Symptoms

There are several different types of eczema. But the most common, and what many of us think of as eczema, is the atopic form, sometimes called atopic dermatitis. Dermatitis is just another word for eczema. “Atopic” describes a tendency to develop asthma, eczema and hay fever. This often runs in families, so if you have at least one of the three linked conditions, it’s likely a close relative will have one or more of them, too.

Atopic eczema can appear for the first time in adulthood, but usually starts in the first few months of a baby’s life, often on the face and scalp. And

although children often grow out of it, it can come back later.

What exactly causes it is still unclear. But it is known that people with this type of eczema have a genetic problem with their body’s natural skin barrier – the fats, oils and water-bearing cells that make up the skin’s outer layer. Without its normal protection, skin loses moisture, while products such as soaps and detergents can dry it out even more. Gaps open up between skin cells, and substances that irritate the skin, infect it, or cause an allergic reaction, can work their way in. This is when the skin becomes red, itchy and inflamed. Inflammation is caused by the body’s immune system, and there’s almost certainly a fault with this, too.

The symptoms of eczema can vary from mild to severe, and there may be just patches of skin involved or the whole body. Symptoms also tend to come and go. During a flare-up, the skin can be red, cracked and sore. And it will itch even more and may bleed if the urge to scratch proves irresistible. Scratching also makes infections more likely, which can make the area crust over and weep. Infection with the cold sore virus is particular dangerous – if it enters eczema-affected skin and spreads, it can be life-threatening.

In most cases, there are no obvious reasons for flare-ups. But some people find there are things that trigger them or make the symptoms worse. Heat, dust, wool, pet hairs, perfume and house dust mites are a few possible culprits. Women sometimes find their symptoms flare up just before their period or during pregnancy.

Other types of eczema have similar symptoms to the atopic form, but may affect particular parts of the body or have different causes. Varicose eczema, for example, affects only the lower legs. It often develops at the same time as varicose veins, and is a reaction sparked by fluid seeping through the walls of small blood vessels.

Contact dermatitis affects around nine per cent of the UK population. It’s usually caused by frequent contact with a substance that irritates and damages the skin, such as hair dyes, solvents, bleach or even water. Hairdressers, nurses, cooks and cleaners often suffer from this type of eczema.

Treatments

With contact dermatitis, just avoiding the offending substance will make the rash disappear. But for the majority of people with eczema, there’s no cure, and only treatments to ease the symptoms. Most treatments are topical, meaning that they are applied directly to the skin. Medical moisturisers called emollients are soothing, lock in moisture and leave an oily layer on the skin that acts as a protective barrier. It’s best to use these at least once a day, even when there’s no flare-up. There are also topical steroids that can dampen down inflammation, and creams and gels that suppress the immune system.

For severe eczema, there are other drugs available, including steroid tablets, as well as phototherapy, which uses ultraviolet light to reduce

Eczema affects around one in 12 adults

inflammation. Avoiding any triggers will help, too, if you can pin them down. A pharmacist can give advice on emollients, but for anything stronger, see a GP.

Mental toll

An all-party group in Parliament recently commissioned a survey on skin disease and mental health. The report included some harrowing testimony from people suffering with eczema. “I got eczema at 35 – it hit like a train and ripped my life apart,” said one. “I distanced myself from friends until no one called. So, all my life was work, deal with eczema at home, try to sleep for a few hours, and go to work exhausted looking like a blotchy, itchy mess.” Another added, “I sometimes think, ‘What is the point of living?’ The condition exhausts me.”

The National Eczema Society also ran a major survey recently. Of the adults with eczema quizzed, almost three-quarters said it had negatively impacted their mental health, while twothirds said they were lonely or socially isolated because of their eczema. Nearly nine in ten said it significantly reduced their quality of life.

“The emotional impact is often more difficult to deal with than the painful physical symptoms,” says

Andrew. “Over time, eczema can undermine your self-confidence and make you feel angry, frustrated or depressed.” What’s more, while eczema can cause stress, stress often makes eczema worse, triggering flare-ups and increasing the urge to scratch.

Support

In theory, if an eczema patient is struggling, doctors can arrange for them to see a psychologist free on the NHS. There’s even a branch of psychology dedicated to helping people with skin conditions called psychodermatology. But fewer than half the people surveyed by the National Eczema Society had been offered any emotional or psychological support.

Andrew says, “It’s really important for people to talk to their doctor about how eczema is affecting them emotionally, as the psychological impact can be significant. Doctors don’t always think to ask about it, so people need to be proactive.”

As well as tackling issues such as stress, anxiety and low selfesteem, a psychologist can offer practical techniques to combat the scratching that makes eczema worse. Scratching may start as a conscious way to ease an itch, but can quickly become an unconscious habit. One technique that can help is habit reversal therapy – and if you have eczema, you can try this simple version yourself.

First, spend a week keeping a record of when and how you scratch, and the effect that it’s having on your skin. This is the “awareness training” step. Then, whenever you feel like scratching, do something else instead, such as clenching your fist for 30 seconds, until the urge has passed. Combined with the usual medical treatments, it could take just a few weeks to make a difference.

Over time, it can undermine your selfconfidence

● For more information, visit the National Eczema Society website at Eczema.org or call their helpline free on 0800 448 0818.