Itchy and scratchy

Eczema can be a year-round tor­ment for the 1.6 mil­lion adults af­fected in the UK, but win­ter causes par­tic­u­lar mis­ery, says Ann Robin­son

The Guardian - G2 - - Health -

Win­ter can be grim: coughs, cold, flu and the gen­eral sense of malaise brought on by dark nights, too much food and not enough ex­er­cise. And to add to the mis­ery, as the tem­per­a­ture plunges and the heat­ing goes on, nor­mally re­li­able and trou­ble-free skin can start to itch, flake and drive a per­son to dis­trac­tion. Wel­come to the on­set of win­ter eczema. About 1.6 mil­lion adults in the UK live with eczema, many since child­hood. It can be a year-round tor­ment or flare up in the cold months. A re­cent Al­lergy UK sur­vey of adults with eczema found that 88% say it has an im­pact on their daily lives, 58% say it af­fects per­sonal re­la­tion­ships and 73% claim that their so­cial life suf­fers. But de­spite the scale of the prob­lem, adult eczema re­mains an un­der­funded, un­der­recog­nised and un­der­treated con­di­tion that can cause pro­found dis­tress.

Why is it worse in win­ter?

“A com­bi­na­tion of cold weather, warm in­door en­vi­ron­ments, hot baths and woolly clothes can all ag­gra­vate eczema. Heat is a com­mon trig­ger, stim­u­lat­ing the itch/scratch cy­cle,” says Holly

Shaw, nurse ad­viser at Al­lergy UK.

She adds that sources such as cen­tral heat­ing and fan heaters can be a prob­lem and sug­gests turn­ing car heat­ing vents away from your face and keep­ing cen­tral heat­ing in the home at a steady, com­fort­able am­bi­ent tem­per­a­ture. Wear­ing cot­ton clothes helps to keep a layer of moist air next to the skin, which stops it dry­ing out and helps to break the cy­cle of itch and scratch­ing, says der­ma­tol­o­gist Dr Howard Stevens. Eczema is a com­plex con­di­tion, though; an in­her­ited ten­dency, mild dys­func­tion of the skin bar­rier and im­mune sys­tem and ex­po­sure to en­vi­ron­men­tal fac­tors such as pets, house dust mites and pollen may all play a role.

What is the dif­fer­ence be­tween eczema and der­mati­tis?

None – eczema and der­mati­tis are two names for the same thing. Eczema comes from the Greek word “to boil”, which seems ap­pro­pri­ate for the red, dry and itchy skin it de­scribes. Re­peated scratch­ing can make the skin thick and in­fec­tion can cause weep­ing and blis­ter­ing. The two main causes of eczema are an over­ac­tive im­mune sys­tem (atopy) that also causes hay-fever, al­ler­gies and asthma, or con­tact with chem­i­cals.

Why are my hands red raw since I started my new job in a hos­pi­tal?

It could be the hand sani­tiser. Con­tact der­mati­tis causes red, cracked, itchy and sore skin in places where ir­ri­tant chem­i­cals, or ones you are al­ler­gic to, touch the skin. A patch of eczema round the belly but­ton, ear­lobes or round a new pierc­ing is of­ten due to an al­lergy to nickel, which is found in but­tons, jean studs and cheap jew­ellery. Hand sani­tis­ers, ex­ces­sive hand wash­ing and chem­i­cals used by hair­dressers, painters and gar­den­ers can all be ir­ri­tants and cause eczema, pri­mar­ily on the backs of hands. Stevens says “ap­ply­ing mois­turis­ers im­me­di­ately af­ter wash­ing hands re­places the nat­u­ral oils in the outer layer of the skin that are re­moved by soaps and de­ter­gents”. Peo­ple who de­velop con­tact eczema at work may find it so hard to avoid the chem­i­cals re­spon­si­ble that they even­tu­ally have to give up their jobs.

Can I be re­ferred for al­lergy test­ing?

Good luck; the wait­ing lists are hor­rific in many ar­eas; it’s just not a high pri­or­ity, although Al­lergy UK ar­gues it should be. Patch test­ing can be used to iden­tify which chem­i­cals are re­spon­si­ble, but it helps to give some thought to likely sus­pects be­cause there is a limit to how many chem­i­cals can be tested for. “Luck­ily, a rel­a­tively small num­ber of chem­i­cals cause most of the prob­lems, so the com­monly used stan­dard bat­tery of patch test al­ler­gens iden­ti­fies 70% of the chem­i­cals that com­monly cause eczema,” says Stevens.

What can I do in the mean­time?

The so­lu­tion lies in iden­ti­fy­ing and avoid­ing the cause, heaps of emol­lient (mois­turiser) and a pos­si­bly short course of a po­tent steroid oint­ment from your GP – wrap­ping the hands in cling­film overnight helps the steroid to pen­e­trate the skin bet­ter and stops it rub­bing off on the bed­clothes, which could be a real fire haz­ard in the case of paraf­fin­based emol­lients. In very se­vere cases, short cour­ses of oral steroids are pre­scribed or longer-term cour­ses of im­muno­sup­pres­sants that damp down the whole im­mune sys­tem. An­tibi­otics are only use­ful if there are signs of in­fec­tion-like pus or weep­ing blis­ters.

Do most kids grow out of it?

Many kids do, but not all, and some peo­ple de­velop it for the first time as adults. In kids, atopic eczema typ­i­cally af­fects the backs of knees and el­bow creases. Adults of­ten find hands, eye­lids and skin creases af­fected. Any­one with atopic eczema is also more prone to con­tact eczema. And as well as be­ing more prone to other al­ler­gic con­di­tions such as asthma, hay-fever and food al­ler­gies, there are also links with in­som­nia, de­pres­sion and at­ten­tion deficit hy­per­ac­tiv­ity dis­or­der (ADHD). Some adults with eczema are well aware that they get a flare up when ex­posed to a par­tic­u­lar trig­ger such as stress but, of­ten, the eczema waxes and wanes for no ap­par­ent rea­son.

I’m sick of it. What can I do?

You are prob­a­bly all too aware of the op­tions: try to iden­tify and avoid trig­gers; wear loose, cool lay­ers to avoid get­ting too hot; use emol­lients, steroid oint­ments or creams, or an­ti­his­tamines to stop itch­ing; tacrolimus or pime­crolimus oint­ments, which are non-steroid op­tions; and drugs that sup­press the im­mune sys­tem (such as oral steroids) if all else fails. Talk­ing ther­apy can be use­ful to deal with the stress that can be both a trig­ger and con­se­quence of eczema and deal­ing with the im­pact it has on life.

Any hope on the hori­zon?

Yes. There are two hope­ful prod­ucts in the pipeline; crisabo­role (Eu­crisa), a non-steroidal oint­ment for mild or mod­er­ate eczema, and an in­jectable, bi­o­logic drug called du­pli­umab for more se­vere cases.

‘Cold weather, hot baths, cen­tral heat­ing and woolly clothes can all ag­gra­vate eczema’

A re­cent sur­vey found that 88% of adults with eczema say it has an im­pact on their daily lives

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