How to Ease that Eczema Itch the Dermatologist Way

November 03, 2020

For people suffering from eczema, the constant itch that they experience can put a damper on their daily lives. A common skin condition, eczema presents a set of different symptoms from skin redness and dryness to itchiness. However, the intense itch is the most burdensome of them all.

While eczema is a common skin condition and there are many treatments available, it is not an easy skin problem to rectify. Most of the time, those with eczema do not know what causes it or triggers it. This makes finding the right treatment a complicated process even though symptoms may be similar.

Dr. Low Dyoi-E, Consultant Dermatologist at Pantai Hospital Cheras explains that eczema can affect anyone – infants, children, as well adults and seems to be more common in certain families. "Most people with eczema develop their first symptoms as children, before the age of five – intense itching of the skin, patches of redness, and skin flaking are common," says Dr Low.

He adds that symptoms also vary from one person to another and can appear in multiple areas. “In infants, there may be red, scaly, and crusted areas on the front of the arms and legs, cheeks or scalp; in children and adults, eczema commonly affects the back of the neck, the elbow creases and the back parts of the knees. Other affected areas may include the face, wrists, and the forearms. Skin may thicken and darken or even scarred, from repeated scratching. Other findings in people with eczema include dry scaly skin, plugged hair follicles causing small bumps, increased skin creasing on the palms and darkening of the skin around the eyes.”

Eczema can be somewhat a mystery as scientists and doctors have not been able to pinpoint the exact cause of this skin condition. However, the National Eczema Association remarks that for most types of eczema, researchers believe a combination of genes and triggers are involved. It is also found that people with eczema tend to have an over-reactive immune system that when triggered by a substance outside or inside the body, responds by producing inflammation. It is this inflammation that causes the red, itchy, and painful skin symptoms that appear in most types of eczema.

According to Dr. Tee Shwu Hoon, a Consultant Dermatologist at Columbia Asia Hospital - Puchong, there are different types of eczema such as atopic eczema, seborrheic eczema, contact eczema, nummular/discoid eczema, dyshidrotic eczema, statis eczema and asteatotic eczema. Each of them may be associated or caused by different health or environment conditions and also present different symptoms.

The National Eczema Association further states that it is possible to have more than one type of eczema on your body at the same time. As each form of eczema has its own set of triggers and treatment requirements, a dermatologist should be consulted instead of self-treating it with over-the-counter medication.
The Different Types Of Eczema
Atopic eczema

A chronic, itchy inflammatory skin disease that occurs most frequently in children but can also affect adults. It follows a relapsing course. It is often associated with elevated serum immunoglobulin (IgE) levels and a personal or family history of type I allergies, allergic rhinitis, and asthma.

atopic eczema
Seborrheic eczema

Usually presents with itchy reddish or scaly patches affecting areas with a high density of sebaceous glands, such as the face (lateral sides of the nose and the nasolabial folds, eyebrows and glabella, retroauricular folds), and scalp. Less commonly involved are the chest, upper back, and axillae. Dandruff of the scalp is a mild form of seborrheic dermatitis.

seborrheic eczema
Contact eczema

Any skin lesions or inflammation arising from direct skin exposure to a substance such as chemicals, detergents, soaps. It may either be allergic or irritant-induced.

contact eczema
Nummular / discoid eczema

A chronic, recurrent, inflammatory skin disease characterized by multiple itchy, coin-shaped, inflamed lesions on any part of body.

contact eczema
Dyshidrotic eczema

An intensely itchy, chronic, and recurrent skin condition of unknown cause that typically presents with vesicles (small blisters) on the palms and soles and sides of the fingers.

contact eczema
Stasis eczema

A common inflammatory skin condition of the lower limbs occurring in patients with chronic venous insufficiency (poor blood circulation) on legs.

contact eczema
Asteatotic eczema

Usually presents with itchy inflamed skin on lower limbs due to extreme skin dryness. Low environmental humidity (eg. cold and dry weather) and exposure to harsh detergents or irritants are the exacerbating factors.

contact eczema
Itchy Triggers
Many things can trigger an eczema flare-up. These triggers are often due to changes in the environment or contact with a source of allergen. "There are various studies which have identified triggers for eczema flare. This include house dust mites, cold or dry environments, excessive sweating, emotional stress or anxiety, exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibres, sand, and cigarette smoke. By identifying and eliminating the trigger, this will help to prevent eczema flares," Dr. Low says.

For those who often have eczema flares at night, temperature is a main contributor. "Body temperature tends to cool down at night and the change of the temperature can cause the skin to feel itchy. Similarly, when one switches on the air conditioner at night with temperature less than 25⁰C, this will product a drying effect on the skin which will then trigger the itch,” he explains.
itchy triggers

It is interesting to note that many sufferers describe eczema as “the itch that rashes" because it can be so incessant and never goes away. Many doctors may suggest patients to stop scratching the itch as it can make eczema worse. However, it is easier said than done as scratching provides instant relief.

"Eczema flares are frequently triggered by the “itch-scratch cycle.” This is when itching leads to scratching, which results in the release of inflammatory mediators, leading to the development of eczema and more dry skin. Dry skin and eczema flares lead, in turn, to more itching— and so the cycle continues, "The National Eczema Association says. "Itch is a complicated symptom of eczema. Multiple nerve pathways and chemical mechanisms have been identified—as well as other contributing factors, including a defective skin barrier, external triggers and human nature."
Eczema Control
Currently, there is no definite cure for eczema. Does that mean sufferers will need to live with the itch forever? The good news is for some lucky folks, eczema goes away on its own over time. But for some, it is indeed a lifelong burden to bear. Fortunately, there are ways to remedy the itch and effectively treat eczema symptoms to reduce frequent scratching.

"There is no one-size-fits-all eczema treatment. In order to find an eczema treatment that is suitable just for you, it’s best to consult a dermatologist. By proper history taking, and sometimes performing special tests like skin prick or patch test, a dermatologist might be able to help identify the triggering factors for your eczema and design a specific treatment plan for you, " Dr. Low advises.

Treatments are usually targeted at healing affected skin and preventing flares. They also vary according to the causes and types of eczema.

"For example, contact eczema which is due to irritation or allergy requires avoidance of the causative agents that cause the eczema while infected eczema requires treatment with antimicrobial or antifungal therapy to address the skin infections. Additionally, eczema secondary to any underlying medical conditions requires optimization of the patient’s medical conditions," Dr. Tee explains.

Dr. Tee reminds patients that a treatment that works for someone they know may not always work for them. “The most important thing to remember is that eczema and its symptoms are different for everyone. Patients should find an eczema treatment that is suited for them by looking at signs of improvement of symptoms such as relief in itchiness, resolution of skin inflammation, reduction in frequency of flares, improvement in quality of life as well as sleep. Apart from this, they should also be able to cope with the burden of treatment they have chosen, including time spent on treatment, cost of medications, and frequency of health provider visits.”
Ezcema Control
Depending on the severity of a person's eczema, several types of medications may be prescribed. Doctors usually recommend the least invasive ones first like topical application to see how a patient's skin responds. "Medication can include topical steroids, topical tacrolimus/pimecrolimus which are useful in sensitive areas such as the face and groin as well as oral steroids and oral antihistamines," says Dr. Low.

"For people with severe eczema who do not improve with other treatments, immunosuppressive drugs are sometimes recommended. However, these drugs weaken the immune system and can cause serious side effects, including an increased risk for infection.

Other treatments like phototherapy or injectable medications such as Dupilumab are reserved for those with moderate to severe eczema that has not responded to other treatments."

Other unique cases of eczema also require a different approach. Dr. Low gives an example: "Another special scenario would be stasis eczema, which is usually caused by water retention over the gravity-dependent area. Thus, simple leg elevations while sleeping at night can actually help to relieve the symptoms, on top of using topical moisturizers and steroidal cream."

Currently, due to Covid-19, there is an increase of face masks usage which leads to a surge in facial eczema occurring below the eyes or around the mouth areas. According to Dr. Low, topical steroids sometimes worsen the condition in these cases; therefore topical tacrolimus/pimecrolimus should be used instead.
Home Remedies
For Dr. Low, he believes that home remedies can also help to keep the itch under control. He recommends several methods that people with eczema can do easily at home: "Always keep your skin hydrated with moisturizers. I always tell my patient there is no limit of doing that. There are many good moisturizer brands out there, either cream or ointment form; just choose the ones that suit you best. Also take lukewarm baths or showers to hydrate and cool the skin. This temporarily relieves itching.

An unscented, mild soap or non-soap cleanser should be used sparingly. After bathing or showering, immediately apply moisturizer to prevent your skin from drying out as a result of water evaporation. Hot or long baths (more than 10 to 15 minutes) and showers should be avoided since they can dry out the skin."

He also advises patients to avoid scratching by applying anti-itch cream containing steroids or menthol which will help to relieve the itching sensation.
Home Remedies
Another way is to put a cool compress to the itching skin. "In this method, soak a clean towel in cool water, wring it till damp and then immediately apply the cool towel to the itchy skin, leave it as long as the cooling effect is still there, followed by moisturizer application."

Dr. Tee also recommends some of her go-to eczema home remedies that are simple to implement daily: “Wear soft, breathable clothing and pat the itchy skin rather than scratching. You can also use wet dressings (wet wraps) to help soothe the skin. It’s best to avoid sitting on grass, rough carpet or dirty areas as there may be allergens.”

Dr. Tee Shwu Hoon
Consultant Dermatologist
Columbia Asia Hospital - Puchong

MBBS (IMU), Advanced Master in Dermatology (UKM), MRCP (UK)

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  This article first appeared in Natural Health, Vol. 116, October 2020.
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