13 – 19 September 2020 is National Eczema Week. Eczema, or dermatitis, is a skin disease that stems from inflammation. It is characterised by rough, itchy patches of skin that can cause sufferers great irritation and can affect people of all ages, from infancy to old age. The most common type of eczema, out of the 15 detected types, is known as atopic eczema. Atopic eczema appears more commonly in young people, affecting one in five children and one in every dozen babies.
The cause of eczema is unknown but is thought to be a combination of genetics and a series of trigger factors, which can cause flare ups. Frequently, sufferers have an over-reactive immune system that, when triggered by external or internal bodily factors, responds by producing inflammation, causing the skin to flake and become itchy.
Skin cells use chemical messengers to communicate with other cells. Occasionally, a cell will incorrectly communicate a message to other cells. This process then worsens, as one cell will communicate an incorrect message to two cells, and then those two cells will subsequently communicate the same message to another four and so on. This eventually leads to a flare up of eczema.
Further research has shown that some people who suffer from eczema have a gene mutation that causes them to under-produce a protein known as Filaggrin. When not enough of this protein is created in the body, the skin cannot build up a strong barrier. This means that moisture can escape more easily and bacteria are prone to enter, causing dry, irritated skin.
There are a multitude of triggers that have been reported by eczema sufferers. These include allergies, stress, sunlight, swimming, dry skin, irritants (like perfumes), hormones and hot climates (increasing the levels of sweat).
Covid-19 has been problematic for eczema sufferers in a range of ways.
The frequent washing of hands using soap, while vital to reduce the risk of viruses such as Covid-19, can dry out skin. Dry skin is known to be a trigger in the onset of an eczema flare up. People who suffer from eczema typically use emollient wash (medical moisturiser hand wash). However, these soaps are not as effective in killing off the virus. Hand sanitisers, due to the chemicals and alcohol they contain, irritate the skin, further drying it out and triggering any pre-existing eczema.
It is recommended that people who have eczema wash their hands with soap and then wash their hands again, using emollient wash, afterwards. This will help to protect the skin and prevent any drying out. Eczema sufferers are also advised to pat their hands dry instead of rubbing them, and to apply moisturiser regularly throughout the day. If the eczema is particularly severe, a moisturising hand mask can be applied overnight, or clean cotton gloves can be worn.
Face coverings may lead to a worsening of eczema as, depending on the material, they can irritate the skin. Further, masks may increase the level of sweat on the skin when worn, particularly in hot climates. Increased sweat, coupled with irritation from the fabric, can trigger a flare up.
To prevent an eczema flare up from wearing masks, experts advise that emollients should not be put on the skin prior to putting a mask on, as this will increase the temperature under the mask. Masks that are made of 100% cotton are softer on the skin, which will reduce irritation, and will also keep the face cooler. For those suffering with eczema behind the ears, masks with cloth straps are kinder to the skin than elastic straps. It is also recommended that masks that tie around the back of the head, avoiding the ears altogether, are worn.
The recent lockdown has increased levels of anxiety, emotional stress and other mental health issues. For many, this is a trigger for an eczema flare up. It is important that eczema treatments are more closely monitored and administered during this time.
As eczema is a multifactorial condition, some treatments can be ineffective, depending on the type of eczema. Because of this, progress made in eczema treatments has been slow compared to other dermatological conditions, such as psoriasis.
Psoriasis, compared to eczema, is largely controlled by two particular chemical messengers in the body, so they can be effectively blocked from inflaming the skin relatively quickly and easily. However, it is not known exactly what controls and causes eczema, so it is harder to treat.
A number of different treatments, such as immunosuppressant drugs and emollients (medical moisturisers that can come in cream, oil, gel, spray and ointment form), are available. Knowledge of eczema is improving and research into new medications is increasing, which will hopefully lead to the development of more treatments. The UK is a world leader in immunology research. Medications used to treat other inflammatory conditions, like arthritis, have been reported to help eczema.
Eczema is not simply a skin condition. It can affect the way a person looks and therefore how they feel about themselves. Severe eczema can affect a person’s self-esteem and the relationships they have with others. Many people consider eczema to be a mild inconvenience. However, patients with moderate to severe eczema can experience sleep disturbance, anxiety and depression, leading to poor mental wellbeing and in more severe cases, a poor quality of life.
If you are badly affected by eczema, there are local support groups that can help. More information about these groups can be found here.
It is hoped that with a greater level of knowledge and research, those that suffer severely from eczema can be treated successfully.
This article was co-written with Kitty Brockbank, a trainee solicitor in the clinical negligence team.