The Everything Guide To Eczema

Here’s what experts want you to know when it come to eczema. Natalie Arroyo Camacho was enjoying the warmth of early summer weather in 2022 when she spotted something unusual on her right hand. The skin covering her palm was dry, extremely itchy and irritated, nearing the point of raw.

For 28 years, Natalie had lived her life free of any serious skin issues, so she assumed this sudden dryness must be an allergic reaction brought on by a new scented hand soap. She threw away the suspected culprit and replaced it with an unscented alternative, expecting her skin to return to its normal hydrated state soon after. When a similar patch appeared on the palm of her left hand a few weeks later, she knew it was something more. Natalie thought she’d developed a new sensitivity to fragrance, so she combed through her entire personal care regimen, removing any scented lotions, oils and body washes.

Three months later, the dryness was still there – and it had dramatically worsened. “My hands were severely cracked and so painful – sometimes they even bled,” she recalls. “That’s when I realised I had to do something about it.” She booked an appointment with her GP and her worst fears were confirmed: the dry patches that had plagued her hands for months were not a temporary reaction to any product or ingredient but, in fact, an eczema flare-up.

How Do You Get Diagnosed With Eczema?

Natalie is one of about 204 million people worldwide who have eczema, a broad term for a skin condition marked by redness, dryness, itching and sometimes flaking. Essentially, “the skin barrier is not functioning optimally, leading to microscopic cracks in the outer skin layer that result in dryness and inflammation,” says Dr Joshua Zeichner, director of cosmetic and clinical research in the department of dermatology at Mount Sinai Hospital in New York. While eczema typically develops during childhood and often goes away during puberty, it can appear at any age and persist well into adulthood. It can occur anywhere on the body but is most often found on the arms, hands, legs, behind the knees and on areas of the face, such as the eyelids and around the mouth.

Types Of Eczema

There are several different types of eczema, each of which can be triggered or worsened by a variety of things. The major commonality among all varieties is the heavy physical and emotional toll on those who struggle with the condition. In fact, research has linked eczema with myriad mental health disorders, such as stress, anxiety and depression. And all of those can, in turn, lead to flares, creating a vicious cycle. Eczema is also believed to have a genetic component and there is often a family history of the condition among newly diagnosed cases. However, it can also be kick-started by environmental exposures, like the weather.

“Some triggers include dryness, stress and direct contact with something irritating, such as harsh soaps, detergents, chemicals or clothing with a rough texture, like wool,” says Dr Marisa Garshick, a clinical assistant professor of dermatology at Weill Cornell Medical Centre. “For some, intense heat and humidity can also [cause flares].” On the other end, exposure to cold, dry temperatures can also strip skin of essential oils and lead to eczema.

READ MORE: Different Types Of Eczema You Should Know About

Signs And Symptoms Of Eczema

The symptoms can be debilitating: red, flaky patches that itch significantly and can become dry and cracked, darkened, raw and marked by small or even oozing and crusty bumps, depending on the severity of the case and whether it’s exacerbated by further irritants or scratching. “In the most severe cases, eczema can actually affect large body-surface areas and interfere with sleep,” adds Dr Zeichner. This can be painful for those living with the condition and can even result in a second set of symptoms, especially if it develops on an area that’s frequently used or exposed to harsh environmental factors. “My eczema was agonising. I realise that sounds dramatic, but it was so painful and so frequent that I almost couldn’t do anything,” says Natalie, adding that, “Because my hands were affected, even day-to-day chores were difficult.”

How To Find A Treatment Plan

One of the first steps is to identify the causes – and the best person to help you do that is a dermatologist. Pinpointing triggers can bring relief, but often it takes adding skincare products formulated to treat the condition to make symptoms and flare-ups go away. There’s a wide range of over-the-counter topical products available for eczema and most patients will need to try a few to see what works best. But Dr Zeichner says a good rule of thumb is to “stick to products that contain ingredients like ceramides and colloidal oatmeal, which soothe and protect skin.” Prescription treatments can be helpful too. These include topical steroids, non-steroidal topicals like tacrolimus and Eucrisa, oral medications like JAK inhibitors, and injectable meds like Dupixent.

“Flare-ups are often treated with topical steroid creams or non-steroidal creams, while maintenance relies on using gentle cleansers and moisturisers,” says Dr Garshick. Managing eczema and keeping flare-ups at bay also come down to some lifestyle changes. “Patients should take only short lukewarm showers or baths once daily, moisturise once or twice daily after getting out of the shower and wear breathable fabrics,” says Dr Garshick. “Humidifiers can be useful in helping increase the skin’s moisture.” 

What Are The Best Products For Eczema

Eczema creams are different from your regular fare. They’re specifically formulated for eczema-prone skin: that is, they contain specific ingredients to effectively treat sore skin. Our picks…

READ MORE: How To Soothe And Treat Eczema-Prone Skin

The Side Effects Of Eczema

If acute flare-up symptoms weren’t awful already, the condition can also have some troubling side effects, like long-term pain and discomfort, which can impact daily activity and quality of life and can result in difficulty with sleep due to persistent itching.

“Eczema may also increase the chance of infection as a result of a weakened skin barrier and scratching,” explains Dr Garshick. Perhaps most notably, though, eczema can take a heavy toll emotionally, causing many who struggle with it to feel insecure and self-conscious. “I was super embarrassed by my eczema flare-ups because they were just plain unsightly,” recalls Natalie. “My friends would tease me all the time – which was all in good fun, of course, but still made me feel even more insecure about it.” Even now, with her eczema all but non-existent, she still gets PTSD just thinking about her ongoing battle with the condition. An exhausting battle – but worth it!

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Can You Really Live With Eczema?

The most important thing to do to prevent a potentially painful bout of eczema is to keep skin moisturised. The best way to do this is by following Dr Garshick’s advice on showering, using moisturiser and choosing clothing. Also worth considering, she notes: “Avoid using products on the skin that contain a lot of fragrance.” For Natalie, figuring out the best treatment took trial and error.

After removing scented products from her routine with no real improvement, she started using a steroid cream formulated with triamcinolone, a topical ingredient known to relieve itching, redness, swelling and discomfort. While the cream did stop her itching, the eczema persisted and it wasn’t until she discovered CeraVe Healing Ointment and Eucerin Intensive Repair Lotion that she was able to make serious progress with her skin. “I saw results pretty early on – like week two – but it took a year of consistently using the combo for me to see significant improvement,” she says. “Now, I can use the Eucerin just post-handwashing and only incorporate the CeraVe if my hands are especially dry.” Ultimately, a worthwhile journey, with relief on the other side.

READ MORE: Top Hacks To Summer-Proof Your Skin

This article was first published in the March/April issue of Women’s Health Magazine. Additional reporting and products added by the Women’s Health SA team.