DR MIKE DILKES reveals the surprising triggers that can make eczema worse

Eczema is painful, unsightly and, as the 1.5million British sufferers will no doubt know, confidence-sapping. As many as one-in-five children are born with the characteristic patches of scaly, red skin all over their bodies, with many suffering well into their teenage years – and even adulthood.

Hay fever and eczema, along with the breathing condition asthma, are often linked. If you have one condition, you’re more likely to suffer the other two.

In reality, eczema isn’t just one disease, but a range of skin conditions, many of which are caused by allergies.

Common eczema triggers include cigarettes, soap, perfume and gold

Common eczema triggers include cigarettes, soap, perfume and gold

Uncommon eczema triggers include baby wipes, shampoo and tanned leather

Uncommon eczema triggers include baby wipes, shampoo and tanned leather

Eczema is a condition that causes the skin to become itchy, red, dry and cracked (pictured) 

Eczema is a condition that causes the skin to become itchy, red, dry and cracked (pictured) 

The inflammatory reaction usually occurs when the skin touches a trigger or allergen.

But sometimes irritants in the atmosphere are microscopic, meaning flare-ups can be unpredictable and random.

Whether your symptoms are a minor irritation or a permanent, painful battle – you don’t have to put up with it.

I’ve pooled together the latest scientific research about what works and what doesn’t to form this simple guide to beating skin allergies.

First, get clued up on your condition. This information is vital to get you, or your child, the right diagnosis. Next, I’ll reveal the surprising hazards that may be making your skin allergies worse.

Finally, I’ll detail four, science-backed treatments that are proven to soothe the skin and stop you scratching.

THE SKIN IS IN PRIME POSITION FOR ALLERGIC REACTIONS

Although eczema is very common in young children, it is estimated that 60 to 70 per cent will grow out of it by the age of three, as the immune system develops. However, for a third of these children, it can carry on.

Typically, redness and rashes appear firstly on the cheeks and scalp before spreading to the legs and chest.

After about the age of one, the symptoms appear on the elbows, wrists and ankles.

Case study: Cutting out cow’s milk ended Rory’s flare-ups 

When, in 2012, ITV weather presenter Becky Mantin first spotted an eczema patch on her baby son’s foot, she thought nothing of it.

But, ten months later, she woke up to find ten-month-old Rory covered in an angry, red rash.

‘We feared the worst and thought it was meningitis so took him to A&E,’ Becky, 38, recalls.

‘The doctor told us it was eczema and I was relieved at first.’

Becky Mantin with her son Rory when he was a baby

Becky Mantin with her son Rory when he was a baby

Little did she know that this was just the beginning. Over the next couple of years his flare-ups got worse, becoming more frequent.

‘He would scratch himself raw,’ says Becky. ‘We put socks over his hands to stop him from scratching.’

‘He once spent five days in hospital on an antibiotic drip after his eczema became infected and he developed abscesses. He was so pale, he wasn’t speaking. It was heart breaking to watch.’

The turning point came when Rory was three and a half. He had picked up a type of the herpes virus that affects the face called herpes simplex while in hospital.

Every time the virus flared up, so would his eczema. He was put on medication to tackle the herpes virus. At the same time, Becky, who is also mother to Thomas, six, and Elizabeth, three, took Rory for a food intolerance test with a nutritionist. 

‘There’s a history of eczema in my husband’s family so I had an inkling that could be part of it.’ 

While food intolerance testing is not usually done with eczema, it’s not uncommon for it to exist alongside other allergies – including food.

It is thought that some people’s immune systems are especially sensitive to any potential triggers.

In Rory’s case, cow’s milk seemed to make the eczema worse, so Becky cut it out of his diet. His herpes flare-ups became less frequent and the eczema began to clear.

Rory is now eight and his eczema is largely under control. He has a food allergy test once a year.

Becky’s advice to other parents coping with childhood eczema?

‘Every case is different, but know your enemy so you can tackle it. Ask for your child to be screened, find out what you are up against. Keep going until you find out what it is.’

While the exact cause of eczema remains unknown, it’s likely due to a combination of genetic and environmental factors.

Most cases are known as atopic eczema. Atopic means it is caused by the immune system, and symptoms are linked to other allergies, such as sensitivity to pollen or dust mites.

So sufferers can find themselves sneezing, wheezing, with itchy eyes and all the other things an allergic reaction causes in the short term.

But, because their immune system is overactive, they can also start to get eczema-type skin problems too, which are more long-term.

To make life harder, some patients – particularly children – don’t have an obvious sneezy, wheezy allergic reaction. And this can make it difficult to work out what is triggering the eczema.

Eczema is sometimes referred to as dermatitis if it is caused by substances the skin comes into direct contact with. Unlike atopic eczema, this is caused by substances the skin comes into direct contact with.

Flare-ups can be triggered by jewellery made from nickel and gold, and cleaning products.

In some cases, rashes can spread to areas of the skin that haven’t touched the trigger.

As I’ve already mentioned, an allergy is a faulty immune reaction. The skin acts as a barrier between the inside of the body and the atmosphere, so it is abundant in infection-fighting immune system mast cells.

In those with atopic eczema or dermatitis, these cells over-react, releasing a cascade of chemicals that cause chronic soreness and inflammation under the skin. The surface of the skin soon becomes dry, red and itchy, which is the immune system’s attempt to fight the phantom threat. Rashes become sore and scratching can also cause thickened skin, dark unsightly patches and even scarring. Tears and cracks in the skin can get infected. It can be distressing, to say the least. Unlike inhaled allergies, specific tests aren’t usually necessary to diagnose eczema.

The symptoms are so characteristic most doctors can make a diagnosis by examining the skin, and asking about family history of allergies. Dermatitis is diagnosed according to the individual triggers and the spread of the reaction.

The distinction is usually achieved with questions – has there been a change in the washing powder or soap? New cosmetics if the reaction is on your face?

Keep a detailed note of each flare-up, where exactly it is and when it occurred. This will lead you to the all-important triggers that you must avoid.

STAY OUT OF THE SUN… AND EAT PLENTY OF NUTS

There are several effective methods to help ease eczema flare-ups.Most involve a series of steps, taken every day, to keep your skin in the best possible condition. This limits the frequency and severity of outbreaks. Avoiding triggers goes without saying, although this is easier said than done.

While some are well-known – cigarette smoke, laundry detergent and perfumes, for instance – others are less so. Even sitting on a leather couch can spark a flare-up in some, due to chemicals used to tan leather.

A full list of common obvious and non-obvious triggers can be found in the box above.

Practise each and every one of these five tips religiously for maximum protection.

1. Drink plenty of water

A simple but important rule. Keeping your skin hydrated is essential for repairing tears and lesions that can leave serious gaps in the body’s defence against irritants. Adults should aim for two litres of water per day – preferably on top of other drinks.

Drinking as much water as you can will keep the skin moist. When skin is dry, open wounds are most susceptible to infection.

Adults should aim to drink two litres of water (stock image) per day – preferably on top of other drinks

Adults should aim to drink two litres of water (stock image) per day – preferably on top of other drinks

2. Eat nuts, salmon and cucumber

As well as drinking enough water, certain foods with a high water content can contribute to hydration, preventing the skin from drying out.

This is because the foods take a while to digest, so the water stays in your bloodstream for longer than if you were to drink it. Cucumber, for instance, is made up almost entirely of water.

Try snacking on nuts – a source of essential fatty acids shown to keep your skin supple and improve elasticity. Foods like oily fish are rich in omega 3 fats, which helps regulate the skin’s oil production.

As well as drinking enough water, certain foods with a high water content can contribute to hydration, preventing the skin from drying out. Cucumber, for instance, is made up almost entirely of water

As well as drinking enough water, certain foods with a high water content can contribute to hydration, preventing the skin from drying out. Cucumber, for instance, is made up almost entirely of water

3. Ditch caffeine and booze

Although caffeinated drinks such as tea and coffee do count towards your water intake, be aware that they are also diuretics.

Drinking several cups throughout the day will make you go to the toilet, actively drying you out.

As well as being diuretic, alcohol constricts the blood vessels, limiting the nutrients that can be absorbed from all those good foods listed above.

Drinking several cups of coffee (stock image) throughout the day will make you go to the toilet, actively drying you out

Drinking several cups of coffee (stock image) throughout the day will make you go to the toilet, actively drying you out 

4. Keep showers tepid… and stay out the wind

Everyone’s skin feels dry after a steaming hot shower, allergy or no allergy.

For those with a dry bout of dermatitis, overly hot showers and prolonged sun exposure will further dry out and damage your skin.

It puts the skin under excess strain, reopening and deepening tears on the skin’s surface.

Sunbathing is similar, and a factor 30 (ideally 50) suncream is a must for prolonged spells outside in the sun, even in milder temperatures. Be wary of wind exposure, too. Wind dries out the skin very quickly and then leaves you open to the elements for the rest of the day.

Everyone's skin feels dry after a steaming hot shower, allergy or no allergy. For those with a dry bout of dermatitis, overly hot showers and prolonged sun exposure will further dry out and damage your skin

Everyone’s skin feels dry after a steaming hot shower, allergy or no allergy. For those with a dry bout of dermatitis, overly hot showers and prolonged sun exposure will further dry out and damage your skin

HOW TO TREAT SKIN ALLERGIES

As with the hay fever ladder, detailed on the previous pages, start at the first step and move down. You might find using more than one step at the same time helps.

With any medical intervention, you should consult your GP first.

1. Emollients 

These over-the-counter treatments, such as E45 cream, cover the skin with a protective film to trap in moisture.

Available as gels, ointments, sprays, creams or lotions, they keep the skin moist and supple and reduce inflammation.

Wet wrapping: How bandaging can help soothe pain 

Do this twice a day for two to three days and you’ll see a dramatic reduction in flare-ups.

1. Bathe the affected area in lukewarm water for 20 minutes.

2. Pat (don’t rub) your skin dry with a towel

3. Apply emollient cream to the affected area.

4. Wrap damp bandages over the moisturised skin, followed by a dry layer of bandages, then comfortable clothing.

5. Keep the wraps on for at least three hours.

Some simple emollients include a type of oil that reduces water loss from the outer layer of skin, providing a moisturising effect.

Other, stronger products contain additional ingredients such as humectants. These attract and hold water in the skin.

Ointments are thick, greasy and stick well to the skin (ideally slathered all over the body before bed).

Creams are thinner and are absorbed more quickly, so are good for daytime. Lotions are thinner still and a useful option for hairy skin.

2. Steroids

Steroid medication, such as hydrocortisone cream, works to dampen down the immune system’s response to the trigger, reducing inflammation in the skin.

Mild steroid creams and ointments are available over-the-counter, with stronger doses available on prescription. Steroid ointments are particularly effective when used in combination with emollients – just wait half an hour for the emollient to be absorbed before applying.

The general rule is to use milder steroid creams first (hydrocortisone 0.1 per cent is the mildest), then work up to stronger ones if required. Apply once or twice daily – but speak to your pharmacist or GP before using them.

They’re typically only suitable for short-term use, of around two weeks, as used for longer they can severely damage the skin.

3. Antihistamines 

Medicines to block the effects of histamine can provide some relief from scratching, but they are usually only effective in combination with steroid treatments.

Some find the drowsy types, taken orally, are useful if their symptoms keep them up at night.

4. Wet wrapping 

Encasing the damaged skin in a damp bandage for a few hours, or overnight, is very effective for preventing the skin from further drying out.

It also gives the skin ample time to heal, while removing the temptation to scratch. It is a time consuming process but is well worth it for the long-lasting relief from symptoms. Follow my simple step-by-step guide above.

Did you know? The word ‘eczema’ is derived from the Greek word for ‘to boil’, originally used to describe the blistered, red patches of skin.  

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