What's going on in eczema?
Itch, it’s quite possibly the body’s most irritating sensation. While many things trigger itch, there aren’t too many that can match the level of annoyingness and chronicity of eczema. Despite a whopping 10-20% of the world’s population having eczema, there are still many basic misconceptions about what it is and what you can expect from treatment. In today’s article, we hope to explain what eczema really is and why some treatments work. At the same time, we hope that this explanation can also help dispel some common eczema myths.
How eczema works
The actual name for eczema is atopic dermatitis. ‘Atopy’ is when there is an exaggerated response to a normally non-irritating stimulus and ‘dermatitis’ means inflammation of the skin. Atopy is also seen in some other conditions like asthma and hay fever. By the end of this article, you will understand why this name actually accurately describes what eczema really is. However, to start, let’s talk about what happens to the skin in eczema.
Biology of eczema
If you pretend the skin is a brick wall, then the bricks are the cells (keratinocytes) and the mortar is the protein and fat cocktail that holds everything together. In eczema, the mortar is loose, and it allows for substances like water or bacteria to seep through. When this happens, your skin gets dry (from water loss) and gets irritated and red (from environmental debris and bacteria). This is the atopic component of atopic dermatitis. Common things like sweat or cosmetics that typically do not irritate the skin can penetrate eczematous skin and cause inflammation and itch. When eczematous skin becomes inflamed, it tends to lose even more water causing further itchiness and redness. If you scratch at it, that will only make everything worse.
In summary, the basic components of eczema are:
Loss of water
Course of eczema
Eczema is a chronic condition, which in most cases, starts during childhood. Fortunately, almost everyone simply grows out of it. Unfortunately for those who continue to have eczema, we don’t currently have a way to cure it. However, that doesn’t mean that we can’t treat it. In fact, the treatments available for eczema are very effective!
Eczema is also a waxing and waning condition, meaning that it is normal for it to naturally get better and worse over time.
Treatment of eczema
Just like with any other skin condition, understanding the basics of eczema allows us to make sense of why treatments work, and most treatments work by breaking what we call ‘The Eczema Cycle’. While we won’t touch on every treatment available, we will explain why some of the most commonly used treatments work. Keep in mind that, as always, we are not recommending (nor are we sponsored by) any specific treatment or brands, because the best and most appropriate treatment for you needs to be determined clinically by your doctor.
Let’s start with the basics, moisturizers. That’s right, something so simple is actually super important in eczema management. These work by essentially filling the holes where eczematous skin has poor barrier function. By breaking the cycle right at the beginning, you are able to stop the dryness, the irritation, and the inflammation from happening in the first place. Yes, we know that there are hundreds or even thousands of brands of moisturizers available out there, but a good principle to keep in mind is that the more vaseline-like it is in texture, the more effective it generally is at improving barrier function. Some studies have even shown that in babies, daily application of moisturizers actually reduce the risk of ever getting eczema by half!
Bleach baths are pretty much just a normal bath but with some bleach added in. This helps eczema by killing the bacteria that sits on your skin. Normally, these bacteria are harmless and do not irritate the skin. However, on eczematous skin, these bacteria can go through the skin barrier and cause inflammation and sometimes even infection.
These are mostly prescription medications that reduce inflammation. If used appropriately for the right reason, they are very effective at stopping The Eczema Cycle by preventing inflammation. No inflammation, no itch, no scratching, no rash. When this happens, the skin has enough time to heal itself.
Alright, myth busting time. Let’s get right to it.
Myth 1: Eczema is contagious
Fact: Infections can be contagious. Eczema is not an infection. Therefore, eczema is not contagious. Of course, damaged skin such as eczematous skin is prone to infection, but even most of those cases are not contagious because the infection is from bacteria that is normally found on everyone’s skin anyway.
Myth 2: Eczema can be cured
Fact: We touched on this topic a bit already. Unfortunately, eczema can not be cured because it is an inherent minor defect in the skin. So don’t lose faith in the cream that your doctor gave you if your eczema returns after you stopped using it.
Myth 3: Eczema is an allergic reaction
Fact: It’s actually quite understandable that eczema is frequently confused with an allergy. Allergies are common and can produce itchy rashes, and so does eczema. However, remember that allergies are triggered by very specific things that you are allergic to but eczema is an atopy, meaning that it can be triggered by many things that you are not allergic to (or even nothing at all). In a small percentage of people with eczema, food allergies can trigger eczema, but for most people, eczema should not be related to diet.
Myth 4: Regularly bathing will make eczema worse
Fact: Technically, bathing can actually improve eczema, such as in the case of bleach baths. However, bathing worsens eczema when the bath ends up drying or irritating your skin. This happens if the water is too hot, if things like irritating bath salts or scented oils are added to the bath, if you stay in the bath for too long, or if you don’t apply moisturizer to your skin immediately after. If done correctly, regularly bathing can improve your eczema.
Myth 5: Anything topical, including moisturizers, will irritate eczema.
Fact: This is a bit tricky because ‘moisturizers’ is an umbrella term that encompasses many products. While some products are sure to cause irritation to anyone’s skin, there are certainly many others that can improve eczema. As a general principle, vaseline like moisturizers are better for trapping in water and repairing the skin barrier. Check out our other article on ceramides for more details on one such product!
Myth 6: You can’t go swimming if you have eczema
Fact: Sure you can! A swimming pool is somewhat similar to a bleach bath (although not as good) so a quick dip once in a while may be beneficial. However, swimming for a long period of time or using the hot tub, just like a long or hot bath, can end up drying out your skin.
Myth 7: Eczema can leave scars
Fact: Eczema itself does not cause scars. However, untreated eczema can be very itchy, and scratching can cause wounds, which can then lead to scarring. The key here to to make sure your eczema is kept under control so you aren’t so tempted to scratch.
We hope that this article has given you a better understanding of what eczema is. Remember to use your moisturizers!
That's all for today folks!