Living with eczema can be uncomfortable and it can take an emotional toll on sufferers, as Victoria Goldman explains…

The National Eczema Society’s ‘More than Just an Itch’ campaign highlights the debilitating nature of eczema and its profound effect on people’s lives, shining a light on the mental health impacts that are so often overlooked.

In a recent survey by the charity, 91 per cent of respondents said their eczema made them feel self-conscious or embarrassed, and around four in five respondents thought that eczema reduces patients’ quality of life.

“Often people initially suffer from skin conditions, and from there it can develop into a negative spiral, as the symptoms undermine self-esteem and increase anxiety levels,” says Dr Nisa Aslam, a skin expert from the Skin Life SciencesFoundation.

“This adds to the risk of depression and raised levels of stress hormones – which fuel inflammation and promote unhealthy habits such as over-eating and excessive alcohol consumption.”

Improving management

In July 2023, the National Eczema Society (www.eczema.org) and other charities launched a patient charter for people living with atopic eczema, developed in collaboration with Sanofi. In a 2021 survey, a third of respondents said they spend at least an hour every day managing their eczema, including applying emollients and other topical treatments.

Half of the adults who took part in the survey reported having to take time off work because of their eczema.

“The itch of eczema, which is always present for some people with eczema, can make it difficult to focus on tasks or activities, cause people to feel self-conscious in social situations, and lead to problems sleeping,” says Alice Lambert, head of services at the National Eczema Society.

“Eczema can also make people feel self-conscious about their appearance (especially when it’s on visible areas of skin such as the face or hands) and reluctant to leave the house.”

The new patient charter makes a number of key recommendations, including:

• improved access to specialist dermatology care and psychodermatology services
• people living with eczema to become genuine partners with healthcare professionals in their own care
• better education to help people self-manage eczema, and improved mental health support
• dermatology services are supported to provide patient-centric care.

“Under-treated eczema and psoriasis can have a serious impact on quality of life and increase the risk of infection and chronic skin changes,” says Dr Aslam. “So, it’s important to seek out evidence-based information and support and ensure the condition is managed as effectively as possible.

“There really is no need to suffer in silence as there are a variety of prescribed skin treatment options, from ointments and creams to the development of medicated tapes. Finding the most effective therapy is often a matter of trial and error.”

Trigger awareness

One of the best ways to manage eczema flare-ups is to avoid known triggers – keeping a symptom diary may help. “Common irritant trigger factors for atopic eczema include stress, soaps, detergents, perfumes, cleaning products, synthetic and wool clothing and changes in temperature,” says Alice Lambert.

“There are also allergic trigger factors, which vary from person to person. These include allergies to house dust mite, tree and grass pollen, animal dander, metals, cement and latex.”

However, it’s not always possible to identify the cause of eczema flare-ups. Kenny Chan says chemicals may trigger an immediate reaction, but it can sometimes take hours or days for the symptoms to appear.

“Those with eczema should check product ingredients before applying to them to the skin,” he says. “Body products that are free from fragrances and dyes reduce the chance of an eczema flare up.”

Environmental factors can trigger flare ups as well. “Cold weather often lacks humidity and can cause dry skin,” says Kenny Chan. “Hot weather causes you to sweat more than usual. If heat aggravates eczema, keep the rooms in your home cool, especially the bedroom. Central heating can often dry the air and lead to drier skin; placing bowls of water near radiators to offset this drying effect.”

Treatments approaches

Alice Lambert says that emollients are the first line of defence against eczema – in the form of lotions, creams, gels, sprays and ointments. “It’s important that people with eczema are aware of the different formulations and which would be most suitable for their specific skin needs,” she says.

“For example, if a person’s skin is very dry, an ointment-based emollient is likely to be more effective than a lighter lotion. People with eczema should use emollients both as leave-on moisturisers and as soap substitutes. The only emollient that can’t be used for washing is 50:50, which is a very greasy ointment.”

When their eczema is flaring, people often need a short course of a topical steroid as well. “Pharmacy teams could advise people with eczema to try and leave a gap of 30 minutes between applying a topical steroid and an emollient, so the topical steroid doesn’t become diluted or spread to areas of skin that are unaffected by eczema,” says Alice Lambert. “Recent research shows that it’s best for the topical steroid to be applied first, and then the emollient. Pharmacy teams should advise customers to use topical steroids for the full length of time advised by their GP or dermatologist (usually up to two weeks at a time) rather than sporadically.”

Several new treatments are now available on the NHS for more severe eczema. “These are abrocitinib, upadacitinib and tralokinumab,” says Kenny Chan. “All three are available under specialist supervision due to their potential side effects. They can be used to treat moderate to severe atopic eczema for patients over 12 years old, and work by inhibiting the inflammatory response of the skin.”

Alice Lambert says that the biologic drugs and JAK-inhibitors have narrower, more targeted, mechanisms of action than conventional immunosuppressive drugs (such as azathioprine and methotrexate) and, as a result, fewer side-effects.

“Pharmaceutical companies are also trialling topical versions of JAK-inhibitors,” she says. “These could offer an effective approach to managing eczema inflammation while minimising potential systemic side effects.”