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By Dr. Michelle Hure
Once October rolls around and the humidity and temperatures start falling, dermatologists start seeing flares of chronic skin conditions, with one of the most common being eczema (atopic dermatitis). It’s no coincidence, therefore, that October is Eczema Awareness Month. Eczema can appear very differently based on your age, body site or skin tone but the most well-known presentation is the red, itchy, scaly skin at the bend of the elbows and knees that worsens with cool and dry conditions. Despite affecting nearly 32 million Americans, eczema continues to be one of the most stigmatized and misunderstood skin conditions that deserves attention.
We’ve come a long way from believing that evil spirits caused eczema and that using arsenic was the best treatment. While the exact cause has yet to be fully described, it’s well-known that eczema is caused by an overactive immune response (inflammation) in the skin coupled with a defective skin barrier. Without a healthy skin barrier, water is lost through the top layer of skin (leading to dryness) and irritants/allergens permeate more easily, triggering the exuberant immune response. Stress, being the insidious agent it is, can also wreak havoc on the skin barrier and throw the inflammation into high gear leading to worsening flares.
So, what strategies help control eczema flares? First, realize that eczema can only be controlled and not “cured” and continued maintenance of proper skin barrier health is necessary, even when no active spots are present. So many of my patients come in with a long history of eczema and multiple doctor visits, nearly addicted to using steroid creams daily without being educated about their disease. Many times, just understanding the mechanism, reasons for flares and best skincare choices can dramatically reduce the need for prescription medications.
With all the misinformation in the media about skincare, it’s no wonder that patients end up doing the opposite of what they should be with regards to their eczema. It’s vital for eczema patients to be on a skin diet, free of common irritants/allergens and avoid further breakdown of the skin barrier by being as gentle as possible. This means using fragrance/dye free personal care products and laundry detergent (ditch the fabric softener and dryer sheets too), never scrubbing or dry brushing the skin, avoiding hot showers and always moisturizing with a thick cream (not lotion) right after bathing. Realize that essential oils (either applied or diffused) and botanical ingredients in “organic” skincare are some of the most common culprits for skin allergy, sensitization, and eczema flares. Less is more when it comes to skincare and a good regimen shouldn’t be expensive or exclusive. In the spirit of this month, avoid the tricks and only treat your skin.
Dr. Hure is a double board-certified physician practicing medical, surgical, cosmetic dermatology and dermatopathology at Orange County SkinLab, her award-winning solo private practice clinic near the Los Rios District. She is a native Californian and proud to call San Juan Capistrano home, along with her two young daughters and husband.