Astellas Phama Canada Inc.

www.eczemacanada.ca
1 866 432-0362 PRT1011100EN
Understanding eczema and what you can do about it
Introduction

INTRODUCTION
Eczema can be very different for everyone who has it. Yet, no matter how
severe your eczema, everyone deals with the same basic symptoms: dry
skin, sore rashes, and intense itch. It can be frustrating and uncomfortable
trying to manage eczema and keep eczema flare-ups under control. At its
most severe, eczema can cause serious health problems, profoundly affect
quality of life, and interfere with normal, everyday activities.

Eczema is a recurring, long-term inflammation of the skin, and there is no

cure. It usually begins in childhood, appearing within the first six months,
and can continue through adolescence into adulthood. Although some
children may eventually outgrow eczema, about 80 per cent will have dry,
irritable skin their whole lives.

Often, people suffering from eczema or parents of children with eczema

dont understand the disease or how to manage the condition. Some
people have even stopped seeing their doctor because they are frustrated
with their current treatment. This is not the answer. There is hope.

This book, along with the website www.eczemacanada.ca, is a part of

the Eczema Awareness, Support and Education (EASE) program, which
provides free educational resources to help patients better understand
eczema. Developed in collaboration with leading Canadian dermatologists,
these resources will help teach you about current therapies as well as new
treatments that could make a difference to your skin. You will gain a better
understanding of the chronic nature of eczema, as well as tips to help you
manage your skin on a daily basis, so you can take control of your eczema
right now!

The first step, if you think you have eczema or if your current treatment does
not seem to be helping, is to see your family doctor. A correct diagnosis and
the proper treatment are very important. If a referral to a dermatologist is
necessary, your family physician will help you get one.

1
 Contents
CONTENTS

What is eczema?......................................................... 4
The itch-scratch-rash cycle........................................... 4
Eczema and your skin................................................... 5
Eczema and the immune system.................................. 5
How is eczema diagnosed?.......................................... 6
Eczema flare-ups......................................................... 7
Myths and facts about eczema..................................... 8
What triggers your eczema?......................................... 10

Managing childhood eczema..................................... 12

Learn your childs eczema triggers............................... 12
How can I stop my child from scratching?.................... 12
Tips to help manage your childs eczema..................... 13
Managing your childs eczema at school...................... 14
Answers to common questions . .................................. 16

Managing adult eczema.............................................. 19

Moisturizers................................................................... 19
Bathing and showering................................................. 19
The itch.......................................................................... 20
Know your triggers........................................................ 20
Clothes, towels, and bedding....................................... 20
Makeup and cleansers.................................................. 21
Soap and hair products................................................. 21
Stress............................................................................ 21
Medication..................................................................... 22
Ways to manage your eczema...................................... 22
Talking about eczema.................................................... 22
2
How is eczema treated?............................................. 23

CONTENTS
Antibiotics...................................................................... 24
Antihistamines............................................................... 24
Coal tar preparations..................................................... 25
Phototherapy................................................................. 25
Topical Calcineurin Inhibitors........................................ 26
Topical Steroids............................................................. 26
Treatment progress chart.............................................. 28

Resources and support.............................................. 30

Books............................................................................ 30
Web resources............................................................... 30
Notes............................................................................. 31

33
 What is eczema?
W H AT I S E C Z E M A ?

Although we often associate eczema with only one type of skin condition,
it really describes a whole group that can affect anyone, at any age.

Atopic dermatitis is only one of this Eczema = Atopic

group and doctors usually refer to it
as simply eczema because it is the Dermatitis
most common within this group.

The itch-scratch-rash cycle

The constant itch that goes along with eczema makes it very different
from any other skin condition. Eczema is often called
the itch that rashes rather than the rash that
itches because the itch starts before the rash ITCH
appears. The itch leads to scratching and
thats when the red, raw rash appears.

The signs and symptoms of eczema vary

from person to person. It can range from
mild where skin is dry, hot and itchy
RASH SCRATCH
to its most severe when the skin
becomes broken, raw, and bleeding.1

The skin barrier appears to play a significant

role in how effectively the skin functions, and
why certain people get eczema while others do not. In healthy skin with
a resilient skin barrier, allergens cannot penetrate deeper into the skin.
Instead, bacteria and irritants are prevented from entering; the barrier also
helps to protect proper levels of hydration in the skin. Research into the
skin barrier has shown that there is a genetic predisposition to a weakened,
defective skin barrier. This allows allergens to penetrate the deeper layers of
the skin.2

In addition, the defective skin barrier allows for increased interaction with
environmental factors such as soap and detergent, house dust mites, hard
water, infection and some topical medications and cosmetic products. This
can result in a worsening of eczema symptoms, and a further breakdown of
the skin barrier.

1. T
 he Chronicle of Skin & Allergy, February 2010
4 2. Cork MJ, The importance of the skin barrier function. Journal of Dermatological Treatment 1997; Vol. 8, S7-S13
Eczema and your skin

W H AT I S E C Z E M A ?
Your skin is quite amazing. Its the largest organ of
your body; flexible, relatively waterproof, keeps you
warm or cool by regulating body temperature, and
protects you from tiny organisms and infections.

Normal skin tends to take care of itself, rarely

causing too much trouble. Skin affected by eczema
is often dry and cracked with the protective outer
layer of skin damaged. As a result, skin affected by
eczema loses a lot of water, which interferes with
the natural healing process.

Eczema and the immune system

Our immune system is very complex and it works very hard to protect us.
Once the white blood cells of our immune system are set into action, they
release substances that cause inflammation. This inflammation causes
redness to appear, as well as releasing other substances that can cause
itching.

Some researchers believe that people who have eczema also have a
reduced threshold for the itch sensation. So once your skin gets itchy, its
very hard to resist the urge to scratch.

Scratching can damage your skin, causing more inflammatory substances

to be produced that, in turn, cause more white blood cells to respond to
this reaction. This increases the redness and itching, which makes it even
harder to resist scratching.

This process is known as the itch-scratch-rash cycle and it can become so

severe that it can lead to sleeplessness, irritability, stress, thickening skin,
and intense pain. Scratching can tear or break the skin, causing it to bleed
and ooze, allowing bacteria to enter which can cause secondary infections
to develop.

Generally, treatments like topical steroids and antihistamines work to relieve

the symptoms of eczema once they have already appeared. Relatively
newer treatments called Topical Calcineurin Inhibitors (TCIs) are available
in Canada that some dermatologists consider to be a promising option in

5
W H AT I S E C Z E M A ?
eczema therapy. TCIs appear to prevent the release of the inflammatory
substances that cause the red, itchy skin associated with eczema. This
treatment works to calm and control the skins reaction. In 2010 Health
Canada approved one of the available TCIs for maintenance therapy. Talk
with your doctor; he or she has the most up-to-date information about
eczema treatments.

How is eczema diagnosed?

Your doctor cannot diagnose eczema by a blood test, urine sample, or by
any other laboratory tests. The only way to tell if you have eczema is by
having a physical examination.

Your doctor may ask if:

You have a family history of allergic diseases, like hay fever or asthma.
It is not unusual for people suffering from eczema to have asthma or
hay fever, or have a close relative with eczema, asthma, or hay fever.

You have trouble sleeping or concentrating because of pain or
itchiness.

Your skin condition comes and goes or is always present somewhere

on your body.

You have a rash in the folds of your elbows, behind your knees, on
the front of your ankles, on your hands, wrists, or neck.

You have frequent skin infections.

Mild Eczema Moderate Eczema Severe Eczema

The signs and symptoms of eczema vary from person to person and can
range from mild where skin is dry, hot and itchy to its most severe,
when the skin becomes broken, raw and bleeding.

6
Eczema flare-ups

W H AT I S E C Z E M A ?
By nature, eczema symptoms can come
and go. At times, symptoms can be
more severe or the rash and itching can
completely disappear for long periods at a
time. However, when symptoms suddenly
reappear or become worse, its called a
flare-up.

A number of different factors appear to

trigger flare-ups of eczema. Flareups
can happen when your skin comes in
contact with irritants like soap, detergents, abrasive clothing (e.g., wool and
synthetic fibres), perfume, carpet fibres, or dust. Overheating, excessive
sweating or low humidity can also trigger a flare-up.

The chart found on pages 10 and 11 can help you identify irritants that may
trigger your eczema and cause flare-ups.

7
 Myths and facts about eczema
W H AT I S E C Z E M A ?

Unfortunately, there are a lot of misconceptions about eczema. Its

important that you understand your condition so that you can help
others understand it as well.

Here are a few common myths about eczema and the truth about
each one.

Myth: Eczema is just like acne.

Fact: No.
Eczema is not like acne they are
completely different conditions. However,
it is true that some medications may cause
acne and complicate eczema. Talk to your
doctor, there are different medications that
may help.

Myth: Eczema is caused by an emotional disorder.

Fact: No.
Although at one time doctors did believe that eczema was caused by an
emotional disorder, we now know that emotional factors, like stress, can
make eczema worse. There are techniques that can help you manage
the stress, anxiety, anger, or frustration that can lead to increased
instances of eczema flare-ups.

Myth: You can catch eczema from someone who has the disease.
Fact: No.
Eczema is absolutely not contagious. This means that you cant catch
the disease from another person and you cant give it to someone by
touching him or her.

8
 W H AT I S E C Z E M A ?
Myth: You cant go swimming if you have
eczema.
Fact: Most people with eczema can go
swimming.
However, some people who have severe
eczema find that the chemicals used in
swimming pools or the salt in sea water
makes their eczema worse, so they choose
not to go in. Make sure that before and after
you go swimming, you rinse your skin and put
on a moisturizer.

Myth: People who have eczema do not wash properly.

Fact: Of course this isnt true.
Having eczema has nothing to do with personal hygiene; the disease is
believed to be caused by a combination of environmental, genetic and
immune system factors. In reality, many eczema sufferers bathe much
more frequently than non-eczema sufferers to help hydrate the skin!

Myth: Eczema will leave permanent scars.

Fact: Generally, no.
Although your eczema can be very uncomfortable and unpleasant, it is
very unusual for it to leave any permanent marks on your skin.

Myth: Eczema can be cured with steroids.

Fact: Unfortunately, there is no cure for eczema.
Although steroids have been used for a long time to treat eczema, they
are not a cure and they do have limitations when used as treatment.

9
 What triggers your eczema?
W H AT I S E C Z E M A ?

Triggering factor Yes/No Eczema symptoms

Stress
Anger
Frustration
Anxiety

Hot weather
Cold weather
Humidity
Dry weather
Sun

Sweat

Wool
Synthetic fibers

Latex
Rubber
Plastic

Hot baths
Hard water
Chlorinated water
Salt water (oceans,
mineral spas)
10
 W H AT I S E C Z E M A ?
Triggering factor Yes/No Eczema symptoms

Air borne pollutants:

Dust mites
Mould
Animal dander
Pollen
Smog/air pollution

Eggs
Milk
Wheat
Soy
Seafood
Nuts
Food additives
Citrus fruits
Strawberries

Soaps
Detergents
Lotions, creams
Perfumes
Makeup
Hair shampoos
Styling aids
Conditioners

Other:
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 Managing Childhood Eczema
M ana g in g C hi l dhood E czema

The pain and constant itch of eczema can distress children and disturb their
sleep. It can interfere with school, cause low self-esteem, and make them
feel self-conscious about their appearance. Some children even avoid social
situations because of it.

You can help your child cope with their condition by helping them
understand the importance of a daily routine to keep their eczema under
control. Smaller children and toddlers will also benefit from good skin care
practices and the right treatment.

Learn your childs eczema triggers

A number of different factors appear to trigger flare-ups of eczema.
Contact with irritants such as soap, detergents, abrasive clothing (e.g., wool
and synthetic fibres), carpet, certain foods, heat, sweat, and low humidity
can trigger itching that leads to flare-ups. The chart found on pages
10 and 11 will help you keep track of what affects your child so you can
eliminate or manage their effects.

How can I stop my child from scratching?

Scratching is an instinctive reaction to itching and it is particularly hard for
babies and children to resist the urge to scratch. Unfortunately, scratching
does not stop the itch. In fact, it breaks the natural barrier of the skins
surface, aggravating the skin and making the condition worse. The skin then
becomes sore and inflamed, eventually cracks and bleeds and may even
become infected.

The only effective way to stop a childs scratching is to stop the itch. You
can help by applying a moisturizer or by covering the affected area with a
cool, damp towel. Medications applied to the skin, such as topical steroids,
can also help to control inflammation, while newer therapies such as Topical
Calcineurin Inhibitors (TCIs) are effective in relieving the itch. Ask your
doctor about the most appropriate treatment option for your child.

If you notice your child develops a habit of scratching at a certain time of

day or during a particular activity (such as watching television), try to break
this habit by applying the moisturizer or a cool, damp towel to the skin at
that time. It may also help to distract them by playing a game or starting a
new activity.

12
 M ana g in g C hi l dhood E czema
Moisturizers

Moisturizers, sometimes called emollients, are mixtures of oils, fats and

water, which help to restore the oil and moisture content of the skin. Using
moisturizers regularly on your childs skin is the most important thing you
can do to manage eczema. Moisturizers are available over-the-counter
or by prescription in the form of creams, ointments, soap substitutes, and
lotions. Use moisturizers as often as you can, especially after bathing or
showering.

Bathing

Frequent bathing is essential. Make sure the water is warm, not hot. After
the bath, pat your childs skin dry, then immediately apply a moisturizer to
seal in water.

Although there are conflicting opinions regarding the amount of time a child
should remain in the bath, a good rule of thumb seems to be about 5 to 10
minutes daily, before bed time. Always moisturize immediately after bathing.

Tips to help manage your childs eczema

Keep them cool. Use cool, light bedding, loose clothing and always keep
the bedroom somewhat cool at night.

Keep the skin moist. Keep skin well-moisturized, even when a rash is
not present. This will help prevent the skin from flaring.

Use 100% cotton clothes and bedding. Avoid nylon and wool. Wash
clothes and bedding in a mild detergent, avoid bleach and fabric
softeners, and rinse clothes twice.

Pets. Avoid pets contact with fur and feathers can irritate the skin.
Animal dander can also produce an allergic reaction in some sufferers.
Dander, or the proteins in skin flakes, hair and saliva, are very small
particles that can be carried through the air. All pets shed some amount of
dander, even pets that are considered to be hypoallergenic. However, a
hypoallergenic pet (for example, dog breeds such as Poodles or Yorkshire
Terriers) may cause less of an allergic reaction in sufferers. If your child
has their heart set on a pet, consider animals that do not normally
produce an allergic reaction, such as turtles, lizards or aquarium fish.

13
M ana g in g C hi l dhood E czema
Keep fingernails short and clean. If necessary, use cotton gloves or
mittens at night to prevent scratching during sleep.

Diet. Changes to diet may be effective for some children if food has been
identified as a trigger factor. Only do this with advice from your doctor or
a dietitian.

Emollients/moisturizers. Make sure the moisturizer/emollient you

choose does not contain alcohol, which will dry your childs skin. While
the skin is still damp, apply moisturizers to create a barrier against
water loss. Make sure any moisturizers or emollients you use are rich
enough (have a high oil-to-water ratio) to help keep moisture in the skin.
Lotions generally have the lowest oil-to-water ratio, followed by creams.
Ointments have the highest oil-to-water ratio. Because of this, ointments
generally provide the best hydration.

Be patient. Eczema is a chronic disease and must be managed daily.

Find a routine both you and your child can live with and stick to it.
Remember, you are not alone, and there is support.

Involve your child. Its important for your child to feel involved in their
own skincare. It helps them achieve a sense of control over their disease
and helps them feel good that they can do something about the awful
itch.

Managing your childs eczema at school

It is important to remember that eczema can
change quite dramatically in a short period
of time and may require immediate treatment
or care. Parents may find it helpful to alert
teachers, school nurses, or administrators
to their childs eczema. Discuss your childs
condition with their teachers at the beginning
of the school year, and check in with updates
when necessary.

14
 M ana g in g C hi l dhood E czema
Tips for managing eczema at school

Ask that your child be seated away from heat sources, like sunny
windows, air vents, or radiators.

If school uniforms are required, ensure that a cotton alternative is

acceptable.

Over-heating from school activities and sports may aggravate eczema.

Sore or cracked skin may also prevent your child from taking part in some
sports. Work with the schools gym teacher to develop a fitness program
that meets your childs needs.

Children may feel embarrassed at exposing their skin. Help your child
deal with the possibility of hurtful comments and if possible, help educate
other classmates about eczema. Be sure to stress that eczema is not
contagious.

Swimming. Saltwater or chlorine may irritate skin. Applying an emollient

before swimming and after showering can help.

Over-tired. The discomfort and itch of eczema can mean that your child
is restless and unable to sleep at night. Your child may be irritable or tired
at school. Work with teachers and administrators to find a solution that
everyone can live with.

School activities. Some school activities that involve paste, paint, clay,
food preparation, wood or metal shop may cause an eczema flare-up. It
is best to talk to your child about what things they can do and what things
they cannot do. Offer alternatives so that they wont feel left out.

Food. Some foods may make your childs eczema worse. Inform the
school of any food triggers and make sure your child understands which
foods they should stay away from.

Its hard for children not to scratch, but it is equally important that you
inform your childs teachers of this, and ask that they quietly remind the
child not to scratch if they notice it during class. Let the teachers know
that it may be an unconscious reaction and that often the child just needs
to be made aware that they are scratching.

15
M ana g in g C hi l dhood E czema
W
 hile certain activities such as sports or arts and crafts may not be
possible in severe cases, its important to encourage your child to pursue
as normal a life as their condition permits. Encourage your child to talk to
other children about their condition, and speak openly about eczema with
other parents and teachers who have contact with your child.

You can help your child cope with their condition by helping them
understand the importance of a daily routine to keep their eczema under
control. Smaller children and toddlers also benefit from a good skin care
routine and proper treatment.

Answers to common questions about

childhood eczema
Where does eczema usually appear?

Babies and toddlers:

Scalp,
 face, and neck.
Back
 of the arms.
Front
 of the legs.
Torso.

Children and teenagers:
Inner
 creases of the elbows.
Back
 of the knees.
May
 also affect the hands, face and eyelids.

At what age does childhood eczema occur?

Most (up to 75 per cent) cases of childhood eczema appear before six
months of age. Almost all cases (up to 90 per cent) occur by the age of five.

What is the incidence of childhood eczema in Canada?

12 to 25 per cent of Canadian children suffer from eczema.

16
 M ana g in g C hi l dhood E czema
What happens as my child gets older?

Although some children may eventually outgrow their eczema, about 80

per cent will have dry, irritable skin throughout their lives. About 10 to 15
per cent of children will continue to have eczema as adults. Eczema may
reappear at any time, especially during times of stress.

Why do some children suffer from eczema?

This difficult condition tends to run in families where there is a history

of eczema, asthma or hay fever. Not every child in a family will develop
eczema, but if you have one child with eczema, there is a one in four
chance your next child will have it. If both parents are affected, the risk is
even greater. However, eczema can also affect children in families with no
known history of eczema or other allergic conditions.

Is a child with eczema likely to suffer from other conditions?

Because eczema is closely related to asthma and hay fever, it is quite

common for children with eczema to suffer from one or both of these
conditions. About 40 to 50 per cent of kids with eczema have asthma, hay
fever, or both.

What is hay fever?

Hay fever is the name given to pollen allergy. Other terms for hay fever
include seasonal allergic rhinitis or pollinosis. Symptoms include:
Repeated and prolonged sneezing.
Stuffy and watery nose.
Red, swollen, and itchy eyes.
Itchy nose, throat, and mouth.
Itchy ears or other ear problems.
Breathing difficulties at night due to a blocked nose.
What is asthma?

Asthma is a chronic disease that inhibits airflow in and out of the lungs.
People with asthma may respond to environmental factors, or triggers, that
do not affect most people. In response to a trigger, an asthmatics airway
becomes narrowed and inflamed, making it difficult to breathe and resulting
in wheezing and/or coughing.

17
M ana g in g C hi l dhood E czema
Is it possible to catch eczema?

Eczema is definitely not contagious, so it cannot be passed from one

person to another. If you have one child with eczema and others who do not
have it, they are in no danger of catching it.

Is childhood eczema caused by an allergy?

Childhood eczema has not been proven to be caused by an allergy;

however, children with eczema do have hypersensitive skin that may react
to allergens such as grass, pollen, house dust mites and household pets.
These allergens may aggravate the eczema and make it flare-up.

Can certain foods cause childhood eczema?

While food is not a cause of eczema, in some children, certain foods

can trigger flare-ups. If this is the case with your child, the doctor may
recommend that you consult an allergist and a dietitian. Making the right
changes to your childs diet may reduce the number or the severity of
flare-ups.

18
Managing adult eczema

M ana g in g adu lt eczema

For many people, eczema has become a life-long struggle to control the
itchy, red, weeping, and oftentimes, painful condition of their skin. Although
a number of treatments have been successful in managing the terrible
discomfort of eczema, no one treatment has safely or effectively worked
for everyone, every time. Even after your skin has healed from one eczema
flare-up, it is important that you continue to look after your skin. This can
help reduce flare-ups and help you control your eczema.

Moisturizers
Moisturizers, sometimes referred to as emollients, should be used regularly
to keep skin moist and flexible. You can help your skin look and feel
better by getting into the habit of applying moisturizers after you wash or
whenever you feel that your skin needs it. Your doctor or pharmacist can
recommend a moisturizer for eczema-prone skin. It is important to always
test the emollient on a small patch of skin to ensure it will not irritate you.

For the most part, moisturizers are an oil and

water combination designed specifically for
your skin. Creams tend to be primarily made of
water, to which oil has been added and lotions
are watery creams. Ointments are different from
creams and lotions because they are generally
made of oil alone. Creams and ointments should
be applied as often as needed. Lotions tend to be
the least helpful, as they usually contain perfumes, alcohol, or preservatives
that can irritate the skin.

Bathing and showering

Bathing and showering helps to hydrate your skin. You can bathe as often
as you like as long as you apply a moisturizer immediately after. Depending
on where you live, you may find that you need to hydrate your skin more or
less often. Keep the water temperature cool or warm, not hot. Soaking in
the tub can be good for your skin because it can help the skins outer layer
absorb water and become less dry. Soak for 5 to 10 minutes, then use a
soft towel to pat dry without rubbing.

Apply a moisturizer immediately after you pat dry your skin. This helps seal
in the moisture.

19
 The itch
M ana g in g adu lt eczema

The itch that accompanies eczema can be very difficult to put up with
and to manage. Scratching is difficult to resist because it can make you
feel so good in the short-term. It seems that the more you think about not
scratching, the worse the itch gets. However, it is not beneficial in the long-
term as scratching damages the skin and contributes to the itch-scratch-
rash cycle, making it more difficult to ignore the intense itch and leading to
bleeding and oozing of the skin.

There are some practical things you can do:

Keep
 cool. Try to keep your body temperature constant, wear light
clothes, keep your bedroom cool.
Use
 moisturizers whenever you feel like scratching. Refrigerate
moisturizers; it feels great.
Keep
 fingernails short.
Dont
 scratch. Rub or pinch the area instead of scratching.

Know your triggers

Managing your environment can be a frustrating and time-consuming job
but certain foods, pollen, air pollution, animal dander, mould, dust and dust
mites have all been linked to eczema flare-ups. If you suspect that your
eczema may be triggered by any of these irritants, talk to your doctor.

Clothes, towels, and bedding

Try to wear fabrics made of 100 per cent cotton as they seem to provide
the best comfort. Cotton is very breathable, which helps to prevent skin
irritation. Choose loose-fitting clothing that does not rub against the skin.
Although polyester may appear smooth and lightweight, this fabric contains
tiny fibres that can result in intense irritation. The harshness of synthetics,
wool, hemp, mohair or rough linen can also irritate skin and cause a flare-up
of symptoms. Some eczema sufferers must avoid denim and leather, which
can provoke skin due to heat build-up and the roughness of certain denim
fabrics. Residual detergent, bleach, or fabric softener left on clothes after
washing can also cause itching.

There are some practical things you can do:

Wash
 clothes in mild biodegradable, non-phosphate detergent.
Rinse
 twice if necessary.
Avoiding
 bleach or fabric softeners may also be helpful.

20
Makeup and cleansers

M ana g in g adu lt eczema

No makeup or facial cleanser is 100 per cent safe to use on your skin if you
have eczema. However, there are a number of products for sensitive skin
that are hypoallergenic. Theres a bit of trial and error involved in discovering
which products are best for you. Ask your doctor what they recommend
and you can also talk to the people who work at the makeup counters.
Always test a bit of the product before using it all over. Fragrances,
preservatives and lanolin, ingredients commonly found in cosmetics, cause
most skin problems. Also be sure to avoid putting makeup onto weeping or
very irritated skin.

How to do a patch test:

Test the product on eczema-clear skin; under your jaw line is a good place.
Allow the product to remain on the test area for at least 24 hours; check
for a reaction.

Soaps and hair products

Commercial soaps, hair products, perfumes, scented lotions, or shaving
cream can cause serious irritation to your skin. Bathe only with a mild soap
and use only as much as necessary. Avoid using it on your face.

Stress
Eczema can flare up when you are under stress, feel anxious, angry, or
worried. You can learn how to recognize and cope with these emotions
through stress reduction techniques available through local community
workshops. Changing your activities to reduce daily stress can also be
helpful.

Exercise can greatly reduce stress, but avoid excess sweat as it can
aggravate your eczema. Too much heat and sweat can make your skin more
irritated and itchy.

21
 Medication
M ana g in g adu lt eczema

When your eczema flares up, use the medication prescribed by your doctor.
Ask what to expect from the medication and what to do if you dont see the
results you expect. Make sure you follow up with your doctor. Its important
that you follow your doctors directions for using the medication and check
the label for proper use.

For more information on eczema medications, please refer to the section on

how is eczema treated on page 23.

Ways to manage your eczema

Dont
 scratch, moisturize!
Follow
 a daily routine, even if there is no visible eczema.
Take
 as many baths or showers as you like and always moisturize afterward.
Keep
 cool and calm.
Wear
 cotton, sleep on cotton.
Find
 out what triggers your flare-ups.
Test
 any new product for your face or body first.
Be
 patient.
Follow
 your doctors treatment advice.

Talking about eczema

If you have eczema, you may have had people stare at you or make unkind
comments about your appearance.

Often, eczema appears on the face or hands, and this is the first thing
that people see. Unfortunately, many people are not always as sensitive
as they should be to people who look differently than they do. Generally,
most people just need to be educated about the disease. You can help your
family, friends and co-workers understand your condition by talking to them
about it. Tell them how it affects you, what it is, and more importantly, what
it is not. There are a lot of myths out there about eczema, and generally,
once people understand the disease, they can be quite understanding and
supportive.

22
 H O W I S E C Z E M A T R E AT E D ?
How is eczema treated?
Although there is still no cure for eczema and no one treatment has safely or
effectively worked for everyone, every time, there is hope and treatment.

Over the past 40 years, a number of treatments have gone a long way
towards managing the terrible discomfort of eczema. Some treatments
appear to target the origin of eczema rather than treating the symptoms
once they have already started. These treatments do not have the same
potential limitations that current treatments have. Generally, treatments like
topical steroids and antihistamines work to relieve the symptoms of eczema
once they have already appeared.

Relatively newer treatments called Topical Calcineurin Inhibitors (TCIs)

are available in Canada and some dermatologists consider them to be a
promising option in eczema therapy. TCIs appear to prevent the release of
the inflammatory substances that cause the red, itchy skin associated with
eczema. This treatment works to calm and control the skins reaction.

23
H O W I S E C Z E M A T R E AT E D ?
In 2010, Health Canada approved one of the available TCIs for maintenance
therapy. If you have any concerns or questions about treatments prescribed
for you or your child, talk with your doctor; he or she has the most up-to-
date information about eczema treatments.

To help you manage your treatment and monitor your progress, a

Treatment Progress Chart is located at the end of this section for use with
your current treatment.

Antibiotics
Antibiotics are used to treat the secondary bacterial skin infections that
may accompany eczema. Bacterial infections, like staphylococcus and
streptococcus, are common in the skin of people suffering from eczema.
Scratching can cause the skin to break down, allowing these micro-organisms
to enter the body. The immune system of eczema sufferers may also be
compromised, making it more difficult to fight off skin infections.

Caution: Nausea, diarrhea, and allergic skin rashes are the most common
side-effects. It is important to notify your doctor if you experience any
unexpected side effects.

Antihistamines
These are sometimes prescribed or available over-the-counter to aid sleep
and relieve itching. However, histamine does not appear to play a major
role in the itching caused by eczema. A doctor should always be consulted
before giving antihistamines to children.

Caution: Overuse can produce excessive sedation. Use antihistamines only

when absolutely necessary.

24
Coal tar preparations

H O W I S E C Z E M A T R E AT E D ?
Crude coal tar extracts have been used to treat the inflammation and itch of
eczema. Coal tar treatments have a soothing effect on inflamed skin. Tars
contain hundreds of chemicals, most of which have never been identified,
but seem to have a medicinal effect. However, most people shy away from
these preparations because they tend to be messy, time-consuming, smelly,
and inconvenient.

Caution: Coal tar should not be used for acute dermatitis because it may
cause stinging and irritation. As well, folliculitis (inflammation of the hair
follicle) and sensitivity to light have been reported. Speak to your doctor if
you have questions about the use of coal tar.

Phototherapy
Sunlight has been known to have a beneficial
effect on certain skin disorders. Ultraviolet
light waves found in sunlight were discovered
to be the source of this therapeutic effect.
Phototherapy uses these ultraviolet light waves
for the treatment of eczema.

Most short-course photo therapies like ultraviolet A (UVA), ultraviolet B

(UVB), ultraviolet A and B (UVAB), and psoralen plus UVA (PUVA) have
shown to be beneficial for adults with severe atopic dermatitis. UVAB and
PUVA appear to be the most effective.

Caution: UVA light is the portion of sunlight responsible for changing

skin colour, or tanning. However, with prolonged exposure there is a risk
of sunburn, eye damage, skin cancer, dry skin, freckling of the skin, and
premature skin aging. Some patients actually experience a worsening of
their condition when light therapy is applied. As well, light therapy requires
several trips to the doctors office or clinic. This can be time consuming and
inconvenient.

25
 Topical Calcineurin Inhibitors
H O W I S E C Z E M A T R E AT E D ?

For many years, doctors relied primarily on corticosteroids (steroid

treatments) to treat eczema. However, significant medical advances have
resulted in the development of newer molecules to treat eczema, offering
additional treatment options to physicians and their patients.

Topical Calcineurin Inhibitors (TCIs) prevent cells in the immune system from
switching on and releasing chemicals that cause the inflammation and
itching associated with eczema.

These topical therapies can be applied directly to all affected areas of the
skin including the face, neck and eyelids, and work quickly, often within a
few days, to reduce eczema symptoms. In 2010, Health Canada approved
one of the available TCIs for maintenance therapy. Your dermatologist or
family physician will be able to provide you with more specific information
and advice on selecting the appropriate treatment.

Caution: Some patients have reported a mild-to-moderate burning

sensation on the skin after the ointment is applied. This discomfort
is usually short-lived and is limited to the area of the skin where the
medication was applied. As with any prescription medication, it is important
to follow the doctors advice and instructions on how to use the medication
and what to expect.

Topical Steroids
Topical steroid creams, also called cortisone creams, are applied directly
to the skin and have been a traditional treatment for eczema for the last
forty years. There are many different topical steroids which fall within one
of seven classes, ranging from Class I (super potent) to Class VII (low
potency).

Topical steroids are anti-inflammatory treatments to bring the itch of eczema

under control. They should only be used under doctors supervision and
it is essential to use the appropriate strength and quantity that has been
prescribed by your doctor. Only one cortisone cream can be bought from a
pharmacist without a prescription. This is hydrocortisone and it is sold as a
cream or ointment. It can be used to treat mild eczema.

26
 H O W I S E C Z E M A T R E AT E D ?
Caution: When cortisone creams are correctly used under the supervision
of a physician, they can be a safe and effective treatment for eczema.
However, certain side effects have been documented. Stretch marks,
thinning skin, fragile skin, increased fine hair growth, and skin discolouration
have all been reported. These side effects are related to the potency of the
cortisone cream, where it is being used on the body and the condition of the
skin it is applied to. Cortisone creams have been shown to be less effective
when used over a long period of time. There is also a risk that they could be
absorbed into the blood through the skin. In rare instances, this could slow
growth in children by suppressing the adrenal gland. Generally, cortisone
creams are only prescribed for short periods of time. It is important not to
confuse topical steroids with those steroids used illegally for body-building
or those used in the contraceptive pill; they are completely different.

27
 Treatment Progress Chart
H O W I S E C Z E M A T R E AT E D ?

Where treatment Results

is applied

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

28
 H O W I S E C Z E M A T R E AT E D ?
Where treatment Results
is applied

Week 7

Week 8

Week 9

Week 10

Week 11

Week 12

29
 Books Available from
RESOURCES AND SUPPORT
Chapters.indigo.ca
Baby Skin: A Leading
Dermatologists Guide to Infant
and Childhood Skin Care
Nelson Lee Novick
Published by Crown Publishing
Group, Incorporated, 1991
Coping with Eczema
Sheldon Press Staff
Published by Milestone
Publications, Limited, 1996
Eczema & Psoriasis
Stephen Terrass
Published by HarperCollins Canada,
Limited, 1995
The Psoriasis and Eczema
Solution; New Hope for Physical
and Emotional Relief
Michael F. Holick
Published by Transmedia, 1999
Atopic Dermatitis:
The Epidemiology, Causes and
Prevention of Atopic Eczema
Hywel C. Williams, 2000
30
Web Resources
EASE Program
www.eczemacanada.ca
Pennys World
www.pennysworld.ca
Canadian Dermatology
Association
www.dermatology.ca
Eczema Informant
www.eczemainformant.com
Eczema Guide
www.eczemaguide.ca
Eczema Society of Canada
www.eczemahelp.ca
National Eczema Association
www.nationaleczema.org
National Eczema Society - UK
www.eczema.org
The American Academy of
Dermatology
www.aad.org
Notes

RESOURCES AND SUPPORT

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 Notes
RESOURCES AND SUPPORT

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The information contained in this booklet has been developed by the RESOURCES AND SUPPORT
EASE Program, solely funded by an educational grant from Astellas
Pharma Canada, Inc. 2011

EASE (Eczema Awareness, Support and Education) is a national public

education program that provides eczema sufferers, families, healthcare
professionals and the general public with accurate and comprehensive
information about eczema.

The material contained in this booklet is provided for informational purposes

only and is not a substitute for a call or visit to your physician.

33