Astellas Phama Canada Inc. www.eczemacanada.ca 1 866 432-0362 PRT1011100EN Understanding eczema and what you can do about it 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. INTRODUCTION Introduction Often, people suffering from eczema or parents of children with eczema don’t 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 child’s eczema triggers............................... 12 How can I stop my child from scratching?.................... 12 Tips to help manage your child’s eczema..................... 13 Managing your child’s 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 CONTENTS How is eczema treated?............................................. 23 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 W H AT I S E C Z E M A ? What is eczema? 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 group and doctors usually refer to it as simply ‘eczema’ because it is the most common within this group. Eczema = Atopic Dermatitis 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 that’s 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 — to its most severe — when the skin becomes broken, raw, and bleeding.1 RASH SCRATCH 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. 4 1. T he Chronicle of Skin & Allergy, February 2010 2. Cork MJ, The importance of the skin barrier function. Journal of Dermatological Treatment 1997; Vol. 8, S7-S13 Your skin is quite amazing. It’s 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 W H AT I S E C Z E M A ? Eczema and your skin 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, it’s 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 skin’s 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 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, it’s called a ‘flare-up’. A number of different factors appear to trigger ‘flare-ups’ of eczema. ‘Flare—ups’ 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’. W H AT I S E C Z E M A ? Eczema ‘flare-ups’ The chart found on pages 10 and 11 can help you identify irritants that may trigger your eczema and cause ‘flare-ups’. 7 W H AT I S E C Z E M A ? Myths and facts about eczema Unfortunately, there are a lot of misconceptions about eczema. It’s 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 can’t ‘catch’ the disease from another person and you can’t give it to someone by touching him or her. 8 Myth: People who have eczema do not wash properly. Fact: Of course this isn’t 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! W H AT I S E C Z E M A ? Myth: You can’t 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: 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 W H AT I S E C Z E M A ? What triggers your eczema? Triggering factor Stress Anger Frustration Anxiety Hot weather Cold weather Humidity Dry weather Sun Sweat Wool Synthetic fibers Latex Rubber Plastic 10 Hot baths Hard water Chlorinated water Salt water (oceans, mineral spas) Yes/No Eczema symptoms Air borne pollutants: Dust mites Mould Animal dander Pollen Smog/air pollution Yes/No Eczema symptoms W H AT I S E C Z E M A ? Triggering factor Eggs Milk Wheat Soy Seafood Nuts Food additives Citrus fruits Strawberries Soaps Detergents Lotions, creams Perfumes Makeup Hair shampoos Styling aids Conditioners Other: 11 M ana g in g C hi l dhood E czema Managing Childhood Eczema 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 child’s 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 skin’s 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 child’s 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 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 child’s 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 child’s 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 child’s 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 M ana g in g C hi l dhood E czema Moisturizers 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 child’s 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. It’s 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 child’s 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 child’s eczema. Discuss your child’s condition with their teachers at the beginning of the school year, and check in with updates when necessary. 14 • 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 school’s gym teacher to develop a fitness program that meets your child’s 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. M ana g in g C hi l dhood E czema Tips for managing eczema at school • 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 won’t feel left out. • Food. Some foods may make your child’s eczema worse. Inform the school of any food triggers and make sure your child understands which foods they should stay away from. • It’s hard for children not to scratch, but it is equally important that you inform your child’s 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, it’s 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 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. M ana g in g C hi l dhood E czema What happens as my child gets older? 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 asthmatic’s 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 18 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 child’s diet may reduce the number or the severity of ‘flare-ups’. 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. M ana g in g adu lt eczema Managing adult eczema 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 skin’s 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 M ana g in g adu lt eczema The itch 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 longterm as scratching damages the skin and contributes to the itch-scratchrash 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. • Don’t 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 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. There’s 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. M ana g in g adu lt eczema Makeup and cleansers 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 M ana g in g adu lt eczema Medication 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 don’t see the results you expect. Make sure you follow up with your doctor. It’s important that you follow your doctor’s 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 • Don’t 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 doctor’s 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 skin’s 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-todate 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 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. H O W I S E C Z E M A T R E AT E D ? Coal tar preparations 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 doctor’s office or clinic. This can be time consuming and inconvenient. 25 H O W I S E C Z E M A T R E AT E D ? Topical Calcineurin Inhibitors 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 doctor’s 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 doctor’s 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 H O W I S E C Z E M A T R E AT E D ? Treatment Progress Chart Where treatment is applied Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 28 Results Week 7 Week 8 Week 9 Results H O W I S E C Z E M A T R E AT E D ? Where treatment is applied Week 10 Week 11 Week 12 29 RESOURCES AND SUPPORT Books Available from Chapters.indigo.ca Web Resources Baby Skin: A Leading Dermatologist’s Guide to Infant and Childhood Skin Care Nelson Lee Novick Published by Crown Publishing Group, Incorporated, 1991 EASE Program www.eczemacanada.ca 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 Penny’s 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 ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ RESOURCES AND SUPPORT Notes ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 31 RESOURCES AND SUPPORT Notes ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 32 RESOURCES AND SUPPORT The information contained in this booklet has been developed by the 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
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