Red, flaky patches. Irritation. Itchy skin. These are all telltale signs of eczema, a skin condition that can pop up year-round but often rears its head in the cold, dry winter months.
According to the Canadian Dermatology Association, up to 17 percent of Canadians will suffer from atopic dermatitis (as eczema is also known) at some point in their lives. And while there's unfortunately no cure, there are ways to soothe the itch and manage flare-ups.
We asked Dr. Kerri Purdy, a Halifax-based dermatologist and president of the Canadian Dermatology Association, and Dr. Carmel Anderson, a dermatologist at Kelowna Skin and Laser Clinic and a clinical assistant professor of dermatology at the University of British Columbia, to answer frequently asked questions about the condition, including what causes it, the best ways to prevent it and, above all, how to treat eczema.
For starters, there's more than one type of eczema.
Atopic eczema refers to inflammation of the skin when the immune system reacts to an allergen (either inside or outside of the body) and results in patches of itchy, red and flaky skin. In more extreme cases, skin can appear swollen and blistered.
Infantile eczema refers to atopic eczema in children, which often occurs within the first few months of a baby's life. Another common type is contact eczema, which happens when skin reacts to contact with an irritating substance and tends to be localized, but can sometimes spread elsewhere on the body over time, according to Anderson.
While eczema can arise anywhere on the face and body, Anderson explains that the location of eczema patches can vary. "Infantile eczema tends to occur on the outer areas of the limbs and body, while older children and adolescents often experience eczema in the folds of the arms and legs," she says.
Adult eczema can appear virtually anywhere. It's most often found in the folds of the neck and elbows, behind the knees, as well as on the inner wrists, hands and face.
"There is no one ‘cause' for atopic eczema and there are a lot of theories to explain why it happens," says Purdy. A genetic predisposition seems to put some people at a higher risk of developing eczema, particularly when they have other conditions such as asthma and hay fever.
Ultimately, atopic eczema is thought to be caused by a combination of genetics and specific triggers, while contact eczema is the result of direct exposure to an allergen.
Atopic eczema is aggravated by different factors depending on the individual. Common triggers include cold, dry weather, stress, hot water and harsh soaps, says Anderson.
In the winter, cold outdoor temperatures and indoor heating make for an irritating combination. "Most people with [atopic] eczema get better in the summer as the temperature and humidity levels tend to be higher, leaving the skin more moist," says Anderson.
As for contact eczema, Anderson says skin will flare up whenever it's touched by an irritating substance, regardless of the season. That includes tea tree oil and nickel.
If the eczema is mild and doesn't compromise your ability to function and enjoy life, you don't necessarily need to see an MD, says Anderson.
But if the itching is keeping you up at night, if you have blisters or if the affected skin shows any signs of infection, see a doctor as soon as you can.
A family doctor will often be able to treat mild eczema. For more severe cases—or if the condition isn't responding to treatment—Purdy advises getting a referral to a board-certified dermatologist.
Treatment varies depending on the type of eczema and how severe the flare-up is. Some may prevent eczema flare-ups, while others work to relieve already-affected areas.
"For classic atopic eczema, I generally recommend a combination of lifestyle changes moisturizing regularly and avoiding irritating fabrics>, and sometimes prescription medications, which can include topical creams—there are cortisone and non-cortisone options—pills and even injectables," says Purdy. Anderson says oral antihistamines may also help to relieve itch.
For cases of contact eczema, avoiding the allergen is essential to clear up the irritation and to limit future reactions.
Anderson explains that preventative measures go a long way in limiting breakouts. She also recommends visiting The Eczema Society of Canada for further advice and recommendations. And, she says, don't lose hope.
Surprisingly, no. "It seems counterintuitive, but I actually recommend more frequent bathing when people have symptoms eczema," says Purdy.
She notes that the water should not be too hot and that the bath doesn't need to be very long. Stick to short periods of around 10 to 15 minutes. Post-soak, apply a cream or topical ointment onto damp skin to seal in moisture.
Both Purdy and Anderson stress the importance of using fragrance-free products, as fragrance is a known irritant. Avoiding fragrance also reduces the risk of skin infections.
Opt for a mild soap; in terms of a cream, choose an ointment or salve. "In the case of eczema," says Anderson, "ointments are more helpful than creams and creams are more helpful than lotions."
One percent hydrocortisone cream can also be effective in treating mild cases of eczema with little to no major side effects.
Treatment is similar to that of adults—use mild soap, moisturize the skin frequently and try a cortisone or non-cortisone ointment, as recommended by your child's dermatologist. "Many children that have eczema will outgrow the flare-ups as they get older, but some people continue to have them throughout their lives," adds Purdy.
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Originally published in 2020; updated in 2023.
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