What is Eczema?

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition that typically presents as an itchy, dry, red rash on the inside of elbows, backs of knees, hands and face. It occurs in individuals of all ages but most often starts in childhood and comes and goes over a lifetime. Flare-ups can be mild to severe and triggered by stress, allergens, irritants, hormones and changes in weather. For this reason, eczema tends to be a condition that requires ongoing management aimed at both treating active flare-ups and preventing them from occurring in the first place. The exact cause of eczema is not fully understood, but it is believed to be due to a combination of genetic, environmental, and immunological factors.

The Naturopathic Approach to Eczema

The skin barrier is the uppermost layer of the skin, composed of dead skin cells and fats/oils, that serves as a water-proof barrier. This barrier protects the skin from environmental threats such as; microbes, pollutants, chemicals and allergens, (something that causes an allergic reaction), and prevents the loss of water from the skin. People with eczema have a naturally disrupted skin barrier which means that they are prone to drier skin and are less resilient to environmental exposures. They are also predisposed to having an overactive immune system, similar to those with allergies or asthma, which means that they can be hypersensitive to triggers in the environment and have an exaggerated inflammatory response to these triggers. This is why, when treating eczema from a naturopathic perspective, we focus on both the integrity of the skin barrier and the inflammatory response. 

Summer and Eczema

Managing eczema in the summer can be extra challenging as it brings on some additional triggers to consider. Firstly, the heat itself can cause irritation and dry out the skin, but it also increases the likelihood of sweating. Sweat leaves behind trace minerals which can cause irritation and also leads to a buildup of moisture in areas most susceptible to the eczema rash. Warm weather also comes along with common allergens, like pollen, and an increased need for sunscreen, both of which can exacerbate symptoms. 

Understanding the triggers and physiology of eczema should help in making use of the tips below.

#1: Reconsider Your Bathing Regimen:

Bathing can significantly impact the skin barrier and so for those with eczema, who are predisposed to a disrupted barrier, a proper bathing regimen is key. Surfactants, found in soaps and cleansers, carry away dirt and oil to clean the skin but can also take the oils of the barrier with them. Excess water left on the skin to evaporate after bathing can actually pull water out of the skin and soaking in water for prolonged periods, or using overly hot water, can strip the natural oils of the skin. 

1. Take short (10-15 minute) lukewarm showers rather than long, hot showers or baths.
2. Use soaps and cleansers that are fragrance-free, hypoallergenic and made for sensitive skin. Bar soaps tend to be the most drying. 
3. Use soaps/cleansers only where skin meets skin or in areas that are visibly dirty. Try not to overuse soaps.
4. Don’t use a towel to dry off. Instead, air dry until the skin is slightly damp and apply moisturizer directly onto damp skin to trap water.

#2: Be Mindful Of Your Skincare Products:

1. Use fragrance-free, hypoallergenic products or products made for sensitive skin. The chemical structure of fragrance, including those that are natural, make them incredibly irritating. Hypoallergenic products and those made for sensitive skin avoid ingredients that are known to cause irritation and often contain additional moisturizing ingredients for the skin barrier. 
2. Use occlusive products. An occlusive is an ingredient that forms a physical barrier on the surface of the skin and helps compensate for a disrupted skin barrier. Lotions contain the least amount of occlusive ingredients, while creams and then ointments contain the most. 
3. Sunscreen has pros and cons. It is very important to protect sensitive skin from the sun, but sunscreen can also be very irritating. Use a broad-spectrum, fragrance-free sunscreen, with at least SPF 30, ideally for sensitive skin. Chemical based sunscreens tend to be more irritating than mineral, so if you find sunscreen to be an issue, try mineral and wash off as soon as you are no longer exposed to sunlight. 
4. Utilize products and remedies for itch (like oats), to prevent scratching during a flare-up.  Scratching will significantly worsen symptoms and start an itch-scratch cycle that is hard to break.

#3: Modify Lifestyle Factors:

1. Identify triggers. Take time to analyze food, clothing, bedding, all of your topical products and stressors that worsen symptoms and avoid them while flared-up. 
2. Drink adequate water. Water maintains the skin barrier, promotes wound healing and is vital for skin hydration, (preventing dryness which can worsen symptoms of eczema). Well hydrated skin can actually absorb and retain topical products better. 
3. Manage stress. Stress can play a bigger role than most people realize in an eczema flare. Practice stress-reducing techniques such as meditation, yoga, deep breathing exercises or whatever works for you. 

#4: What is Coming into Contact with Your Skin?

Think about everything that comes into contact with your skin that could be a problem; clothing, bedding, face cloths, towels, soaps, cleaning products and even furniture. 

1. Avoid rough, scratchy fabrics. 
2. Avoid laundry detergents with fragrance and consider switching to a product that is hypoallergenic or for sensitive skin. Detergents stay in clothes, bedding and towels and so come into close contact with your skin. 
3. Consider gloves if you have to wash hands frequently. 

#5: Managing the Sun, Heat and Sweat:

1. Do your best to stay cool. Heat is a trigger, so avoid overheating. Stay out of the sun and make use of fans and air conditioning. 
2. Manage how much you are sweating. Sweat is also a trigger. If you exercise, do so in cool environments and choose activities that minimize sweating. Make sure to shower as soon as you can afterwards and if you cannot, change out of sweaty clothes and gently pat skin dry. 
3. Use sunscreen. As mentioned above, sunscreen is necessary to protect your skin, but can also irritate eczema. There are hundreds of sunscreens on the market so keep trying until you find one that works for you. 

# 6: Seek Professional Care:

See a naturopathic doctor or other healthcare professional. Eczema is a complex, chronic condition that is best managed with both an internal and external approach. Naturopathic doctors look to the root cause; skin barrier integrity and the inflammatory response, and utilize blood work and functional testing to investigate nutrient deficiencies, insulin dysregulation, gut and liver health, inflammation and any hormonal and nervous system influences.

Author: Dr. Rebecca Anderson