What is Microbiome: Role in Eczema and its Treatment

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Want to know what is microbiome? We all know that our body is made up of innumerable cells. Scientists mention that an average human body approximately consists of 37.2 trillion cells, a few more or less depending upon the factors like size, weight, age, etc of an individual i.e. 37200000000000 that’s too many zeros, isn’t it?

But there is something more in numbers in the human body than the number of cells. It is the Microorganisms, yes you read it right – the human body also consists of innumerable microorganisms and the number is estimated to be three to ten times the human cells in an average human body.

What is the Human Microbiome?

One may always think of what is the human microbiome. Microscopic living things such as bacteria, fungi, viruses are called Micro-organisms and conveniently called Microbes. The genetic material of all the microbes – bacteria, fungi, protozoa, and viruses – that live on and inside the human body is collectively termed as Microbiome.

Though there are different types of Microbes that reside in and on the human body, the most studied are bacteria which are huge in number, hence its nothing wrong in saying that we more bacteria than a human.

What role does Microbiome have in the human body?

Have you ever come across questions such as What is the human microbiome? and what are their roles in the human body? Let’s check out below:

Microbes are present in every part of the body, on the skin, up the nose, but a chunk of them resides in the gut inside the large intestine. Microbiome plays a vital role in the development of immunity and nutrition. The bacteria in the microbiome help in digestion, regulate the immune system, produce vitamins, and protect against other bacteria that cause disease. New research says that gut microbiome may also affect the central nervous system, which controls brain function.

Similarly, microbes residing on the skin also play a critical role in skin health. Any alterations in the composition and function of these microbes lead to changes in immunity causing skin diseases, such as Eczema or Atopic Dermatitis as it is commonly known.

Skin Microbiome and Eczema

Eczema is a skin condition marked by red, itchy, inflamed skin. There is no direct known cause for eczema except that it is caused by the combination of genetic and environmental factors. But recently researchers linked the onset of eczema flares to the activity of microorganisms. Various environmental factors, such as stress, diet, and pollutants, affect microbial composition in the skin.


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Skin microbiomes influence the skin barrier by controlling ecological factors, such as humidity, temperature, pH, and lipid content. These changes can exacerbate skin barrier impairment and are associated with abnormalities in the functions of skin barrier-associated genes. Earlier studies have found that the Microbe Staphylococcus aureus creates susceptibility to develop Atopic Dermatitis and is directly linked to Eczema Flares.

The Experiment

In an Experiment by Dr. Kong [1] and his team, the researchers sampled the skin of pediatric eczema patients, before a flare, during the flare, & after a flare and analyzed the bacteria, using advanced gene sequencing techniques. As a result, they could see more S. aureus during flares compared to samples taken before and after and from healthy controls. This clearly proves the association of S. aureus with eczema flares exacerbating the eczema symptoms.

Microbiome and Eczema

Moreover, it was also found that the presence of S. aureus results in skin barrier dysfunction further delaying the healing process in Eczema.

For further clarification on the role of S. aureus in the development of Atopic Dermatitis, the researchers collected samples from human skin and administered colonies of the bacteria to the mouse. The skin on the mice became inflamed and thick. They found that S. aureus made use of a process called “quorum sensing” as a means of communication between S. aureus individuals.

The bacteria use it to know when to release toxins and enzymes that break down the skin barrier, allowing the bacteria access to interior parts of the skin, which causes flareups.

Good Bacteria Vs Bad Bacteria

While the problem is caused by one microbe the solution was also found in other microbes. While screening the S. aureus killing strains, a couple of bacteria that dwell on the skin was found they were Staphylococcus epidermis and Staphylococcus hominis.

These bacteria living on the skin and fight off the toxins using proteins called antimicrobial peptides that interfere with quorum sensing. When the researchers cultured some of the “good” bacteria and applied it to the skin of mice with eczema, it prevented flareups.

Good bacteria vs Bad Bacteria

Similarly, in another research by Ian A Myles [2], another gram-negative bacteria called Roseomonas mucosa was found to be improving the skin barrier function, immune balance, and property of killing S aureus which when sprayed on mice prevented it from developing Eczema.

Using Microbes for Treating Eczema Patients

A topical lotion with S. epidermis and S. hominis strains to test their effects on atopic dermatitis patients was created by Dr. Gallo’s and team. Application of this lotion on volunteers suffering from eczema gave results in 24 hrs vanishing S. aureus. The same Lotion without these microbes remained ineffective on the patients.

For testing the therapeutic effect of R mucosa in humans with AD live strains of R mucosa isolates were sprayed on eczema of each participant twice weekly for 6 weeks in adults. There was a significant decrease in a rash, itch and the need for topical steroids.

It was also found that while the helpful S. epidermis and S. hominis strains are abundant on the skin of healthy people, they are rare on the skin of atopic dermatitis patients. This suggests that they provide the first line of defense against the pathogen causing the skin barrier dysfunction leading to the onset of Eczema. The Exact reason why some human body fails to develop these good bacteria is still unclear and requires further research.

Conclusion

As there are numerous treatment options and precautionary measures available for treating eczema, the different method works for different individuals. The treatment also depends on managing triggers and care routine. The theory of treating eczema with microbes is an interesting development in treating eczema. This method will be effective as it directly acts on the actual cause of the flare-up i.e. killing the S. aureus bacteria. These studies and experiments will aid in developing effective treatments consisting of Microbiome. Methods and solutions to improve the healthy skin Microbiome shall also play a crucial role in preventing and treating Atopic Dermatitis

References:

  • https://www.niams.nih.gov/newsroom/spotlight-on-research/role-microbiota-eczema-findings-suggest-striking-right-balance-keeps [1]
  • https://www.contemporarypediatrics.com/pediatric-dermatology/microbiome-based-therapy-eczema-horizon [2]

Video Source: https://www.youtube.com/watch?v=YB-8JEo_0bI

 

Stress Management Techniques to Control Eczema

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Eczema and Stress

Eczema and stress are co-related to each other. Eczema is a chronic skin condition though prevalent amongst the children, it affects people of all ages. Also known as Atopic Dermatitis, it is a multi-faceted skin disease that occurs as a result of one or a combination of various factors such as human genes, weather, environmental factors, etc. Triggers play the role of a culprit in exacerbating the eczema symptoms causing flares.

One of the factors which is not external and nor genes but which aggravates eczema is Stress. Emotional stress, anxiety, low mood, depression, panic, etc can be placed under the roof of stress, which not only affects the person mentally but also physically aggravating Eczema Symptoms.

People suffering from eczema may find that their flare-ups start or worsen with increased levels of stress. Hence people’s condition worsens even if all the triggers are well managed and in control and that is due to Stress. One should not rule out stress or take it lightly while managing eczema. Therefore eczema and stress can make eczema worse.

Eczema due to stress

Eczema due to stress can be found in many people. One of the important reasons for the onset of eczema is skin barrier dysfunction. Stress further worsens the immunity, affecting the skin barrier in people who are already suffering from Eczema. When an individual is tensed the body tries to protect the skin by boosting inflammation there and this boost worsens the condition in Eczema patients.

This happens because people with Eczema has increased response to stress as they have for other factors. This increased response results in the release of a high amount of cortisol “a stress hormone” which is known for its fight-flight response.

While it’s a response from the body to help us face the stressful situation, too much cortisol, suppresses the immune system and causes an inflammatory response in the skin. And as known, people suffering eczema are particularly susceptible to this inflammatory response.

Eczema due to Stress

 

As stress hampers the skin barrier function it leads to more moisture loss and increased susceptibility to eczema infections. It further reduces the natural defense of skin to keep a check on germs and its ability to retain moisture.


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Major causes of Stress

Before heading for the solution let’s check out the common and major reason for stress in human life

what causes stress

 

Major causes of stress in adults

· Work pressures or job loss: Too much of work pressure in completing tasks and completing tasks in the office. The fear of job loss is one of the common causes of stress in adults those who are employed and unemployment itself is a depressing situation.

· Bereavement: Loss of a loved one makes people enter depression

· Relationship challenges: The ups and downs in various types of relationships.

· Money worries: Financial insecurity creates fear and stressful condition especially for a family.

Major causes of stress in children

· Social pressures e.g. bullying: Feeling of inferiority complex and the constant fear of getting bullied leads to panic and stress

· Studying for exams: Important cause of stress in students

· Parental divorce: Another Major cause of stress in children are fighting between their parents or divorce.

Stress Eczema Treatment

Stress eczema treatment is essential for people suffering from eczema. Studies have shown that people suffering from eczema, who tried mediation techniques or received psychological therapy along with their routine medical care have significantly larger improvements in their skin condition than those who just received standard medical care or skincare education. With the help of below stress eczema treatment, one can manage eczema effectively.

Some of the techniques include:

How to get rid of Stress in Eczema

Meditation

There are various techniques and methods of meditation, from deep breathing, yoga, or simply lying or sitting in isolation to relax. Pick the one that suits you and practice it regularly. Different techniques may suit different people, simply spend time just for yourself. Make sure you dedicate time to your schedule and be consistent.

Practice Mindfulness

Mindfulness can be defined as a state of intentional, non-judgmental focus on the present moment. It has four core elements i.e. Awareness, Focus, Acceptance, and Observation. It is something that you can practice anywhere in-home or in the go while eating etc. just keep in mind the core elements.

For e.g. mindful eating involves eating very slowly and deliberately while paying attention to the sensations of holding the item, smelling, tasting, chewing, and swallowing it.

You can try any mindfulness technique including Mindful eating, Mindful breathing, Body Scan, Mindful Movement, Loving-kindness meditation, etc.

Mindfulness can reduce stress responses and help in strengthening the immune system and lowering the blood pressure level.

Sound sleep

Lack of sleep is an important factor that disturbs the mental health of an individual. Many times a sound sleep is what all you need. A good nights sleep can help in lowering the stress, giving space and time for the mind to relax. If it’s the eczema itch that’s not allowing you to sleep, try popping up antihistamine before bed (take advice from your physician for such a situation). Make your sleeping environment comfortable with regards to bed, room temperature, humidity to aid you in a good night’s sleep.

Eczema Groups

Most people suffering from eczema feel lonely and detached from society. It’s common to feel embarrassing about the condition but it’s also human nature to befriend with similar people. In this case, people suffering from the same condition will not have any barrier between them as both are suffering from it. There are several Eczema Support groups across the globe on the internet, social media where one can be a member, share their problems, give solutions from personal experience. These groups even carry out different programs for the people. Joining such a group can boost confidence in reducing the depression of why it happens to me?

Get Involved in Leisure Activities

It is one of the best ways to keep stress at bay – try some exercise, or involve in a sport which you enjoy (Avoid sweating or take a shower as soon as you reach home. You can also involve in activities which you love or makes you relax like reading a book, watching a play, visiting your loved ones, etc.

Visit physician

If things won’t work as you planned, you always have the option of seeking help from your physician. There also exists psychological therapy, Habit reversal technique (Reversing the habit of scratching) and Psychotherapy (also known as “talk therapy”) which your physician may guide you to go for. The addition of psychological treatment also reduces the number of topical steroids needed.

Conclusion

People with eczema experience the onset of eczema flares which worsen with increased stress. Eczema itself can also lead to more stress as it can be itchy and uncomfortable for patients, which will ultimately result in more inflammation and flareup, leading to a vicious cycle. This is because stress hormone which hampers the skin barrier increases the inflammation to trigger an eczema flare.

Managing stress is an essential part of treating eczema as some of the stress managing techniques not only help in preventing eczema flares but also strengthens the immune system and overall skin health. Stress management along with the routine care treatment has shown a larger response in reducing the eczema symptoms than those without stress management.

The Combined Approach to Treat Eczema

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Table of Content

What Triggers Eczema?

Skin is the largest organ in humans constituting the outer most layer of the body. It forms a barrier between the internal body and the environment to carry out these two-key functions:

1) To retain moisture by preventing the loss of water

2) Preventing foreign particles such as pathogens, allergens, irritants etc from entering inside the body.

This is called as the skin barrier function and its maintenance is very crucial for the skin’s health and overall protection of the body. In some Individuals due to complex interaction between the genetic and environmental factor, this skin barrier disrupts, and immune response of the cells gets altered. This alteration gives rise Atopic Dermatitis also commonly known as Eczema.

Eczema is commonly recognized as a dry, red, itchy and inflamed skin condition. This skin condition is common among the babies that disappear as the baby grows. But in some individuals, it continues and becomes a lifelong condition. Many teens and adults too suffer from this chronic skin condition. Eczema in children is common. Eczema gets flared or the condition exacerbates due to its triggers which can be anything from your day to day life such as food, apparel, weather, perfume, detergent, etc.

Eczema doesn’t have a complete cure like diabetes; it needs proper management. So the best treatment for eczema is
essential. A properly managed eczema skin is as good as normal skin. It is very crucial to keep a check or track your various activities for effective eczema management.


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The Combined Approach to Atopic Eczema Treatment

Managing eczema is not only about drugs and lotions, but it is also a multi-step and multi-factor process that includes, avoiding triggers, applying creams, taking medicines, changing behavior, etc. In short, it is a combined approach bringing together the conventional dermatology treatments with a set of psychological interventions. The combination of these topical remedies and the elimination of self-damaging behavior such as scratching optimizes the effectiveness of healing and managing eczema.

This Combined Approach to treating eczema is one of the techniques from behavioral dermatology. It uses behavior modification to optimize the conventional treatment of atopic eczema. It was originally devised by Dr. Peter Norén, Dermatologist in Uppsala, Sweden.  eliminating the habitual behavior is key as it results in the chronic eczema condition not allowing it to heal.

Using the EczemaLess app you can inculcate the combined approach in your routine to treat and manage eczema effectively. Let us check out the fundamentals of treating eczema with a combined approach using eczemaLess app

3 Fundamentals of treating eczema

The 3 fundamentals for treating eczema using the combined approach are

  1. Manging Dryness
  2. Treating Eczema Inflammation
  3. Scratch control

Managing Skin Dryness

Managing Skin Dryness in Eczema

In Eczema due to the barrier dysfunction the skin losses its property to retain moisture. This results in water loss making the skin dry. Dry skin further exacerbates the eczema symptoms giving rise to itching, making the skin susceptible to damage due to scratching. Extreme Dry skin also leads to cracks, which opens the entrance to the pathogen, causing infection in Eczema.

This dry condition can be managed by keeping the skin moisturized. Effective moisturizing is one of the key elements in keeping Eczema flares down and avoiding flare-ups.

For effective moisturizing one should be doing it in a certain fashion, at proper intervals and by selecting appropriate moisturizers. The best treatment for eczema is important hence, check out the tips below to effectively moisturize your skin in Eczema

Step 1 – Select the right moisturizer

Moisturizers come in different forms such as creams, lotion, and ointment. Each one differs from others in terms of water level and medicinal contents. You must always go with the application that is easy to apply and suits your eczema condition or get a piece of advice from your physician

Step 2 – Time to Apply

Figure out the right time and frequency to get maximum benefit in the treatment. The best time to apply moisturizer is immediately after your shower or as soon as you are out of a bathtub.

Reapply the moisturizer frequently, at a regular time interval, or as soon as the previous application dries up to retain the skin moisture effectively. Skin area which is exposed requires more frequent application than those which are covered.

Step 3 – Method to apply

Apply a thin layer to provide insulation for the water inside the skin and not very thick, because thick layer will trap the heat inside which may worsen then condition. Do not rub hard as it may further damage the skin

Apply the moisturizer softly but effectively covering all the skin areas, especially the effected and exposed ones. apply quickly without consuming much time before the wet skin gets dried up.

Treating Eczema Skin Inflammation

Topical Creams to treat Eczema

Eczema cannot be cured completely, the treatment of eczema lies in managing its symptoms such as inflammation, itch, rash effectively and preventing the episodes of flare-ups. As a primary line of treatment to eczema flares, topical and non-topical steroids and creams are used. These creams quickly relieve the itching and reduce the inflammation. Along with the other techniques, this will prevent Eczema flare-ups.

It is very essential to get the right topical treatment from your care provider. It is also very important to use them exactly as it is prescribed.

It is recommended to use it exactly as prescribed by the physician and not to leave until the skin stops itching and the inflammation has gone away. But not too long more than prescribed duration which may lead to topical steroid addiction and other side-effects due to overuse.

Use the fingertip rule for the quantity required to cover the affected area effectively.

Scratch Control

Scratch Control tips

The above two fundamentals fall under the conventional remedy for eczema, whereas this falls under the Psychological treatment that is bringing a behavioral change or habit reversal technique.

Often “itch” and “scratch” are used interchangeably to describe the same thing but clinically both mean different things. Itch is a feeling, while scratching is an action or behavior towards that feeling.

The dry skin and red rash condition of the skin gives rise to an unbearable itch. This itch leads to scratch to get temporary relief. But when an individual scratches the skin it gets damaged. Damaged skin leads to more rash that means more itching and ultimately which causes more scratching. This is called the vicious itch-scratch cycle which causes exacerbation of Eczema and damage to the skin.

When this cycle continues, one tends to scratch again and again which becomes a habit. So now the person starts scratching due to habit without any itch.

Habitual Scratching is the main cause of Chronic Eczema which continuously damages the skin and doesn’t allow eczema to heal. Hence it is very crucial to control the scratching or reverse this habit of scratching. There are numerous habit reversal techniques which can be used to prevent scratching, along with the other treatment.

The scratching can be tracked by counting them and noting the situations, circumstances and what helped for scratching. One of the best ways to deal with itch without scratching psychologically is holding the fist tightly for 30 secs. If it still feels itchy than a pinch or poke a nail on the skin.

Treatment cycle Duration

Treatment with topical steroids occurs in two stages in 1st stage of healing, the normal appearance of the skin is restored i.e. the skin looks good this is called “The look Good Point” and the second one “feel-good point” on.  Hidden healing which further reduces the possibility of a flare-up.

So, it is very important to continue the application beyond the look good point. As per the recommended approach, it takes approximately 5 – 6 weeks while treating chronic eczema to reach the look good point and takes a couple of weeks more to accomplish hidden healing. In acute eczema the numbers approximately the same only the weeks change into days.

The Combined Approach was designed for adults and older children with proper stages and routine to be followed.  A modified version suitable for Younger Children is also released which is almost like the earlier involving the parents. The stages of treatment are outlined, with an emphasis on how the parents, and others, are required to be involved. Both the plans for adults and younger children is based on the three fundamentals of treatment with few pre-treatment assessments.

Other points to consider along with the combined approach

Managing Triggers – Different people have different triggers that cause their eczema to flare. It’s important to keep track to identify the triggers and avoid it. Keep a track of your triggers using the trigger section in the app. In case of food try elimination diet technique (inform your physician before trying)

Managing Stress – Stress aggravates the eczema symptoms causing flare-ups. It also induces scratching leading to the itch-scratch cycle. Try different meditation techniques, to reduce stress and achieve peace of mind

Maintain Attitude – For the people suffering from eczema, life can often be miserable. A psychological boost is important if you believe you can do. Don’t “accept and live with it, think like it’s just a small skin problem.  Don’t give up if previous attempts have failed, the combined approach is holistic and has been shown to provide positive results

Avoid infection: In eczema due to low immunity and skin barrier dysfunction, the patient is at high risk for the infection. The patient needs to be extra cautious about the eczema flares he gets if the treatment is not subsidizing the flare one should seek medical. It may be due to the infection. Look for symptoms for Infection in eczema especially in kids.

Conclusion:

As we can see that though Eczema does not have any cure, by using proper techniques one can overcome Eczema. The combined approach of using conventional treatment along with behavioral changes can be very effective in combating Eczema in the long run.

References:  

  • https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.15092
  • https://www.researchgate.net/publication/311935534_Habit_reversal_for_habitual_scratching_in_younger_children_with_atopic_eczema

Reducing eczema flares using scratch control techniques

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 Introduction

An itch that cannot be scratched, this is what explains eczema which is usually recognized by a dry, red, inflamed and itchy rash skin condition. Rather the phrase can be modified as the “itch that should not be scratched” because there is only a small percentage of people who do not fall prey to scratching. The incessant and uncontrollable itch which is associated with eczema known as “scratching eczema”. One can also go with the eczema flare-up treatment to reduce the itching problem.

Apart from the medicinal treatment, it is very important to bring about a behavioral change, while suffering from Eczema. The reason being, the action of scratching will worsen the skin condition  –  eczema causes itching, itching results in scratching, and it’s the scratching which further results in worsening eczema. This thereby leads to more itch and the cycle continues.

In this article, we shall discuss various aspects of itching and scratching and eczema flare-up treatment and by the end, you shall have a clear understanding and a solution to escape from this vicious itch-scratch Cycle.


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Itching vs Scratching

Often “itch” and “scratch” are used interchangeably to describe the same thing or same event and in many native languages the word used to describe these two are same. In reality and clinically too, these word means different things. To understand the treatment action for Atopic Dermatitis it is critical to distinguish between itch and scratch.

– Itch
Itch is a sensation which is defined as an uneasy irritating sensation in the upper surface of the skin usually caused as a result from mild stimulation of receptors that originates in the skin. Medically it is known as Pruritus. A person gets an itching sensation when factors such as irritants, allergens, dry skin, stimulate a nerve ending in in the nerve fibres in the epidermis.

– Scratch
As a stimulus for the itching sensation, a message is sent to the brain which sends a response and this action is called scratching. This leads to scratching eczema. Traditionally scratching is regarded as a way to relieve oneself by reducing the annoying itch sensation. However, there are even negative aspects to scratching, as one would find noxious scratching highly pleasurable. This action can very be problematic with chronic itch patients, such as ones with eczema. The patient might scratch the affected area until they no longer produce a pleasant or painful sensation. This sensation though subsides itch, which gives very short-term temporary relief further worsens the skin condition.

Actions such as rubbing, touching and pricking the skin due to itch come under the scratching activity also known as scratching eczema. Hence as a statement, we can say that

Itch is a feeling, while scratching is an action or behavior towards that feeling

Both cause an eczema flare-up and one must reduce it with eczema flare-up treatment

Types of scratching in Eczema (Scratching Eczema)

Scratching in atopic dermatitis is a little complicated than it appears from the definition which is a response to the itch. In eczema people tends to scratch due to two different reasons i. e. scratching in eczema can be classified into two categories:

1) Scratching due to an Itch (Neurogenic):  This is scratching stands as per the definition, It is a response to the signals sent by the nerve fibers due to itching sensation. In this case, a person scratches only when he feels the sensation of itching. Hence as a treatment action, one just needs to focus on treating the eczema symptoms.

2) Circumstance or behavioral Scratching (Psychogenic): This scratching is from the unconscious mind or can be said as a habit due to repetitive actions. Any behavior which is repeated number of times becomes a habit and people tend to do that action automatically with or without being required. In this case, a person may scratches due to his behavior even if he doesn’t have itching sensation.

Consequences of Repeated Scratching

“Circumstance scratching” is more dangerous as repeated scratching damages the skin layer making it thick, and red. It further does not allow eczema to heal making the eczema condition chronic. This scratch is psychologic and may result due to, boredom, while thinking, frustration, stress, etc. The treatment action for this situation requires a behavioral change know as Habit Reversal.

If one can understand these aspects of scratching and its relationship with the itch, it becomes easy to treat and improve the condition of eczema.

Itch – Scratch Cycle

Itch- Scratch cycle where the itching leads to scratch and scratching leads to itch is a well-known phenomenon.  Let us understand this cycle in a little more detail,

– In people with atopic dermatitis, when eczema flares up, immune cells send inflammatory signals to the surface, causing the itchy rash leading to an itching sensation.

-This itching sensation causes the person to scratch which in turn damages the outer layer of the skin allowing microbes and allergens to enter.

-As a response to these invaders, the immune cells continue to send signals to the surface, causing even more redness, rashes and itching even more

-Thus, resulting in more scratching and ultimately the skin barrier breaks down, and the itch-scratch cycle continues.

Scratching becomes a Habit

In normal circumstances of scratching a person scratches only when it itches, or his skin gets irritated due to a mosquito bite or any allergen. Whereas in condition like chronic eczema a person gets habituated to scratching.

When a person performs an action again and again, repetitively due to certain situation, it becomes his habit and the person tends to repeat it automatically even in the absence of that situation. Similarly, in chronic eczema, the person scratches whenever it itches multiple times and due to chronic condition, it continues for a long period of time. This now becomes a habit so much so that the person scratches frequently without any itching more than he does when he gets an itch

Hence it is very critical to put an end to this itch-scratch cycle while treating eczema. As the itching is caused due to eczema itself, the key to end it is to control your action of scratching. which will stop further damage to the skin. Meanwhile, you can treat your eczema symptom which leads to itching ultimately breaking this cycle.

How to Track the Scratch?

Any treatment starts with analyzing the severity of the symptoms, similarly, it is good to track and analyze all the episodes associated with the scratching in the first place to understand the behavior more deeply. Close people surrounding you can also be asked to help track it for you in order get a comprehensive statistic regarding the behaviour which may help to find an appropriate solution.

In order to track the scratching, one should note down factors of scratching like:

  • Number of times a person scratch (a counter can be used)
  • Frequency of scratching
  • Circumstances or situations of scratching,
  • What helps in each circumstance?
  • Scratching due to itch or without the itch
  • Way of scratching (rubbing, picking the skin, touching), etc.

How to prevent scratching?

Itch and scratch is something that each and every patient suffering from eczema has to face day in and day out specially when it flares. Itch is the worst thing that occurs in eczema as it is difficult to get rid of. Further adding to it the most frustrating part is trying not to scratch your itchy skin.

One of the best ways to deal with itch without scratching psychologically is holding the fist tightly for 30 secs, you can count till 30 in your mind this should help in reducing the itching sensation. If it still feels itchy than pinch or poke a nail on the skin to fool the brain. By doing this your brain shall give you a little paining sensation but will subside the itching sensation.

Other tips to avoid scratching

Tips to prevent scratching in EczemaReduce Scratching in Eczema@2x

  • Always keep your hands busy (for instance talking on the phone, watching TV with remote in hand) so that they are not free for scratching ultimately forgetting to do it.
  • Another good way to avoid is not giving accessibility for scratching, try to cover the exposed skin, e.g wearing long sleeve clothing
  • While changing dress, people tend to scratch for pleasure. To avoid it, be mentally prepared, undress quickly, apply creams, dress up and then distract yourself for some time to avoid scratching
  • If you feel like scratching after a shower, don’t allow yourself any free time, rush to pat the skin dry with a towel, put on moisturizers, dress-up quickly and distract yourself for 10 mins
  • While sleeping one may do it unconsciously, so remain alert and get up from your bed whenever you feel like scratching.
  • Dealing with the child instead of saying “Stop Scratching”, distract the child with toys, sightseeing or simply, talking to them, etc.

Topical Treatment for Eczema

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Eczema and Inflammation

The skin condition Eczema is mainly recognized by a dry, red and itchy rash that occurs in the patches of inflamed skin. Eczema is also commonly known as “Atopic Dermatitis” where “Atopic” refers to Allergy due to hypersensitivity reactions caused by allergens or irritants and “Dermatitis” refers to the inflamed skin. One can go with the prescription eczema cream if such symptoms appear.

In Eczema the skin appears dry, red and inflamed. The severity of Eczema depends on the level of inflammation, how much the individual scratches due to itch and whether the eczema is infected. Eczematous skin is itchy but it shouldn’t be scratched because scratching increases the inflammation, irritates the skin and further worsens the condition.

Flare-ups in eczema are different in different people and are exacerbated by different triggers in the form of Allergens and irritants. These triggers worsen eczema causing itchy rash leading to increased inflammation to the skin. In some cases, eczema gets infected which can be life-threatening and needs to be addressed immediately.


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Are Topical Steroids Necessary for treating Eczema?

Eczema cannot be cured completely, the treatment of eczema lies in managing its symptoms such as inflammation, itch, rash effectively and preventing the episodes of flare-ups.

Using topical creams in Eczema

 

As a primary line of treatment to eczema flares, topical steroids and creams are used. Steroid creams quickly relieve the itching and reduce the inflammation. Remember, a topical treatment for eczema cannot guarantee complete relief. These steroids and creams are available in different strengths, from mild to strong, the stronger the steroid the more effective it is. One can buy creams with mild strength are available over the counter whereas the stronger ones are available only on physician’s prescription.

The strength of the steroid used is determined by the physician after examining eczema, and factors such as the severity of eczema, condition of the rash and location of the affected area. He may then suggest the best topical treatment for your eczema. It is very important to follow the instructions of the doctor or use the steroidal cream as prescribed by him. For a thick and scaly skin condition in eczema more potent steroid may be prescribed.

Mechanism of Steroid on skin inflammation

The steroids applied on the skin travels from outside to the inside of the skin. It reacts with and modifies the function of dermal, epidermal cells and cells of leukocytes which causes the inflammation of the skin.  After passing through cell membranes these steroids react with protein receptors stimulating the production of glycoprotein.

These glycoproteins called as lipocortin inhibits the production of components that are responsible for the immune reaction and thereby produces anti-inflammatory and immunosuppressive effects which ease down skin inflammation and reduces the eczema flares.

Side effects of steroidal cream

While suggesting a topical treatment for eczema, using an appropriate strength of steroid is critical, because milder than required may not heal the symptoms leading to chronic eczema condition, whereas stronger than required for longer period may lead to side effects.

When used strictly as prescribed by the doctor, the chances of side-effects though exist but are very rare. Side-effects always occur due to the inappropriate use of medication.  Many times, Side effects are only seen after continuous use of treatment with strong steroids for several months.

Apart from potency and duration of use, other factors that determining side-effects include quantity used per application and area of the body where it is applied.

Side effects due to steroids are often temporary and most of the effects only certain part of the body. Common side-effects of Steroid usage include

  • Thinning of skin,
  • Increase in the activity of the sebaceous gland
  • The appearance of Stretch Marks
  • Developing Acne
  • Darkening of the skin
  • Changes in skin pigmentation (white spots),
  • Temporary blisters
  • Some of the rare but more serious side effects consist of Cataracts, little pink bumps skin, Acne, folliculitis (pus-filled hair follicles), Adrenal Suppression

How to use Topical Steroid Effectively?

Like mentioned earlier, while treating eczema it is very important to use topical steroids and prescription eczema cream long enough to suppress the flare-up symptoms. It is recommended to use it exactly as prescribed by the physician and not to leave until the skin stops itching and the inflammation has gone away. Because the treatment is withdrawn too soon, the rash might return which may lead to more usage of steroid medication overall. Also, the next time round you might have to use steroids with greater potency, than if you had continued using it for long enough in the first place. This can cause a condition called Topical Steroid Withdrawal Syndrome or Steroid Addiction.

For effective healing, only a thin layer of topical steroid/prescription eczema cream is required, but make sure while using topical treatment for eczema it is applied enough to cover all eczema affected area. The best way to measure is to use the fingertip rule wherein squeezing cream from the tip of an adult’s index finger to the first crease of the finger should give you a quantity that is enough to spread an area of two adult palms including fingers. In common language, this measurement is called as ‘one finger unit’.

Other tips to apply steroidal cream for effective healing includes

  • Applying cream briskly without any massage, rubbing hard may further damage the skin
  • Use enough amount to cover the entire affected area do not leave any affected area may it be very small
  • Apply enough so that after treatment the skin doesn’t feel sticky and messy.
  • Apply moisturizer after putting on the steroids to increase the potency of healing

Hidden healing is important

The condition in eczema can be explained in two stages one the appearance of the skin, how it looks? dry, red, rashes, etc. and second the damages inside the skin, the inflammation, the damaged skin barrier, etc.

Similarly, treatment with topical steroids occurs in two stages in 1st stage of healing, the normal appearance of skin is restored i.e. the skin looks good this is called as “The look Good Point” and the second one “feel-good point” on complete healing from inside or hidden healing which further reduces the possibility of a flare-up on stopping the anti-inflammatory application and recurring of rashes.

So, it is very important to continue the application beyond the look good point until the feel-good point is reached or hidden healing is accomplished. while treating chronic eczema the 1st stage is reached in 4 to 6 weeks and takes a couple of weeks more to accomplish hidden healing.

Conclusion

As we can see topical treatment can be very effective in treating the inflammation due to Eczema, which would, in turn, reduce the itch-scratch cycle. However, it is very important to use topical steroids judiciously and as prescribed by the Doctor. Stopping too early might actually cause more use of steroids over time. There are also non-steroidal topical creams like topical calcineurin inhibitors, ask your Doctor for your options.

How to Moisturize your Skin in Eczema?

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Eczema and Dry Skin

Eczema also commonly known as Atopic Dermatitis is a chronic skin condition affecting all age groups, especially babies. Eczema is characterized by itchy, red and Inflamed skin which also makes the skin very dry. The skin usually becomes dry in winter and low humid condition or when the temperature is too high, In Eczema the skin becomes dry due to loss of Moisture. Generally, the skin tends to lose moisture, but in Eczema the skin loses the moisture more quickly. Effects of Dry skin on Eczema In Eczema the uppermost layer of the skin loses its property of acting as a barrier which is called Skin Barrier dysfunction. The skin fails to retain moisture and water escapes more quickly and frequently making the skin dry.

Severe dry skin further leads to crack and in extreme case may also bleed. Cracks open up allowing the entry to bacteria providing an avenue for infection

Dry skin also causes itch. Similarly, due to barrier dysfunction, the skin also fails to prevent the entry of foreign particles including microbes such as bacteria and virus increasing the chance of eczema infection. Additionally, very dry skin can trigger symptoms of eczema and cause the area to become itchy, known as pruritis, also increasing the likelihood of bleeding due to scratching. It further worsens the condition leading to the onset of “itch-scratch cycle” which occurs with rubbing or scratching the skin causing more irritation, and thus, additional itching. Excessive dryness of the skin can cause a flare-up of eczema worsening the condition. It is always good to know about the importance to moisturize your skin.


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Tips to Moisturize in Eczema

 

Importance of Moisturizing

It is very important to moisturize your skin in eczema. Effective moisturizing not only prevents it from drying but also helps in protecting the outermost layer of the skin known as stratum corneum or commonly known as a skin barrier.

Keeping your skin moisturized is one of the best solutions for eczema, but it should be done in a certain fashion, at proper intervals and by selecting appropriate moisturizers to make it more effective. You need to follow the tips below to effectively moisturize your skin if you have Eczema.

Topical applications play a major role in controlling Eczema and come in different forms such as cream, lotion, and ointment. You must always go with the application that is best for Eczema.

Types of Topical Applications

Lotion

A lotion is a low viscosity topical preparation intended for application to the skin. Since it has higher water content than creams and ointments, it is more liquid and can be applied easily to external skin with a brush, cotton wool, clean cloth or with your bare hands.

Cream

A cream is a preparation used for application to the skin. Creams are semisolid emulsions (a mixture of more than one liquid that are normally immiscible) like water and oil. Roughly water and oil in a cream preparation is 50:50. One should always use the best eczema cream for better results. Creams are of two types “Oil in Water” and “Water in Oil”. The Water in Oil creams are more moisturizing because they provide an oily barrier which reduces the loss of water from the outermost layer of the skin

Ointment

An ointment is a semisolid preparation usually containing medicinal substances, which is intended for external application to the skin.

In Brief Lotions are thinner and more liquid than Creams. Creams are thinner than Ointments. Hence lotions are easy to apply than creams but are less effective when it comes to treating eczema. Creams are easy to apply than ointments because ointments have the least amount of water of the three.

Moreover, the physician prefers ointments over creams and lotions because of less content of additives than creams and lotions which may cause side effects, Ointment also lasts longer than the other two. If applying ointment becomes messy than creams are preferred. Finally, it’s up to the preference of the patient and which one suits him. The best moisturizer is one which is used appropriately, is effective in insulating against water loss and containing no additive causing side-effects.

Step 2 – When to apply?

After selecting the best moisturizer for eczema, one should also figure out the right time and frequency to get maximum benefit in the treatment. The best time to apply the moisturizer is immediately after your shower or as soon as you are out of a bathtub.

Take a bath in warm and Avoid Hot water as it may raise the body temperature resulting in water loss. Sitting in a Bathtub for 10 –15 mins shall help tour skin soak enough moisture.

After shower Pat dry your instead of rubbing with a towel which may damage your skin further and apply the moisturizer immediately when your skin is still wet.

Reapply the moisturizer frequently at a regular time interval or as soon as the previous application dries up to retain the skin moisture effectively. The frequency may be different for different parts of the body for e.g. body parts such as hands and face which are exposed may require more frequent application. Also, do not forget to reapply whenever you wash your hands as washing hands will also wash away the moisturizers applied.

Step 3 – How to Apply?

To get the best healing from the moisturiser it is important for us to know how the moisturizer acts when applied on the skin. The main objective with which the moisturizer is applied to the skin is to retain the moisture of the skin which evaporates, rather than adding water to the skin from outside.

Hence, it should be applied in a thin layer to provide insulation for the water inside the skin and not very thick because thick layer will trap the heat inside which may worsen then condition.

Eczema is very sensitive to rough treatment, do not rub hard as it may further damage the skin, a gentle touch is always ideal even applying the moisturizers. Apply the moisturizer softly but effectively covering all the skin area, especially the effected and exposed ones. While applying, apply quickly without consuming much time before the wet skin gets dried up.

Moisturizing Tips

  • Bathing or taking a shower is always a good way of moisturizing the skin in eczema, just avoid extended period and hot water, instead use luke-warm water.
  • A bath with an appropriate amount of bleach added to the water may give relief from eczema symptoms. Moreover, a bleach bath can kill bacteria on the skin preventing infections, reducing itching, redness, and scaling. Consult your doctor before giving it a try.
  • Use moisturizer prescribed by the physician instead of over the counter as medicated moisturizers have the added benefit of reducing side effects.
  • Apply topical medication if you use one before applying moisturizer to enhance the healing.
  • Be sufficiently hydrated by drinking enough quantity of water and juices to keep your skin moist.
  • Try wrapping your skin with a therapeutic wet bandage or use paper towels, make them wet and place over the skin and top them up with dry dressing once the bottom layer dries you can remove and replace it another wet one.
  • If the climate in your area is to dry and less humid use humidifiers in your rooms to make the air moist to comfort your skin.
  • While using a moisturizer or liquid cleanser (soap) use pump dispenser instead of an open container in order to avoid the spreading of the infection.
  • Avoid using soap as it increases the PH level of the skin and makes it dry, instead use a gentle cleanser to avoid scrubbing with a loofah.