It’s dry. It’s itchy. It’s driving you crazy. But is your problem just dry skin, or is it eczema, also known as atopic dermatitis?
“The difference between dry skin and eczema is the presence of inflammation,” dermatologist Joshua Zeichner tells HuffPost. “With eczema, the skin barrier is not working as well as it should be, resulting in loss of hydration and disruptions in the outer skin layer. If your skin is red, itchy and flaky, then it’s probably more than just dryness, and you probably have eczema.”
Another clue is where those dry, itchy patches are located. “It most commonly affects the antecubital fossa (elbow creases) and popliteal fossa (back of the knee),” dermatologist JiaDe (Jeff) Yu explains. (And you now know two new body part names, so you’re welcome.)
A key difference between the two conditions is that eczema will continue to get worse if it’s not treated correctly, according to Vivian Shi, a dermatologist and associate professor in the department of dermatology at the University of Arkansas for Medical Sciences. “It can lead to severe symptoms like cracking, skin thickening and more intense itching,” she says. “People with eczema also are more prone to skin infections by a bacterium called staphylococcus aureus.”
What causes eczema?
“Eczema is caused by a deficiency in one of the proteins that makes up the top layer of the skin,” explains dermatologist Julie Russak. “Skin is designed to be a protective barrier for our body, with proteins that act like glue and hold cells together. When there’s a mutation in the proteins that holds the cells of the top layer of skin together, the cells start falling apart, and the skin can’t act as a protective barrier.”
What’s making your skin act up?
“It can be triggered by cold weather, stress, infections and illness,” Yu says. “And in most people, it affects more than the skin, since it’s been shown to be associated with depression, insomnia and other medical conditions.”
The good news is that there are things you can do to help. You’ll need to start by paying attention to everything that might affect your skin.
“We need to do some careful questioning to look for irritants that can damage the skin barrier and even cause irritation,” said Peter Lio, a dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine. “In addition to other factors, you might also consider things like frequent washing, the use of hand sanitizsrs and certain chemicals you might be exposed to at work or home.”
When should I go to a dermatologist?
“If your skin is dry and itchy and doesn’t improve with good, thick moisturisers, then it’s time to see a certified dermatologist,” Yu says. “That doctor can provide you with targeted, site- and age-appropriate therapies.”
Are there products that can help?
“The care regime for dry skin and eczema is similar, since in both cases the goal is to repair and protect your skin barrier to prevent water loss from the skin,” Shi says.
So, start with what you’d do for dry skin. Yu suggested thick moisturisers that prevent water loss from the skin, especially in drier and more arid conditions.
“In general, you want to choose a product that has very few ingredients in it and ideally one that contains ceramides,”paediatric nurse practitioner Sam Casselman advises. “Those are the proteins which repair the skin barrier and relieve dry skin, so use that moisturiser with ceramides as often as possible. For more severe dry skin, get a thicker alternative with a petrolatum base.”
When and how often should I use topical treatments?
After you’ve purchased a moisturising product, the key is to use it – frequently. “The brand of product may not be as important as how liberally you apply it,” Shi says. “Make sure you’re applying it several times a day, especially after showering.”
Your skin covers all of you, so you need to take care of all of it at the same time. “Treat not only spots where you have active eczema, but the rest of the skin as well, because your skin barrier is not functioning optimally all over,” Zeichner said.
While you should be generous in applying over-the-counter moisturisers, be cautious in using a topical prescription as a preventative measure. “It’s a very common mistake for people to continue applying topical steroids even after a flareup is resolved,” Casselman says. “Research is unclear if topical steroids applied to chronic areas of eczema will prevent it from flaring again, and the risk of chronic use of topical steroids on healthy skin outweighs that possible risk.”
Still, timing is everything, and you want to get after it right away when there’s a flare-up, Casselman says. “A common mistake patients make with prescription topical products is waiting to apply them until an eczema flare gets ‘bad.’ If you wait to treat it, the inflammation and itching will continue to worsen and can become very intense. When you treat early and effectively, you’ll shorten the time of an eczema flare and likely use less medication in the long run.”
Are there any new treatments out there?
Russak said we now know eczema “is a chronic genetic immune-mediated condition” and recent clinical and genetic studies have helped explain it. “This means there are new targeted therapies that use small molecules to block specific pathways for the development and flares of atopic dermatitis.”
One of the more promising new topical treatments in the US is ruxolitinib cream. “It targets and blocks a special inflammatory marker in the skin called janus kinase,” or JAK, Yu explains.
Another product, dupilumab, is the first biologic medication for moderate-to-severe atopic dermatitis. “This has been a game-changer for those with more difficult-to-control eczema,” Lio says. “Because it isn’t an immunosuppressant or a steroid, it can be an important option for those who are stuck in a loop of medications that might have more significant side effects.”
There are probably even more treatments on the way. “We dermatologists are really excited, because after a seemingly interminable drought of new treatments for eczema, we are finally witnessing an incredible explosion of new medications,” Lio says. “With topical therapies, oral medicines and even injectable medications, we finally have a pipeline of more than 100 therapies in development.”
Even though these drugs are great news for many, you may not need them. “For many of the milder cases, the new medications are likely unnecessary,” Lio says. “More conventional therapies like good moisturisers, topical corticosteroids, topical calcineurin inhibitors and crisaborole may be enough to keep things under good control, and to do so safely.”
What else can I do?
“Stick to ultra-gentle, soap-free cleansers,” Zeichner says. “I recommend Dove Sensitive Skin Body Wash, which contains extremely mild cleansing ingredients in a formula that contains the same type of hydrators found in traditional moisturisers.”
“My favourite option is just plain Vaseline petroleum jelly,” Yu says. “It’s highly effective, has a low side effect profile and is very affordable. It’s similarly effective compared to other much more expensive topical moisturisers.”
“Be mindful of everything that comes in contact with your skin, from topical creams to the clothing you wear, Russak says. “Try to maintain a relatively cool, neutral humidity environment in your house. Use a humidifier during winter if you’re prone to dry skin and eczema. I recommend using fragrance-free detergents for sensitive skin. And some people find it helpful to store their moisturisers in the refrigerator for a cooling effect.”
Will my eczema ever go away?
The good news is that there are lots of treatment options. The bad news is that eczema is a chronic condition, and the most you can expect is to manage it well with only occasional flare-ups.
“A complete cure isn’t possible in a majority of the cases, because the presence of eczema generally means there is a genetic predisposition,” Casselman says. “In my practice, I focus on educating patients around what help they need and how I can support them.”
Shi tells patients to prepare for “diligent care over a long period of time.”
“Even though your skin may look calm and have no active rash, there can still be underlying inflammation and problems with the skin’s protective barrier,” Shi says. “It’s important to keep up with your moisturisation routine and establish long-term care with your dermatologist.”
