Whether you’re among the 1 in 10 people in the United States who have some form of eczema (per the NEA’s latest figures), or are a caregiver to a child with it, know that there are ways to live well with the condition. Read on to find out how.
Diet for Eczema
A healthy diet with lots of fruits and vegetables is important for most people, but is especially so for people with eczema or anyone with a disease that relates to immune system function, says Seemal R. Desai, MD, a dermatologist at University of Texas Southwestern Medical Center in Dallas and a former president of the Skin of Color Society. Good nutrition will help you achieve the best outcome possible, and it is particularly important in infants and children who are at higher risk of developing eczema because of family history, according to one study. Dr. Desai recommends a daily multivitamin to his patients and testing for vitamin D and iron levels by their primary care doctor. One study published February 2018 in Skin Pharmacology and Physiology found an association between vitamin D deficiency and a higher risk of eczema, while another investigation published January 2016 in JAMA Pediatrics linked iron-deficiency anemia with higher risk for atopic diseases like eczema. Probiotics are fine to use if they are helpful, Desai adds. Furthermore, he says, “Hydration is key, and I tell my patients that a good diet also involves good lifestyle habits. That includes avoiding smoking, avoiding alcohol as best as possible, and avoiding energy drinks or food and drink that have high fructose corn syrup in them.” An eczema-friendly diet also should be mindful of food allergies, the doctor says. According to a news release from the National Institutes of Health, up to 30 percent of children with eczema also have food allergies. An allergist can run tests to help make a diagnosis. RELATED: Researchers Identify Subtype of Eczema Tied to Food Allergies Another common technique for sussing out food allergies and intolerances is an elimination diet. Under a doctor’s direction, you can determine which foods to cut out, eliminate them, and then reintroduce them in a manner that allows you to gauge your reaction to each one. “Swimming is also a great form of exercise that engages many muscle groups,” Dr. Yu says. “The chlorinated water can be helpful in decreasing inflammation in the skin. An important note is to rinse off all the chlorine from the pool water and moisturize immediately after.” The NEA lists other exercise tips, including:
Hydrate before, during, and after exercise.Choose the right clothing to minimize the irritation to your skin as the body heats up.Take a break during exercise to rehydrate and cool down if you’re sensing a flare-up.Moisturize before and after you exercise. Before swimming, use a thicker application of emollient to act as a barrier.Bring your own shower gels and shampoos.
RELATED: The Best Soothing Creams and Moisturizers to Help Tame Eczema
Managing Your Prescriptions for Eczema
The NEA lists a variety of prescription medications for eczema, including topical corticosteroid creams or ointments, topical antimicrobials, topical nonsteroidal medications, oral antihistamines, immunosuppressants, and the biologic Dupixent (dupilumab). Whichever course of treatment you and your doctor settle on, it’s important to take your medications on time. Dan Chojnacki, a certified personal trainer in Green Bay, Wisconsin, says he uses a very simple technique to stay on track with taking Dupixent injections for his eczema: the timer on his phone’s clock app. RELATED: Bacteria Therapy for Eczema Shows Promise for More Effective, Cheaper Treatment
Complementary and Alternative Medicine for Eczema
Advice for natural, complementary, and alternative medical treatments for eczema abounds, but there is limited medical evidence for their efficacy, Yu cautions. He notes that “Sunflower oil as an emollient has perhaps the best evidence, whereas others, such as olive oil, have been shown [as in this past study] to worsen dryness and eczema severity in patients.” But, as the NEA notes, you should avoid sunflower oil if you have an allergy to sunflower seeds. “Coconut oil has been shown to have some benefits in people with eczema as a moisturizer,” notes Yu. The same study mentioned above even found that virgin coconut oil can reduce the amount of staph bacteria on the skin, and in turn reduce the chance of infection from skin that is irritated, scratched or otherwise broken. Natural and alternative therapies should be used in concert with therapies that have more substantial medical evidence and safety, and not as a replacement for them, Yu advises. “Just because something is natural doesn’t make it safe, or effective.” RELATED: Can Apple Cider Vinegar Help Treat Eczema?
Home Environment and Eczema
An important step in managing eczema is minimizing the triggers and irritants in your environment that can cause flare-ups or make them worse. “Common triggers to avoid include fragrances — aerosolized especially — which can serve as an irritant on the skin or induce allergic contact dermatitis in patients with eczema. These include perfumes, colognes, and essential oil diffusers,” says Yu. “I would make sure to avoid cigarette smoke in the home, as this can contribute to worsening eczema. Many people with eczema are at risk of developing asthma, and smoking can exacerbate asthma to a significant degree, especially in children.” Desai recommends using 100 percent cotton towels and sheets, and washing them in fragrance-free fabric softeners and laundry detergents. “Also, if someone has pets in their home then they need to make sure that the pets are clean. They also need to make sure that they are not allergic to those pets.” Pet dander, saliva, and urine are common allergens, according to the Asthma and Allergy Foundation of America. Finally, get a humidifier, says Desai. Very dry air pulls moisture out of the air and worsens eczema symptoms, says the NEA. Both the NEA and the Asthma and Allergy Foundation of America (AAFA) have directories of products they certify to be eczema- and allergy-friendly. RELATED: A Complete Glossary of Eczema Terms
Personal Care With Eczema
Even more important in managing the disease is vetting personal-care product ingredients. “Potential allergens in personal-care products may play a significant role in eczema,” says Yu. “Preservatives are included in all products with a shelf life (regardless how natural or organic the label says). Products recommended by the NEA are typically more gentle and contain ingredients less likely to trigger or worsen eczema.”
Traveling With Eczema
Proper planning can ease the risks of traveling when you or your child has eczema. “Some hotels may have special accommodations available for patients with eczema,” says Yu. “I would also recommend contacting the hotel ahead of time to see if they can launder the sheets in fragrance-free detergent and avoid dryer sheets.” Naturally, if you have an allergy to feathers and down, then you’ll want to request bedding that is free of these materials. “Sometimes I’ll even tell [patients] to take their own towel, to make sure what they’re using is not abrasive to the skin,” says Desai. “Take your moisturizers and any creams with you. And if you need a doctor’s note to travel with those items through TSA at the airport, then ask for one. Also, I recommend that you not use hotel toiletries.” Those items may contain fragrances or other ingredients that can trigger a flare-up. Stick with your own toiletries that you know are safe. RELATED: What to Know About Eczema Awareness Month
A board-certified dermatologistA pediatrician (if the patient is your child)An allergistA registered dietitianA mental health counselorA complementary health provider
The NEA has a directory of providers in each specialty who have experience treating patients with eczema. RELATED: No, Eczema Isn’t Contagious, but Here’s How Secondary Infections Can Be Spread
Board-Certified Dermatologist
A dermatologist is a medical doctor specializing in skin, hair, and nails. This is the specialist who is likely to order tests, diagnose your condition, determine a course of treatment, prescribe medication, and monitor your condition. You’ll want to find one who is board-certified. The American Academy of Dermatology (AAD) notes that in North America, this means passing an exam and being certified by the American Board of Dermatology, the American Osteopathic Board of Dermatology, or the Royal College of Physicians and Surgeons of Canada. You can find one through the NEA’s provider directory or the one posted by the AAD. If you are a person of color, you can find a specially trained dermatologist through the Skin of Color Society directory.
Pediatrician
If you are a caregiver for a child with eczema, you may rely on a pediatrician for guidance and treatment. The prevalence of eczema peaks in childhood, per the NEA, so it makes sense that expertise in the disease is common among this type of doctor. Find one through the NEA’s directory linked above.
Allergist
Eczema is linked to having an overreactive immune system, and the NEA notes that allergens are among the common triggers for flare-ups. No wonder an allergist may be a part of your healthcare team. This specialist may order tests, prescribe medication, and treat allergies that affect your eczema symptoms. The American Academy of Allergy Asthma and Immunology (AAAAI) has a provider directory to help you find an allergist in your area, as does the NEA.
Registered Dietitian
If food allergies, intolerances, or nutritional imbalances are affecting your eczema symptoms, a registered dietitian may be added to your team of healthcare providers. This specialist is trained in the use of diet and nutrition to keep the body healthy. Look for one who is credentialed by the Commission on Dietetic Registration. A registered dietitian can guide you in putting together a diet and meal plan to help manage your symptoms. Find one using the NEA directory or one hosted by the Academy of Nutrition and Dietetics.
Mental Health Counselor
Stigma, isolation, and the misery of the itch-scratch cycle are associated with depression, anxiety, and other types of mental illness in people living with eczema, according to the NEA. But there are mental health providers who address these conditions. Your primary care physician should be able to make a referral and the American Psychological Association has a directory. Type in your zip code and the phrase “chronic illness” to find a psychologist who specializes in the treatment of people living with a chronic condition.
Complementary Health Provider
A complementary health provider can be everything from an acupuncturist to a naturopath to a practitioner of traditional Chinese or Ayurvedic medicine or other treatments that are alternative to Western medicine. As Yu suggests, complementary therapies should be used in concert with the treatment plan that the medical team led by your dermatologist or primary care physician provides. You can find one in your area using the NEA directory of providers. RELATED: Is Honey the Secret to Clear Skin if You Have Eczema? “In severe cases, the burning, itching, and discomfort can lead to sleeplessness especially; and then missed work, missed school, and the stress that comes from that,” says Triano. “Toxic stress builds up, leading to more symptom flare-ups. We see a kind of hopelessness and fatigue that comes from the chronic nature of the disease and not feeling like one has control over it.” You’re not alone if you feel this way. A 2017 NEA survey showed that more than 30 percent of respondents with atopic dermatitis were diagnosed with depression, anxiety, or both. Meanwhile, a study published in December 2018 in JAMA Dermatology found that people with eczema are 44 percent more likely to have suicidal thoughts and 36 percent more likely to attempt suicide than those who do not have eczema. If eczema is wearing you down mentally and emotionally, share that with your doctor, who can make a referral to a mental health provider and perhaps address your stress-producing physical symptoms as well. “Sometimes, especially with younger children, the depression and anxiety resolve once the eczema is well managed and quality of life improves. When this isn’t the case, it can be very helpful to work with a therapist who can help assess the depression or anxiety and offer treatment interventions,” says Jennifer Moyer Darr, a licensed clinical social worker at National Jewish Health in Denver. “There are a variety of interventions; but often, cognitive behavioral therapy, acceptance and commitment therapy, self-hypnosis, and biofeedback will be considered. Medications may also be helpful and are typically prescribed by a psychiatrist, although sometimes the primary care physician prescribes them.” RELATED: Can Yoga Help Relieve Eczema Symptoms?
Managing Depression and Eczema
As Triano says, hopelessness can set in from the chronic nature of eczema. According to the American Psychiatric Association, having the following symptoms for two weeks or longer may be a sign that your feelings aren’t temporary and could be depression:
Feeling sad or having a depressed moodLoss of interest or pleasure in activities once enjoyedChanges in appetite — weight loss or gain unrelated to dietingTrouble sleeping or sleeping too muchLoss of energy or increased fatigueIncrease in purposeless physical activity (for example, hand-wringing or pacing) or slowed movements and speech (actions observable by others)Feeling worthless or guiltyDifficulty thinking, concentrating, or making decisionsThoughts of death or suicide
Seek help if you are experiencing these symptoms. A mental health specialist can work with you on finding ways to cope and prescribe medication, if needed.
Managing Anxiety and Eczema
The so-called itch-scratch cycle can be a great source of anxiety, says Triano. Intense itching can lead to scratching, which in turn irritates skin, leading to more itching and scratching. Not to mention that stress can trigger flare-ups, as the Mayo Clinic notes. Then, says Triano, “With eczema the itch-scratch cycle twins up with anxiety and stress and they kind of feed each other.” As with depression, a mental health specialist can help with stress reduction and prescribe psychiatric medication — and you may find that other members of your healthcare team can help the physical symptoms that are causing angst. The NEA recommends yoga, meditation, and exercise as good stress-relievers as well. “Self-hypnosis can also be useful in ‘dialing back’ the itch and learning how to calm and relax both brain and body,” says Darr. “Developing a strong sense of self and positive self-esteem can be challenging, especially when you have a health issue that is visible to the world,” says Darr. ”From an early age it is important to help foster a sense of identity and accomplishment that is all encompassing — your eczema is just one part of you.” Often people exclude or comment out of ignorance, Darr notes, adding, ”Finding your compassion, and your voice, to educate others in a supportive way can lead to new understanding and new friendships. Talking openly can help remove any curiosity or discomfort others may have. For young children, it often helps for parents, teachers, or the children themselves to educate their classmates.” It is definitely possible to have healthy relationships while you are living with eczema.
Your Friendships and Eczema
Having healthy friendships can help counteract the isolating nature of eczema. If you’re having a hard time making friends, consider finding a support group with others who have eczema or chronic skin conditions, in person or online, advises Triano. Your healthcare provider may be able to refer you to a local support group. Online there are a number of communities, including the International Eczema Support Group on Facebook; the AAFA Community online forum, which includes eczema-related topics; and the NEA-hosted Inspire forum.
Dating With Eczema
Self-compassion and good communication are two keys to dating successfully with eczema, says Triano. So is practice. “Practice being honest and using your voice and being your true self,” she says. You may need to rehearse how you tell a prospective date about your condition and the accommodations it requires. “Maybe even role-play with a friend before your date. How do you want to talk about it? How do you want to introduce it on a date? Find a way to express that part of your story in a way that you feel comfortable with.” Staying grounded also helps, so that the stress of a dating situation does not lead to a flare-up, she adds. “And have a good support system in your corner if it doesn’t work out.” RELATED: 7 Common Myths About Eczema You Shouldn’t Believe Your treatment for eczema may also include the following medications and therapies:
Topical corticosteroid creams or ointments (available in varying strengths), such as hydrocortisone or Clobetasol propionate 0.05 percent (Clobex) lotion, applied to the irritated area in order to reduce inflammation and itchingAntimicrobial therapies, such as bleach or vinegar baths and topical antimicrobials to help keep the bacterial, viral, and yeast colonization of the skin down and decrease inflammationTopical nonsteroidal medications, such as crisaborole, tacrolimus, and pimecrolimusOral antihistamines, such as hydroxyzine and Benadryl, to address itchingDupilumab, an injectable medication for moderate to severe cases that addresses how the immune system responds to triggersPhototherapy, in which ultraviolet (UV) light is delivered to reduce inflammation.
RELATED: ‘I Tried Wet Wrap Therapy for Eczema, and It Helped Reset My Skin’ Here is just how costly it can get, both on a personal and on a societal level, per Wendy Smith-Begolka, the vice president for scientific and clinical affairs at NEA:
Around 42 percent of Americans with eczema spend $1,000 or more out-of-pocket each year to manage their condition, a study published in Dermatitis in January 2021 notes.Total direct medical costs in 2013 (including those paid by insurers) averaged $11,660 per eczema patient, $3,302 annually more than those without the condition. Costs are higher in patients with more severe disease, according to a study published in the July–August 2018 issue of the Journal of Allergy and Clinical Immunology.In 2013, the cost to the U.S. health system to treat eczema patients was $314 million, as noted in a May 2017 report published in the Journal of the American Academy of Dermatology.
Medication Prices for Eczema
The prices of eczema medications vary, and depending on the severity of your case, they can add up quickly.
For a mild case, you may end up paying less than $50 a month for a moisturizing cleanser, moisturizer, and over-the-counter hydrocortisone cream, according to Cost Helper Health.The costs for more severe cases can range from less than $20 a month for an oral steroid medication to up to $500 or more per month for an immunosuppressant cream, before insurance, per Cost Helper Health.As of January 2021, the list price for a month of Dupixent injections was just over $3,200, according to the manufacturer, although very few patients pay the list price.
RELATED: Do You Need a Topical Steroid to Treat Eczema?
Managing Your Work Life With Eczema
Eczema can affect how, when, and where you work. About 15 percent of the workday can be impacted by symptom flare-ups on average, according to a study published in August 2018 in JAMA Dermatology. Regardless of disease severity, people with the disease are more likely to take five or more days off work each year compared with their coworkers not affected by eczema. For some people, that can mean having to work from home or otherwise have special accommodations at work, such as avoiding contact with irritating chemicals, notes the NEA. You may need a doctor’s note for your employer, something that Yu says he has written for patients. Clearly communicate what you need and why so you can navigate work with eczema successfully.
Can You Apply for Disability if You Have Eczema?
If your eczema symptoms are severe enough, you might investigate applying for Social Security Disability Benefits. “Skin disorders are included on the list of disabling conditions, but whether or not you meet criteria for disability depends on many things, including symptoms, severity, frequency of flares, and treatment needs,” says Darr. “The Social Security website lists disabling conditions, criteria, and information on how to apply for disability. When you apply, you will need medical documentation to support your claim.”
Dan Chojnacki: The Right Medication Made the Difference
From creams that made my skin sting and burn as a child to oral corticosteroids that made my stomach turn as an adult, eczema has become part of my identity, against my will. I’ve tried seemingly everything from both the holistic and medical realms. There were homemade lotions containing essential oils, oatmeal baths, diet changes, red light therapy, cryotherapy, and many more nonmedical things I tried. Then, cortisone cream, oral corticosteroids, and countless other medical options might have worked temporarily, but the symptoms returned after a while or if I stopped taking them. My symptoms severely affected my job. As a personal trainer and group fitness director, I spend a lot of time working out with others. My ability to do so was limited because if I couldn’t shower immediately, I would have a severe breakout. In 2014, I began to deal with staph infections, which doctors believed were caused by bacteria entering my body through areas of open eczema. Given that a gym is the perfect place to pick up a staph infection, I dealt with dozens over a four-year period. This pain was unbearable. Fast-forward to today. My eczema symptoms are mild and under control. I met a fantastic physician assistant who prescribed Dupixent. As this medication comes with a very high price tag, I was concerned because I could not afford it. My PA, however, went above and beyond to get me on a patient assistance program that helps pay for it. I still deal with eczema symptoms, but they are so much more manageable than I ever could have imagined. For me, this has been a life-changing chapter. Dan Chojnacki is a certified personal trainer in Green Bay, Wisconsin.
Rashida Brown: A Change in Diet Was Pivotal
Living with eczema since I was a young girl has not been an easy, fun journey. I wish others understood how miserable eczema can make a person feel. Not only that, but how it can tear down a child’s or adult’s self-esteem depending on how severe it is. It’s also a frustrating thing at times, especially during seasons of flare-ups. During my time of flare-ups I’m extremely itchy, like uncontrollably sometimes. The breakouts start to appear in places they weren’t before and it makes me have dark patches on my skin. I currently manage my eczema using cream from the dermatologist periodically, but I also use Aveeno cream and washes. That helps keep it under control the majority of the time. The biggest accommodation that had to be made was my changing diet, which played a huge role in flare-ups and breakouts. I had to eliminate the amount of fast food I was eating and incorporate more greens and fruit into my diet. My advice to others with eczema is to stay encouraged and not allow it to tear down the amazing person God has created you to be. Brown is a fashion designer and publicist in Dallas. RELATED: How the Keto Diet May Help or Harm Eczema
How to Find a Clinical Trial
The National Institute of Allergy and Infectious Diseases lists clinical trials relating to eczema that are seeking participants. Go to the page and click on each study headline for details about how you can become involved.
What to Consider Before Joining a Clinical Trial
Before signing up for a clinical trial, take a look at several informational videos about clinical research participation provided by the U.S. Health and Human Services Department’s Office for Human Research Protections, so you can know what to expect and what to ask. For instance, you’ll want to know how you’ll be protected and if you will benefit personally from the research.
News and Research on Eczema
There are newsworthy developments in the treatment and management of eczema all the time. Some of the best resources for staying up on the latest are below.
NEA: Eczema Treatments in DevelopmentNews and Events: Eczema SocietyHealio DermatologyBlog and News: Asthma and Allergy Foundation of America
Eczema Awareness Day and Month
World Atopic Eczema Day Is September 14, 2021
World Atopic Eczema Day has been celebrated internationally on September 14 since 2018, though it is not observed in the United States, notes the International Alliance of Dermatology Patient Organizations.
Eczema Awareness Month Is October
Each October, organizations in the United States, such as NEA and the AAFA, spread awareness about eczema, new developments for relieving symptoms, and ways to tackle the stigma. The following blogs, apps, and social media accounts can help you to plug into what’s going on with yourself, and with others.
Best Eczema Blogs
It’s an Itchy Little WorldItchin Since ’87NEA: My Journey
Best Eczema Instagram Accounts
@eczemalove@itchin87@nationaleczema
Best Eczema Apps
Eczema TrackeriControl EczemaCara Care Food Symptom Tracker
With all these resources in mind, know that there are many ways to make life with eczema easier. And remember, says Darr, while the disease can sometimes leave you feeling powerless, there is so much in life that you do have control over: “Your eczema is just one part of you.”
