From tell-tale triggers to must-have creams: Eczema expert reveals his 5 top tips on how to manage flare-ups 

The itching and burning of eczema can be excruciating, and it is a reality that affects one in 12 British adults. 

Some have had it all their life – a fifth of children develop eczema, usually before their first birthday.

For others, it comes on suddenly later on in life.

Either way, understanding how to control flare-ups is difficult.

With eczema, your skin cannot produce enough essential oils to form and maintain its natural protective barrier.

This drop in moisture causes skin cells to shrink, as would a dehydrated piece of fruit. 

One in 12 British adults suffer from a kind of eczema – patches of sore, irritated, red, itchy skin

Normally, when your skin is adequately hydrated, it is full, bouncy, and the skin cells are pushed together to form a protective wall.  

By shrinking, the cells leave gaps between one another, causing the skin to become dry and cracked, creating gaps for dirt, bacteria, viruses and fungi.

But there is not one set trigger for this happening – and therefore not one set treatment. 

Eczema is a catch-all term for three kinds of skin conditions: atopic dermatitis (the most common; chronic; inherited), contact dermatitis (a reaction to material), and dyshidrotic eczema (specific to hands and feet).

All three are characterized by patches of sore, irritated, red and itchy skin, but have different triggers that cause them.

Advice on how to handle flare-ups has see-sawed wildly over the years.

Some doctors insist on steroid cream as the only viable option. Others may advise changing your diet.

As the chair of the Dermatology Council for England, Dr George Moncreiff has seen and heard it all when it comes to eczema. 

Here, he shares his wisdom on how to handle your flare-ups:

1. STRESSED? CLEANING? KNOW YOUR TRIGGERS 

Atopic eczema often runs in families and develops alongside other conditions such as asthma and hay fever. 

However, there are often other triggers which can be controlled or managed.

The triggers for flare-ups can be different for each person, but there are a few that are most common:

Infections: Eczema is a vicious cycle once the skin is broken and vulnerable to attack by bacteria. When a person with eczema scratches, this only causes further skin damage.

Allergies: A lot of people think that food allergies cause their eczema, but this is uncommon. Allergies to things that your skin comes into contact with are more common and this may trigger a flare.

Aggravated skin: So much of what people use on their skin today is unnatural, and the skin hasn’t evolved to protect itself against them. Regular use of detergents can damage the skin’s natural barrier catastrophically.

Emotional stress: There is a definite connection between stress and eczema flare-ups, which can be another vicious cycle as having a bad flare-up can be incredibly distressing.

• Women who have their first baby after they turn 25 are ‘more…

  A high fibre diet stops you from getting ill by preventing…

2. DO NOT MISS A CHECK UP 

Your local pharmacy team will have a good understanding of eczema symptoms and the range of treatment options. 

Regular check-ups with the pharmacy team as well as your GP can therefore help manage the condition more effectively. 

It’s also important to know your own skin and what works for you.

There are a range of treatment options available, and your pharmacy team or GP can always provide advice on what may work best for you. 

It is important to remember eczema is a medical condition and it is incredibly important that you use the product that suits your skin, so if you know what will or won’t work for you, make sure you have that discussion with your GP or pharmacist. 

Per NICE guidelines, patients should be offered a choice or preference for emollients when they consult their GP.

The skin barrier is broken, leaving your skin vulnerable to bacteria, irritants and potential allergens which can pave the way for infections and inflammation

3. CLUE UP ON THE PRODUCTS OUT THERE

Emollients are applied directly to the skin to reduce water loss and cover it with a protective film. 

Ideally you should look for emollients that are free from sensitisers, such as Sodium Lauryl Sulphate (SLS), parabens and fragrances which may result in skin irritation and can increase the chance of flare ups.

If you do have a flare-up, it’s usually important to treat it early and vigorously with a topical steroid and continue to use that throughout the flare up and afterwards to make sure the skin is completely healed. 

Accept the fact that if you apply a cream or ointment to broken skin, it may sting, but it should heal it.

Emollient creams should be used in appropriate quantities; NICE estimates 250g per child, per week and up to 500g per adult, per week. 

People who suffer eczema should be empowered to make sure their GP is giving them an adequate amount of emollient cream and steroid ointment to treat the problem areas properly. 

When applying emollients, always use a pump dispenser and gently rub it onto the skin. 

Without a pump, a tub of emollient rapidly becomes contaminated and your hands can spread bacteria further and prolong the flare-up.

4. PREVENTION IS AS IMPORTANT AS TREATMENT

Although it is important to treat the symptoms of eczema, it is equally important to take measures to reduce them. 

The NHS recommends using your emollient all the time, even if you are not experiencing symptoms.

To make sure your skin’s natural barrier is never broken, the protective layer must be maintained. 

It’s important not to ignore eczema because the itchy, red, dry and cracked skin may be a sign that the skin’s natural protective barrier is damaged. Do not itch it

Using emollients routinely will help this, particularly after washing, when your skin will be most hydrated, emollients can help you lock the moisture in. 

I recommend finding an emollient you like and are comfortable with and use it at least daily. 

Even when you are over a flare-up, your skin is still sensitive, so routine treatment is extremely important.

5. DON’T IGNORE THE SIGNS

It’s important not to ignore eczema because the itchy, red, dry and cracked skin may be a sign that the skin’s natural protective barrier is damaged.

Of all itchy skin conditions – eczema is one of the most itchy.

Having a flare can be incredibly uncomfortable, disturbing sleep and concentration, which can result in work or school absence. A flare-up sets off a vicious cycle in your skin. 

The skin barrier is broken, leaving your skin vulnerable to bacteria, irritants and potential allergens which can pave the way for infections and inflammation. 

Exposure to these proteins through the skin can even lead to someone who is prone to eczema developing allergies.