It is dry. It itches. It drives you crazy But is your problem just dry skin or is it eczema, also known as neurodermatitis?
“The difference between dry skin and eczema is the presence of inflammation,” Dermatologist Joshua draftsman tells HuffPost. “With eczema, the skin barrier doesn’t work as well as it should, which leads to moisture loss and disruption of the outer layer of the skin. If your skin is red, itchy, and flaky, it’s probably more than just dryness and you probably have eczema. ”
Another clue is where these dry, itchy patches are. “The antecubital fossa (elbow folds) and the popliteal fossa (hollow of the knee) are most frequently affected,” says dermatologist JiaDe (Jeff) Yu explained. (And you now know two new body part names, so you’re welcome.)
A key difference between the two conditions is that eczema continues to get worse if not treated properly, according to Vivian Shi, a dermatologist and associate professor in the Department of Dermatology at the University of Arkansas for Medical Sciences. “It can cause severe symptoms like cracking, skin thickening, and increased itching,” she says. “People with eczema are also more prone to skin infections from a bacterium called sTaphylococcus aureus.”
What causes eczema?
“Eczema is caused by a deficiency in one of the proteins that make up the top layer of skin,” explains the dermatologist Julie Russak. “The skin is designed as a protective barrier for our body, with proteins that act like glue and hold cells together. If there is a mutation in the proteins that hold the cells of the top layer of skin together, the cells start to break down and the skin can no longer act as a protective barrier. “
What makes your skin glow?
“It can be triggered by cold weather, stress, infection, and illness,” says Yu. “And in most people, it affects more than the skin, as it has been shown to be linked to depression, insomnia, and other conditions.”
The good news is that there are some things you can do to help. You need to be careful of anything that might affect your skin first.
“We need to look carefully for irritants that can damage the skin barrier and even cause irritation,” said Peter Lio, dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern University’s Feinberg School of Medicine. “Among other factors, you could also consider things like frequent washing, the use of hand sanitizer, and certain chemicals that you could be exposed to at work or at home.”
When should I go to the dermatologist?
“If your skin is dry and itchy and doesn’t get better with good, thick moisturizers, then it’s time to see a certified dermatologist,” says Yu. “This doctor can offer you targeted therapies that are appropriate to the location and age.”
Are there any products that can help?
“The care regimen for dry skin and eczema is similar in that the goal in both cases is to repair and protect the skin barrier to prevent water loss from the skin,” says Shi.
So start with what you would do with dry skin. Yu suggested thick moisturizers that would help prevent water loss from the skin, especially in drier and drier conditions.
“In general, you want to choose a product that has very few ingredients and ideally contains ceramides.” Pediatric nurse Sam Casselman advises. “These are the proteins that repair the skin barrier and soothe dry skin, so use this moisturizer with ceramides as often as possible. For stronger, dry skin, take a thick, petroleum jelly-based alternative. “
Eczema, or atopic dermatitis, is characterized by the presence of inflammation that typical dry skin does not have.
When and how often should I use topical treatments?
After purchasing a moisturizing product, it is important to use it regularly. “The brand of the product may not matter as much as how liberally you use it,” says Shi. “Make sure you use it several times a day, especially after you shower.”
Your skin covers you all so you have to take care of everything at the same time. “Treat not only the areas where you have active eczema, but also the rest of the skin, as your skin barrier does not work optimally everywhere,” says Drake.
While you should be generous with over-the-counter moisturizers, use caution when using a topical prescription as a preventative measure. “It’s a very common mistake that people keep using topical steroids even after a flare has wore off,” says Casselman. “Research is unclear as to whether topical steroids applied to chronic areas of eczema will prevent them from flaring again, and the risk of chronic use of topical steroids on healthy skin outweighs that potential risk.”
Even so, timing is everything, and if it comes to a flare up, you want to track it right away, says Casselman. “A common mistake patients make with prescription topical products is waiting for an eczema flare to go ‘bad’ before using them. If you wait to receive treatment, the inflammation and itching will continue to worsen and can become very intense. If you treat early and effectively, you will shorten the time it takes for an eczema flare-up and you are likely to take less medication in the long run. “
Are there any new treatments?
Russak said we now know that eczema “is a chronic genetic immune-mediated disease,” and recent clinical and genetic studies have helped explain this. “That means there are new targeted therapies that use small molecules to block specific pathways for eczema development and flare-ups.”
One of the more promising new topical treatments in the US is Ruxolitinib cream. “It targets and blocks a special marker of inflammation in the skin called janus kinase,” explains Yu.
Another product dupilumab, is the first biological drug for moderate to severe atopic dermatitis. “This was a turning point for those with eczema that is more difficult to control,” says Lio. “Because it’s not an immunosuppressant or a steroid, it can be an important option for those stuck in a drug loop that could have more serious side effects.”
There are probably more treatments on the way. “We dermatologists are really excited because after a seemingly endless drought of new treatments for eczema, we are finally seeing an incredible explosion of new drugs,” says Lio. “With topical therapies, oral drugs, and even injectable drugs, we finally have a pipeline of more than 100 therapies under development.”
While these drugs are good news for many, you may not need them. “For many of the milder cases, the new drugs are probably unnecessary,” says Lio. “More traditional therapies like good moisturizers, topical corticosteroids, topical calcineurin inhibitors, and crisaborol may be enough to keep things under control and do it safely.”
what else can I do?
“Stick with ultra-gentle, soap-free cleaning agents,” says Konstruner. “I recommend Dove Sensitive Skin Body Wash, which is extremely mild cleansing actives in a formula that contains the same type of moisturizer found in traditional moisturizers.”
“My favorite option is simply Vaseline Vaseline,” says Yu. “It is highly effective, has a low profile of side effects and is very cheap. It is similarly effective when compared to other much more expensive topical moisturizers. “
“Think about everything that comes in contact with your skin, from topical creams to the clothes you wear,” says Russak. “Try to maintain a relatively cool, neutral humidity environment in your home. Use a humidifier in winter if you are prone to dry skin and eczema. I recommend fragrance-free detergents for sensitive skin. And some people find it helpful to keep their moisturizers in the refrigerator for a cooling effect. “
Will my eczema ever go away?
The good news is that there are many treatment options. The bad news is that eczema is a chronic condition and at most you can expect to treat it well with only the occasional flare-up.
“A complete cure is not possible in most cases, since eczema usually presupposes a genetic predisposition,” says Casselman. “In my practice, I focus on educating patients about what help they need and how I can support them.”
Shi urges patients to prepare for “careful long-term care”.
“Even if your skin looks calm and doesn’t have an active rash, it can still cause underlying inflammation and problems with the skin’s protective barrier,” says Shi. “It’s important to keep up with your hydration routine and schedule long-term care with your dermatologist.”