More women than ever are suffering from adult onset eczema. But it’s affecting more than just their skin…
Like Care Bears and stabilisers, you might think your childhood days of eczema are well behind you but the infuriatingly itchy skin condition is having an unwelcome comeback among adults – especially women.
Worse, even if you were lucky enough to escape eczema as a child, you could still find yourself developing the telltale sore, scaly patches as a result of stress or contact with the endless environmental irritants around us. In the Stylist office alone, five women have developed the condition as adults and experienced the incessant itching, medical appointments and social anxiety caused by the condition.
An estimated 15 million people in the UK are now affected by eczema, or atopic dermatitis as it’s also known. This is more than double the amount of sufferers identified a decade ago and is commonly blamed on increased pollution and use of water and harsh detergents which can exacerbate the condition. Eczema is still primarily associated with children but one in 12 sufferers are adults and, according yo a study by Mintel, it affects more women than men. The reasons for this are complex but it is believed that this disparity may be partly due to changing hormone levels in women during pregnancy and at different stages of their menstrual cycle.
Physically, eczema causes areas of skin on the face and body to become irritated and bumpy. In the longer term the affected skin can look and feel leathery and result in open wounds and scarring. But it’s the effects it can have on everyday life and mental wellbeing that make it so damaging.
A report by Allergy UK has discovered that 88% of those with eczema say it has a daily impact on their lives. “People with eczema have higher rates of anxiety and depression when compared to those without skin conditions,” confirms psychodermatologist Dr Alia Ahmed. “Lifelong eczema is associated with emotional deprivation, social isolation and feelings of defectiveness.”
This comes as no surprise to journalist Moya Lothian-McLean. “Having eczema has made me feel self-conscious and unattractive. When it came to dating, it undeniably hindered me. I thought I looked like a hideous monster and I would make sure I was the first to point it out or make a joke about it.”
For communications manager Nisha Smith, 31, eczema has had a detrimental impact on her work and social life. “When the patches are at their worst on my face, I work from home – I’m lucky my company has a relaxed policy,” she says. “Once, when I thought I had the patches covered with make-up, I attended an event and someone rubbed my face thinking I had smudged lipstick. It was so embarrassing when it didn’t rub off.”
During a particularly serious eczema flare-up, Stylist’s deputy editor, Gemma Crisp, who developed the condition aged 35, says, “The weeping wounds were so bad I was mortified whenever I had to shake hands with anyone. I was sure people would judge me.”
The term ‘eczema’ comes from the Greek word ‘ekzein’, which means ‘to boil over’ and describes the dry, itchy skin that comes with the condition. It comes in cycles and can affect any part of the face and body, but usually appears near pulse points (which tend to be warmer than other areas of skin) on the wrists and hands, insides of the elbows and backs of knees, as well as the neck.
Outbreaks can vary in levels of severity from mild, which appears as dry, flaky irritated patches, through to severe, which presents as stiff, cracking swathes of skin with open wounds. There are several types of eczema but it’s mainly caused by genetic factors, an overactive immune system or coming into contact with antagonistic irritants including certain soaps, perfumes, dust and chlorine.
Atopic eczema, the most common type, is triggered by hypersensitive allergic reaction and tends to run in families.
“You’re more likely to develop atopic eczema if one or both of your parents has it or another type of atopic condition, like asthma or hay fever,” says Alice Lambert, director of services at the National Eczema Society (NES). “The body’s immune system overreacts to things that wouldn’t normally harm us, for example, pollen or dust mites.” On top of that, eczema is also one of a few dermatological conditions that can be exacerbated by emotion.
With two of the most commonly reported sparks for breakouts being stress and anxiety it’s little wonder that we’re seeing a rise in the number of women experiencing eczema today. “Stress activates the hypothalamic pituitary adrenal axis in the brain, which results in the activation of pathways of inflammation that cause or drive eczema,” explains Dr Ahmed.
It was a period of stress that lead to both Crisp and Smith’s problems. “My eczema was very sudden. I never had anything as a child, but in the lead up to my wedding, red, scaly patches started to appear over my face, chest and body,” Smith says. The stress of exams also triggered a worsening of Lothian-McLean’s condition.
“I didn’t have any major flare-ups until I hit my A-levels. I developed patches of dry, itchy skin on my hands and around my eyes. My hands and wrists were fully covered and I looked like I permanently had a cold, thanks to the perpetually red and cracked area under my nose.”
Since then stress-related flare-ups have become a regular feature of her day-to-day life. “My eczema is an emotional weather vane. If I’m really under strain, there’s one particular red swathe that appears across my jaw. Unfortunately, it’s very hard not to be stressed. It underpins everything.”
The number of different elements that can cause eczema in adults and the fact that triggers vary significantly from person to person can make it particularly difficult to diagnose and treat. Is air pollution causing irritation? Is it an allergy to a pet? A highly scented soap? The stress of a new job? Even coming down with a cold can cause a flare-up.
“My GP initially diagnosed me with ringworm and I was given an anti-fungal cream,” says Smith. “I bought anti-fungal shower gels, disinfected my whole house and even had my cats tested for ringworm.” After two weeks using the cream, and with negative results from her vet, Smith’s irritated patches continued to grow until she consulted a different GP and only then was her problem identified as eczema.
But the story of eczema doesn’t end with a diagnosis. There is currently no known cure for the condition and because so many factors are at play – genetics, allergies, emotions – sufferers face a long, complex search for an effective treatment.
Emollient therapy, where fragrance-free moisturisers in the form of creams, lotions and gels are regularly applied to the skin, is a common first step to soothing outbreaks. By keeping skin supple they help prevent cracks. Replacing dehydrating soap with an emollient substitute and ditching irritating bubble bath for a soak in colloidal oatmeal (made from oats that have been boiled to extract their skin-healing properties) will also ease skin dryness.
An insider tip from fellow sufferers is to apply emollients within three minutes of having a shower or bath to lock in moisture before the skin has a chance to dry out. And keep the temperatures of the water low as a raised body temperature can exacerbate itchiness.
The itch you can’t scratch
At the top of the list of solutions offered by GPs are prescribed steroids. These are used for short bursts to reduce inflammation and can be very effective when flare-ups are at their worst. “Topical steroids come in four different levels of potency, which are determined according to the severity of the person’s eczema and its location on the body,” explains Lambert.
The concern comes when eczema continues over a longer period of time. Topical steroids rarely cause significant side effects but if used incorrectly, they can contribute to thinning of the skin, loss of pigment, bruising and hair growth, so they are generally used as a short-term solution.
“Steroid cream has started to work for me,” says Smith. “I’ve also stripped back my skincare regime. I try and avoid any active ingredients, and lukewarm showers rather than hot seem to be helping too. However, I’m increasingly aware that the steroid cream is becoming a crutch and that I need to address my stress levels for the longer term.”
Looking at food intake can be another route to calmer skin. Intolerance to common allergens like dairy, gluten, citrus fruits, eggs, peanuts and alcohol can exacerbate eczema so identifying any foods that cause irritation can be a game-changer. Nutritional therapist Angelique Panagos says, “You may need to work on a process of elimination [of a certain food] then challenge testing where you reintroduce the food to see if it makes it better, worse or has no effect at all.”
And for a condition so closely associated with emotional distress, it makes sense to consider a psychological approach to treatment. Habit reversal therapy, where mental techniques are used to disrupt the repetitive itch-scratch cycle of behaviour, can be self-taught or accessed through dermatology specialist nurses and psychologists.
“It’s a type of cognitive behavioural therapy that teaches people to recognise feelings of itch and then modify their resultant behaviour (ie scratching) or replace it with an alternative behaviour, such as tapping the skin, that does not result in further damage,” explains Dr Ahmed.
For Lothian-McLean, the search for a solution is ongoing. “The most effective overall treatment is steroid creams and tablets but they are unsustainable,” she says. And while she’s managed to have success with high street purchases, it hasn’t been a cheap journey.
“I’ve tried every single specialist cream, ointment and oral spray going. I’ve spent hundreds of pounds. At any one time, I’m using about three different products because the eczema on my face and the eczema on my body don’t respond in the same way. The admin that goes into having eczema is draining. Even when I pop out of the house for five minutes, I need to take a pot of cream with me or I’m flaking everywhere. I’m constantly smeared in cream.”
Thankfully, scientists are now in the process of developing new non-steroidal ointments and even an injectable drug called Dupilumab for the most extreme cases, so the future for eczema sufferers does look a little brighter – and a lot less itchy.
The best eczema soothing products
Bria Organic Balm
Nourishing rosehip oil and beeswax make this multipurpose balm perfect for sensitive skin.
£14.95, Bria Organics
Grahams Natural Body & Bath Oil
Apply this oil to your hands – it’ll create a barrier to protect skin against frequent washing.
£13.99, Lloyds Pharmacy
Green People Sensitive Scent-Free Shower/Bath Gel
This ultra-gentle shower gel is free of irritating essential oils.
£12.50, Green People
SVR Topialyse Balm Spray
Packed with emollient ingredients, this easy-to-use body spray takes a matter of seconds to apply.
£15, Look Fantastic
Cetraben Natural Oatmeal Cream
This moisturiser includes oatmeal, an ingredient long praised for its soothing properties.
Lavera Netural Cleansing Foam
Lavera’s pH-netural cleanser removes dirt and make-up without stripping the skin.
£6.45, Ecco Verde
Image credits: Getty Images