Eczema in warm weather

Warmer weather can be both a blessing and a curse if you have eczema – some people see a marked improvement in their skin, while others experience a decline. So what steps can you take proactively to help?

Stay safe

Be ‘sun smart’ by applying sunscreen, staying in the shade between 11am and 3pm, wearing clothing that offers additional protection (such as long-sleeved tops or items that have built-in UV protection) and putting on a hat and sunglasses.

Seek shade

But don’t rely on it! Even if you’re sitting completely in the shade you are still indirectly exposed to the sun’s rays when they are reflected off surfaces such as water, sand and concrete. Always protect your skin, even in the shade.

Avoid dehydration

If you have eczema, moisture loss is already a significant issue for your skin. Warmer temperatures therefore mean you need to take on more liquids to ensure your body stays well hydrated.

Avoid extremes of temperature

Try to maintain an even body temperature, i.e. don’t go directly from an air-conditioned office to a sunny park on your lunch break.

Keep your cool

Sweat can be a huge irritant for those with eczema so choose clothing that allows your skin to ‘breathe’, such as loose-fitting garments made of natural fibres.

Don’t fry

If you are using a moisturiser that is greasy or oily, be careful not to overdo the application of the moisturiser as this can cause a ‘frying’ effect in the sun. Leave a gap of at least 30 minutes between applying emollient and sunscreen to ensure that the sunscreen retains its protective properties.

Review your medication

Many drugs, including some used to treat eczema, can cause phototoxic reactions so be sure to review the patient information. People who are using topical calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) are advised to protect the treated area from sunlight (by covering up or applying sunscreen) to avoid the theoretical risk of developing skin cancer.

Plan in advance

Sun cream is one of the biggest sources of frustration for those with eczema and needs to be tackled early:

• While a product may have suited your skin the last time you bought it, always check if the formulation has changed before buying it again.
• If you find something that works, consider stockpiling a few bottles in case the manufacturer suddenly stops making it – always monitor the ‘use by’ dates though.
• If you’re still seeking that elusive ‘good fit’ with your skin, approach brands about supplying you with a sample to try prior to purchase and test it on your inner arm once a day for 5 days.
• Many people with eczema find that mineral-based sunscreens are less irritating than chemical absorbers, but this isn’t true for everyone.
• Unperfumed products are less likely to trigger a flare.

More tips can be found on our Sun and eczema page.

NHS England and NHS Improvement have produced a helpful video on taking photos of your skin to send to your GP before an appointment.

We have further information about preparing for a remote dermatology appointment here, which contains advice that you are also likely to find helpful for a GP appointment.

The following tips are taken from the video above. Some have been amended slightly to be more relevant for people with eczema.

Taking photos of your skin and sending securely to your GP

By sending in your photos, you are agreeing to the photos being saved to your GP records, and to the photo being sent on to other healthcare professionals, such as a dermatologist, for expert advice. Let your GP know if you do not want this to happen, or if you would like the photo to be deleted from your GP patient record after review.

It is not recommended to include photos of intimate areas of skin, such as the groin, breast or buttocks, either of yourself or of a child under 18-years-old.

How to take the best-quality photo

• Try to find someone to help you, such as a family member or friend. It’s much better if someone else takes the photo. If not, you can take the photo yourself using a smartphone or digital camera.
• Make sure the area to be photographed is held still, ideally by resting it on a surface. If possible, use a plain background against the skin. Avoid shadows and any background distractions.
• Take the photo in a well-lit room with lots of natural light, but avoid direct sunlight. If this is not possible, you may have to turn the flash on to help light up the area.
• The photos need to be sharp and in focus. To use auto-focus using a smartphone, tap the screen, which will create a yellow square or circle around the area of interest. Focus is more important than how close-up you can get.
• Don’t edit or add filters to your photos, as this could affect diagnosis. The affected area of skin needs to look the same on the screen as it does in real life.

How many photos should you take?

Please take two to three pictures to show the shape and size of the area. This will enable an accurate diagnosis or assessment.

The first photo should establish the area on your body from a distance. The second photo should be a closer photo of the area of concern. If this is a rash/area of inflammation, take a photo of the worst affected area. If different areas of the body are affected, photos of the different areas will also be needed, for example, on the face, as well as on the body.

Do a check before sending the photos

• Be sure to review your photos before you send them to your GP. Make sure they are the best quality possible and represent your skin condition clearly without any distractions.
• Next, check the file size. The ideal size per photo is between 500KB and 1MB, and the total file size for all images sent in must be less than 5MB, as NHS uploads are restricted to 5MB.
• You will have been told where to send the images, which may be by responding to a secure text message sent from your GP practice, or through the GP practice website, or a secure practice email address.
• Remember to include your own or your child’s name and date of birth in the email.

By sending a photo to a healthcare professional, you must be aware that no communication system can guarantee complete security, and there is a small possibility that the message could be intercepted by a third party.

Claire Moulds looks at ways to proactively improve your eczema routine. This article was published in Exchange 177, September 2020.

With all the pressures of life, it’s understandable to focus on ‘what needs to be done’, sticking to the care regime that you’ve come to rely on, hard won through trial and error. But if your eczema is not as well controlled as you’d like, it’s worth considering a new approach.

Do your research

For real change to happen, you need to identify specific areas and actions. A vague commitment to ‘eat more healthily’ won’t deliver the desired results if you don’t know what ‘healthier’ looks like.

In eczema, one area where there is often disparity is the amount of emollient people think they are applying, compared with the amount they are actually using. The current recommendation is that an adult should use at least 500g per week and a child 250g, although your dermatologist may recommend you use significantly more.

To check, apply your usual amount for a week, but weigh each application beforehand – don’t ‘guesstimate’. If the total falls short, you need to increase the number of applications per day, or the amount per application. It sounds simple, but applying the right amount can make a huge difference. Knowing how long your normal dispenser should last, at the correct usage rate, is handy for staying on track.

Keep a record

Not all changes deliver immediate results so, to stay motivated, it’s worth keeping a diary with a weekly photo and daily reflections, charting your skin’s progress and how you’re feeling. We know eczema can have a significant psychological impact, so it’s important to monitor your emotional state as well as your physical symptoms. Reviewing your diary might then reveal a cycle where stress makes your eczema
worse > deteriorating eczema makes you even more stressed > increased stress leads to further deterioration, and so on.

Similarly, logging how much you scratch, and why, could help you consciously change your scratch pattern and replace it with less destructive techniques, such as pressing, tapping or pinching the skin, clenching your fists gently or squeezing a squidgy ball. So, try keeping a daily scratch record. Write down at the end of the morning, end of the afternoon, before bed and on waking how much you’ve scratched during that time period on a scale of 1 (not at all) to 10 (constantly). Alongside, note anything that contributed to that bout of scratching and anything that helped bring it to an end, so you can build up a picture of triggers and solutions.

We often scratch unconsciously, so also ask your family, partner, friends and colleagues (if you feel comfortable to) to feed back on what they’ve noticed about your scratching, what triggers it and how you manage it. This can be particularly enlightening. You may be unaware that you scratch while watching TV, when you have your head buried in a report at work, or when you’re just back from the gym.

Knowing this can help to break the itch–scratch cycle – for instance, you might choose to go straight to the shower when you come home from the gym rather than chatting (and scratching) with your housemates.

Make it a habit

A habit is created when something becomes the norm so that we do it almost automatically. Turning positive new behaviours into habits is key to establishing change in our lives and one good way to do that is to pair the new behaviour with an existing habit.

For instance, we all know the importance of moisturising our body from the inside out, by drinking more water. One method of achieving this is to link drinking water to a frequent feature of your day. For example, you could drink a glass of water every time you eat or whenever you take a break from what you are doing.

Equally, keeping your fingernails short and filed, to avoid sharp edges, will lessen the destructive impact of scratching. Why not pair nail care with a weekly event, such as your favourite TV programme?

Research shows it takes around two months for a habit to become ingrained. So, it’s crucial to be consistent and stick with a change until it becomes automatic. Two months might seem like a long time and hard work, but you’ll enjoy the benefits for the rest of your life!

Create space for improvement

‘I don’t have the time’ is a common reason people give for not making changes. Yet it’s fair to say most of us probably don’t use all of our hours productively.

The key is to ringfence certain times where you prioritise your needs:

• Make sure you know exactly how much time you need in the morning and evening to properly care for your skin, and what needs to happen to ensure this isn’t rushed or interrupted. For example, does your partner need to look after the children more to make space for this?
• If stress is a trigger, commit to a specific time each day to check in with yourself and make time for practising relaxation techniques, breathing exercises or mindfulness.
• While a good night’s sleep is soothing to mind and body, a bad night can leave our skin, and our minds, on edge. Set a regular bedtime and practice sleep hygiene. Avoid heavy meals, caffeine and alcohol in the hours before sleep, make your bedroom as dark and quiet as possible, and ban TV and mobile devices two hours before lights out.

Be kind to yourself

One of the reasons new year’s resolutions fail is that they often involve multiple major lifestyle changes. Instead of being overambitious, focus on making small, manageable tweaks in order to deliver genuine, long-lasting change.

Accept from the beginning that you’ll have the odd ‘off’ day and be kind to yourself, acknowledge the blip and get back on track straight away. Recognise how far you’ve come and start the next day afresh.

Instead of tying a reward to your end goal, give yourself treats along the way to mark your progress. This can be particularly helpful when trying to motivate young children, who won’t necessarily understand how change will help their skin long term. But us grown ups need incentives too!

We know how important it is for people to see photos of real people with eczema on our website and social media channels. It’s also important that we show people of different ages, sexes and skin colours with eczema, so everyone with eczema can see themselves represented.

Would you be willing to send us a photo of your eczema, that we can use to illustrate our social media posts and website articles?

We are looking for photos of:

• Eczema on the eyelids
• Eczema on the ears
• Eczema on the face
• Eczema on the hands
• Eczema on the arms
• Eczema on the legs
• Eczema on the feet
• Discoid eczema
• Pompholyx eczema
• Seborrhoeic dermatitis

Photos need to be:

• Clear and detailed, with a high image resolution
• Taken against a plain background (if the background is visible)
• Suitable sizes for use on Instagram, Facebook or Twitter (i.e. 1080 x 1080 or 1200 x 630 or 1024 x 512 pixels). Photos don’t need to be these exact dimensions, but if they are very different we may need to edit them slightly (e.g. by cropping them)
• Of eczema that has been diagnosed as eczema by a healthcare professional

Please send your photos to info@eczema.org with your completed consent form.

We really appreciate your help!

Having good quality photos of people with eczema will significantly improve our content by giving a better idea of what different types of eczema look like on different demographics of people.

National Eczema Society has heard from many parents who are worried about the impact of using hand sanitisers and increased hand-washing when their children go back to school. We have some tips for managing hand eczema in light of these precautions below, and an information sheet here, that you can print out and show the school.

• Parents/carers may need to discuss with the school before term or on the first day of term the importance of children being able to bring their own soap to school and double-washing (washing first with soap for 20 seconds and then with emollient). If your child has an Individual Health Care Plan for managing eczema in school, the hand-washing instructions should be amended.
• We advise that children bring their own soap to school, as soap from a dispenser could contain ingredients that are harsh on the skin. Brands of soap recommended by people with eczema on our social media channels included Dove, Faith in Nature and Simple. Olive oil soaps were also recommended.
• Children should bring emollient with them to school and apply it after washing their hands as well as at other times during the day. Provide your child with a travel-sized dispenser (available from bigger pharmacies and online), and decant their preferred emollient into it. They can keep this in their pocket for washing and moisturising at school.
• If your child’s hands start to get sore or cracked due to frequent hand-washing, ask the school if they can wear cotton gloves – remember to apply lots of emollient underneath the gloves and provide two pairs, which the child should change at lunchtime. We list suppliers of 100% cotton gloves in our Clothing stockist list.
• Do keep treating flares of hand eczema with prescribed topical steroids (which can be applied once a day at home, ideally before bed). If hands are sore from the school day, apply an ointment emollient before bed and wear cotton gloves overnight to re-hydrate and restore the skin, ready for school the next day.

If you encounter difficulties with the school, we have an information sheet here that you can print out to show the school. This describes the impact hand eczema can have on children, and explains how schools can support the medical needs of children with eczema, allowing them to fully participate in school life.

We are ‘Unmasking Eczema’ during National Eczema Week this year, from 12-19 September 2020.

Most people have heard about eczema, but few truly understand just how painful and difficult this complex long-term skin condition can be. It’s only if you, or someone in your family has eczema, that you truly know how it can impact every aspect of your life.

This is why, during National Eczema Week, we are unmasking the truth about eczema and releasing the findings of a major new survey* undertaken in collaboration with LEO Pharma. We asked adults with eczema and parents of children with eczema a range of questions, to better understand the day-to-day and longer-term impacts of living with the condition. Over 1000 people responded to this important new survey, which was conducted by the independent market research company Savanta ComRes.

Our charity has been supporting people with eczema for over 40 years, but even we were shocked by the survey findings that lay bare the devastating human cost of eczema. They show how eczema can profoundly affect your physical health, your mental health, your overall quality of life and even your life chances. These realities often remain hidden or are unspoken, but people are left suffering.

In the survey, 89% of adult respondents said that having eczema had significantly reduced their quality of life. Nearly half said eczema had affected their education and 28% reported it had had a negative impact on their career. Three-quarters of adults said eczema had negatively impacted their mental health, leaving them feeling depressed, anxious, helpless and socially isolated. The emotional challenges of eczema can be especially cruel, with 1 in 10 adult respondents saying a romantic relationship had ended because of their eczema.

A quarter of children with eczema were reported to have low self-esteem, with many parents saying that the condition affected their child’s ability to make and maintain friendships. Attendance and performance at school, feeling self-conscious, being bullied and not sleeping were other commonly cited concerns. This survey also highlights the wider impact of eczema on families, with a third having to regularly cancel family activities or trips because of their child’s eczema, while 1 in 5 parents felt it had damaged their relationship with their other children.

We asked people about their experience of healthcare and, while there were many positives, there were also worrying findings. Some 40% of adults and almost the same number of parents said they felt let down by their healthcare professionals when it comes to their eczema. This reflects the lack of effective treatments and complexity in treating eczema. Over half of adults and 40% of children had never been offered an emotional or psychological support service by an NHS doctor to help them cope with the mental health impact of their eczema.

Through sharing these findings, we want to empower people to talk about eczema, knowing that others are going through similar experiences, and to seek the care and support they need. We also want to improve public awareness of eczema’s gruelling impact on daily life and build greater understanding of the condition. The survey also provides a deeper understanding of eczema for healthcare professionals, so they can deliver more effective holistic care.

Watch out for inspiring posts and video content on our social media channels during the week. Please share these and help us spread the word to Unmask Eczema!

For more information about the survey results, please email info@eczema.org

• The Eczema Unmasked report is a collaboration between the National Eczema Society and LEO Pharma. LEO Pharma has provided core funding, editorial input and undertaken survey-based research to support the development of the report. The content was approved by National Eczema Society and reviewed by LEO Pharma to ensure compliance with the ABPI Code of Practice.