You may have noticed the new fire warning labels that are being added to emollient packaging. The Medicines & Healthcare products Regulatory Agency (MHRA) has introduced the labelling on all emollients, including paraffin- and non-paraffin-based products.
It is important to understand that emollients are not flammable in themselves, or when they are on the skin. But if bedding, clothing and dressings containing dried emollient residue catch fire, they ignite and burn more quickly and intensely. Any dried-on cream is potentially flammable, including expensive moisturisers.
To catch fire, the bedding and clothing with dried emollient residue must come into contact with a naked flame. The risk of catching fire is highest for people who smoke because they routinely use lighters or matches.
People with eczema should not be put off using emollients because of any misunderstanding of risks. Millions of people use emollients safely every day to manage their eczema and have done so for years. Emollients are a vital first-line treatment for eczema, helping repair and protect the skin barrier. The overall risk of emollient-related fire injuries or deaths is extremely low for those who do not come into contact with naked flames or other potentially flammable heat sources. Doctors and nurses must continue prescribing emollients for eczema – the clinical guidance on emollient use has not changed.
The MHRA reported 61 emollient-related fire incidents including deaths between 2000 and 2018, and in many of these the precise role of emollients was unclear. The majority (around 75%) of the emollient-related fires recorded by the MHRA were caused by lighters, while others involved halogen heaters and incense burners. To set this in context, in England over a 12-month period in 2017-18, there were 7,300 reported non-fatal casualties as a result of fires.
Starting late July 2020, the MHRA is running a publicity campaign about the fire risk of skin creams, including emollients. National Eczema Society contributed to this campaign, which includes a hard-hitting video and information leaflets.
The Society urges people to continue using emollients as advised and take suitable precautions as needed. If you use naked flames and other potentially flammable heat sources, take extra care and avoid using them near clothing, bedding or dressings that may have emollient residue. We also recommend that you wash clothing and bedding frequently, as this is likely to reduce residue build-up even if it does not remove residue completely.
The first ever virtual edition of Prudential RideLondon will take place on 15 and 16 August 2020 to celebrate cycling and raise funds for various UK charities.
Prudential RideLondon is an exciting, free event that will enable riders of all ages and abilities to cycle a range of distances, based on the events included in the traditional Prudential RideLondon weekend (which cannot go ahead as planned because of Covid-19). We hope that our supporters will want to take part in the event and raise funds for National Eczema Society.
My Prudential RideLondon includes four challenges for all ages and abilities which participants can do on a route of their choice, wherever they are in the world, on either 15 or 16 August:
- My Prudential RideLondon-Surrey 100: 100-mile ride
- My Prudential RideLondon-Surrey 46: 46-mile ride
- My Prudential RideLondon-Surrey 19: 19-mile ride
- My Prudential RideLondon FreeCycle: An event that allows you to set your own challenge (starting from 1km) on the wheels of your choice: bikes, push scooters, skateboards, trikes, balance bikes, rollerskates, wheelchairs or anything that is self-propelled (e-bikes are fine too).
Participants need to register in advance and select their challenge at www.myridelondon.co.uk. They can then start fundraising for their chosen charity or charities.
The new My Prudential RideLondon app will be available to download in event week. Every rider aged over 18 who registers will have the option of being entered into a competition with prizes including a brand-new Brompton bicycle, a High5 nutrition bundle worth and top-of-the-range cycling equipment.
Prudential RideLondon first took place in 2013 as a legacy event from the London 2012 Olympics. In its first seven editions, it has become the world’s greatest festival of cycling, with 100,000 riders of all ages and abilities participating in seven different events on traffic-free roads in London and Surrey. It has inspired hundreds of thousands of people to take up cycling or cycle more often and a total of more than £77 million has been raised for thousands of charities.
Given the ongoing coronavirus situation, many hospital dermatology teams are continuing to offer patients ‘remote appointments’, rather than face-to-face consultations in clinic. This being the case, you may be offered a telephone, an online voice or video call.
The type of remote appointment you will be offered will depend on your own access to technology (do you have a suitable smartphone or computer, say, and internet access) and the systems used by the hospital.
As a guiding principle, you should expect to receive a comparable level of care from a remote consultation as you would from a seeing a dermatologist in a face-to-face setting. Many people find remote appointments more convenient.
If you are unhappy about having a remote appointment, contact the hospital to explain why, and firmly request a face-to-face appointment instead.
Before the appointment
As with any appointment, it’s a good idea to write down a list of the questions you want to ask beforehand. Also make sure you have to hand a list of the medications you’re taking for your eczema, including any that haven’t been prescribed by the doctor.
You may be asked to send photos of affected areas of skin before the appointment. Try to take your pictures during the day in natural light, to get the best quality. To show the size of eczema patches, you could place a coin next to them when taking photos. You might need to ask someone else to take photos for you – it can be difficult to take good photos of your own skin.
Before the remote appointment, make sure the phone, tablet or computer you are using is charged. If possible, find somewhere quiet to speak to the doctor where you won’t be disturbed, and have some toys at hand for children to play with if you are looking after younger ones.
During the appointment
Be clear with the dermatologist about what you hope to achieve for yourself or child from the consultation. Tell them about how the eczema is affecting all aspects of your life, including psychologically.
If you are prescribed medication, be sure you fully understand exactly how it should be used (for example, how long should it be taken for? Can it be used alongside your other treatments?). Also ask how you will collect your prescription. Will it be sent directly to you or your local pharmacy, for example?
Ask about how you can contact the hospital dermatology team for advice if your symptoms don’t improve or worsen, and when you can expect to see the dermatologist again for a routine appointment if applicable.
It can help to take notes during the appointment, to refer to later.
After the appointment
After the appointment you may be offered a face-to-face appointment, if it wasn’t possible to do everything needed or follow-up investigations are required.
Take photos of your skin before you start a new medication, so you will have a record of how the skin looked before you started using it, which can be compared to photos you take during and after use.
The British Association of Dermatologists has produced detailed advice for patients called ‘Guidance for dermatology patients for remote consultations’.
This article was first published in the June 2020 edition of National Eczema Society’s membership magazine, Exchange.
Q: I am 48 years old and going through the menopause. I have had atopic eczema all my life and until recently have been able to keep symptoms under control. But now the menopause seems to have returned my eczema to the severity I suffered as a child. Hot flushes and night sweats are making the irritation worse. My skin is very dry (especially on my lower legs), so I’m itching more and my eczema is flaring.
Can you advise on coping with eczema and the menopause? Might hormone replacement therapy help me?
Julie Van Onselen [NES dermatology nurse adviser] says: As you are going through the menopause, you are getting symptoms that many women will experience. Hormonal changes do seem to affect eczema, and hot flushes and night sweats will worsen your eczema, as perspiration is an irritant to eczematous skin. Menopause also causes changes to the collagen in the skin, changing the structure of your skin and making skin drier and thinner and reducing elasticity. All this can worsen eczema symptoms, and may explain why your eczema has returned to your childhood levels of severity.
Trying to take back control of your eczema and coping with menopausal symptoms is not easy, coupled with the reality that hormonal changes can make you feel more irritated and anxious. As your skin will become drier during and after the menopause, it may be worth changing your regular emollients. Humectant creams contain natural moisturising factors. This gives them enhanced hydration properties, so they last longer than simple creams or lotions. However, you may also need to moisturise more regularly. Ointments are good for hydrating dry skin, and are often recommended for overnight, however they are likely to irritate during night sweats.
Do talk to your GP about controlling your eczema flares. You may need to escalate treatment for a couple of weeks to gain better control. Improving your use of emollients and treating eczema flares is key to controlling itch. If you are considering hormone replacement therapy (HRT), you need to discuss this with your GP. They will discuss the risks and benefits, taking into account your age, medical history, risk factors and personal preferences. For the majority of women the use of HRT for the short-term treatment of menopausal symptoms is considered to outweigh the risks.
If HRT is suitable for you, it is likely to help your eczema as it will stop the hot flushes and night sweats, as well as improving skin hydration, thus removing some of the menopausal triggers for your eczema worsening.
Women on HRT should be reassessed by their doctor at least annually. For you, this will be important so they can assess your eczema too. Some women with eczema use HRT long term, for continued symptom relief and quality of life.
National Eczema Society is asking people with eczema to get behind an important new research initiative called SECURE-AD. You can complete the patient survey here but read on first to check you are eligible.
Coronavirus disease (Covid-19) has impacted us all in different ways and is a global public health emergency. At the moment, we do not know why some people get sicker than others from Covid-19. We also don’t know if people with atopic eczema are affected differently, due to their condition or because of the medication they are taking.
Atopic eczema and Covid-19
Eczema is a common long-term inflammatory skin disease. People with moderate-to-severe eczema may be prescribed medication that influences their immune system. This can be in the form of tablets or injections (systemic medication). The impact of these systemic medications on Covid-19 outcomes is currently unknown.
New patient registry – SECURE-AD
That is why a group of leading doctors and researchers have established a new ‘patient registry, to collect information from and about people with eczema who have experienced Covid-19. This patient registry is called SECURE-AD. People with eczema are being asked to fill in an online survey about their personal experience of Covid-19, and in a separate survey healthcare professionals are being asked to provide information on their patients with atopic eczema who contract Covid-19.
Complete the online survey
If you have atopic eczema and you have also been diagnosed with Covid-19 (or have experienced Covid-19 symptoms), even if this was a while back, you are encouraged to complete the SECURE-AD online patient survey. You will be asked a series of questions about yourself, your medical treatment(s) and how Covid-19 has affected you. This will help researchers understand your personal experience of the infection. The survey takes about 10 minutes and is completely anonymous.
Someone else can complete the survey on your behalf if needed, and parents can complete on behalf of their children. The survey is in English language only although the webpage has translation options. Please also let your doctor know about your Covid-19 infection and ask them to enter your case in the SECURE-AD healthcare professional survey. Both surveys complement each other, are safe and secure, and all the information provided is anonymised.
Help people with eczema stay safe
National Eczema Society is calling for people with eczema in the UK to take part in SECURE-AD if you have experienced Covid-19. This is an international research initiative reflecting the global health emergency and people from around the world are participating. By collecting worldwide information, SECURE-AD will make it possible to better assess the impact of Covid-19 on eczema patients and what influence eczema treatments have on the course of the infection. This in turn will help to guide doctors in their care of people with eczema who are infected with Covid-19.
In addition, SECURE-AD works closely together with the patient registries for other inflammatory conditions, such as psoriasis and rheumatic diseases, allowing researchers to compare results and patient experiences. This makes the impact of the SECURE-AD project even greater and will address the uncertainties we currently face more effectively.
Visit the SECURE-AD website for more information, including the frequently asked questions. If you want to fill in the online survey, you can go directly to the patient survey page. Your support is very much appreciated!
National Eczema Society is a partner organisation for this international research project. The SECURE-AD Steering Group & International Scientific Advisory Committee can be contacted directly at: secureADpatients@gmail.com
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?
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.
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.
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.
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.