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Take back control

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

The coronavirus pandemic has affected our lives in so many ways. Lockdown living has brought with it significant challenges – self-isolating, furloughing, shielding, home schooling and many more. The ways we access healthcare have changed too. For some, waiting times are even longer.

But these strange times have also offered a rare opportunity to take a step back and reassess our priorities, to reflect on how we use our time and find ways we can improve our quality of life. Life seems unlikely to revert to ‘normal’ any time soon. At a time when much is outside our control, re-evaluating how we manage our eczema ourselves is something that’s entirely within our control and provides a genuine opportunity to introduce positive change.

So, this could be the ideal time to review your eczema routine. 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!