Teenagers and eczema

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Will puberty make my son’s eczema worse?

Off to university…with eczema

Will puberty make my son’s eczema worse?

This is an Ask the Expert Q&A with Dr George Moncrieff, General Practitioner, which was published in Exchange 190, Winter 2023.

George Moncrieff says: The teen years can be challenging as young people assert their autonomy before their parents are confident that they fully understand the consequences of their actions. But while hormonal changes might be the cause of your son’s behaviour, it is important to remain sensitive to the effects his eczema might be having on his sleep, relationships and mood.

Generally, eczema improves during adolescence. The surge of hormones increases grease production, which helps maintain the skin barrier. This change may mean your son needs to wash his hair more often – even daily. If he allows any of that shampoo to wash over his body, his eczema will never settle.

Healthy skin habits, such as washing with an emollient soap substitute and applying a quality leave-on emollient to the whole skin after washing, can be time consuming. Life is busy and teenagers may choose instead to use less suitable – even perfumed – alternatives. If any of your son’s skin products are in tubs, make sure he isn’t contaminating them by extracting them using his fingers – he should use a spatula instead.

Using an antiseptic can be helpful for preventing flares. I would recommend a new product called CliniSoothe+ (aqueous hypochlorous). It has excellent antiseptic properties and is available without prescription, online or from pharmacies. It has the same pH as the skin and is non-damaging to mammalian cells – indeed, it is produced naturally as part of our immune system. It also has positive anti-inflammatory effects. Used on the affected area twice a day, it can be particularly effective at preventing recurrent flares.

Topical steroids have been around for more than 70 years and usually work very well at calming eczema flares. Normally, they should only be used as an ointment, once a day, ideally at bedtime (30 minutes before any emollient). They are not licensed for long-term use, so once things are getting under control, they should be tapered off. I usually recommend dropping down to just two consecutive nights a week (for example, weekend therapy) for a further few weeks.

If things rapidly re-flare, I would consider a topical immune modulator, such as Protopic ointment or Elidel cream as an alternative. These are licensed for flare prevention and can be used for many months. I would also recommend that your son takes some vitamin D supplements – somewhere between 2000 and 4000 IU daily.

Off to university…with eczema

Starting university is a big step in anyone’s life, and eczema can be an unwelcome added complication. Claire Moulds explains how to embrace student life without eczema getting in the way. This article was published in Exchange 185, September 2022.

If university is on the horizon, you may be feeling a whole range of different emotions. But if you have eczema, you may be anticipating a fresh set of challenges alongside all the fun. So, what steps can you take to look after your skin as you start this new phase of life?

Open days

Open days are a great opportunity to visit your shortlist to find out more about the university, the course and the local area. Your accommodation will have a big impact on how easy it is to manage your eczema, so try and view some different options as part of your visit.

Things to look out for

  • Building temperature Halls of residence often tend towards extremes: too hot or too cold. Do you feel comfortable in the communal areas? What control would you have of your own room’s temperature – both the heating source and ventilation?
  • Shared facilities Are bathrooms shared? If you’d prefer to have your own private bathroom, can you be allocated one on medical grounds? Having your own bathroom can provide welcome privacy in which to complete your treatment regime. Plus, if household cleaning products are an issue for your eczema, you can then use the right ones for you.
  • Furnishings If dust is one of your triggers, are there residences with hard flooring and blinds in the bedrooms, instead of curtains and carpet?
  • Location Is any of the accommodation close to where you’ll be spending your days? If your eczema requires multiple applications of emollient throughout the day, it will make life easier if you can easily pop back to your room.

Your application form

The UCAS application form has a specific section where you can highlight any physical health condition that might affect aspects of university life. It’s important to give specific examples of the challenges you might face and the adjustments that you might need, rather than simply saying you have eczema.

For example:

  • If your eczema flares up badly you may not be able to attend lectures and tutorials in person, or you might need flexibility with deadlines.
  • If your hands are badly affected you might need extra time in exams or alternative ways to submit your answers.

You’re under no obligation to disclose that you have eczema. You can inform the university once you accept a place, or not mention it at all. It’s entirely up to you. We’d always recommend that you do tell them, though, so they can put support in place.

In your personal statement, you want to outline how you’ve overcome the challenges of eczema and highlight that these haven’t stopped you from achieving your goals. This will give the admissions team a greater insight into you as a person.

You’ve been accepted! Now what?

Every university has a different process when it comes to supporting students with long-term health conditions. If you’ve included information about your eczema on the application form, your university may contact you directly, or they may wait for you to get in touch.

Your university will be supporting a high volume of students at the start of the academic year, so it’s a good idea to contact the student support team as soon as you accept an offer, so that everything is ready for your arrival. Your GP or dermatologist may need to provide extra information and evidence, and this can take time to compile.

Your university may also create a support agreement (sometimes called a personal learning plan, individual learning plan or inclusive learning plan) outlining any support or ‘reasonable adjustments’ that they will put in place to support your study. They will share this, on a ‘need to know’ basis, with your personal tutor, the accommodation team, academic staff and examination officers.

What to take?

Student accommodation is often compact, so it’s important to prioritise what you pack.

Packing list

  • Your own pillow, duvet, sheets and towels
  • Mattress and pillow protectors
  • Disposable dusters or kitchen roll, for damp dusting
  • Eczema-friendly gloves and cleaning products
  • Your usual laundry detergent
  • An electric fan (if you’re prone to overheating)
  • Ear plugs and a sleep mask (for those nights when you really need your sleep but your neighbours have other ideas!)
  • Most importantly, ensure you have a plentiful supply of your emollient and any medication you use, to see you through the first few months – and details of where to get more.

You’re the boss

Over the years, you will probably have taken increasing responsibility for managing your own skin, but your parent or caregiver may still do a lot for you – including giving you a gentle reminder if they think you’re letting things slip.

Living away from home brings with it unprecedented freedom – but it also means you’re the only one making choices and decisions, some of which might negatively affect your eczema. For example, it’s easy to put off an emollient application and then to never do it. It’s also easy to take shortcuts with your normal skincare routine so you don’t turn up late to meet your friends. Most of all, though, it’s easy to burn the candle at both ends.

Nobody’s saying don’t enjoy yourself, but it’s important to find a balance:

  • Get a reasonable amount of sleep, so your skin has chance to heal.
  • Try to maintain a healthy(ish) diet and lifestyle.
  • Avoid your triggers as best you can. Crucially, if your skin is deteriorating, act fast. It’s far easier to try and regain control of eczema that’s only just starting to spiral. Sometimes, ringing home for advice is the quickest way to get back on track.

Organising your medical care

When you start university, you will probably register with a GP surgery nearby. If you have a complex prescription, or struggled for a long time to find a suitable emollient, ask your current GP to write a letter to your new GP so they’re up to speed. Make sure you understand the appointment and repeat prescription process at your new surgery, as these can differ markedly.

If you’re a patient at your local hospital and you register with a new GP outside the area, your secondary (hospital) care will need transferring, too. This means your consultant needs to refer you to another consultant at the new NHS trust, to make sure your care continues smoothly. If you arrange this in good time, you hopefully won’t have to go on a waiting list, but how long you wait for an appointment will depend on the capacity at the new provider, which will differ depending on where in the country you are.

If you’re already on a waiting list to see a consultant where you’re currently living, it’s a trickier situation. By registering with a GP in a different area, your referral will effectively be joining a new waiting list from scratch. If you’ve already been waiting for a number of months, it may be hard to hear that you’re at the back of the queue again.

A spokesperson for NHS England told us: ‘If a patient is currently on a waiting list and their condition is clinically deteriorating, GPs can write to the relevant consultant and request a referral is expedited. This will be reviewed by the consultant and could result in the patient being seen sooner.’ However, there are no guarantees this will happen.

Eczema shouldn’t determine where or when you go to university, but if you are receiving hospital care, it’s important to take your particular medical situation into account. You might decide to go to your local university, or one nearby, and remain registered with your current GP and under the same hospital (or on the same waiting list). This would ensure continuity of care across term time and the holidays.

If your top-choice university is hundreds of miles away and you’ve already been on a waiting list for six months, the thought of starting all over might be unbearable. In this case, an option might be to defer for a year until you’ve finally seen the consultant and started treatment.

Before you make any decisions, talk to your current medical team to get their thoughts and advice, and consider all the options.

For more information on helping your teenager – or yourself, if you are a teenager – manage eczema, please see our Guide for Teenagers with Eczema.