Could This Itchy Rash Be Eczema?
Wondering what’s causing your dry, itchy skin – and what’s up with those red patches that come and go?
There’s a pretty good chance it is eczema, also known as atopic dermatitis.
It’s a common skin disorder that often starts in childhood and can run in families. In children, it may clear up and go away on its own. But it can also last into adulthood. Sometimes, eczema doesn’t begin until you’re older.
If it seems like more and more people are itching along with you, you’re right. Studies show that the incidence of eczema has increased 2-3 times over the past few decades. It’s currently estimated to affect up to 20% of children, and up to 10% of adults. (1,2)
If Your Symptoms Get Severe, Eczema Can Affect Your Quality of Life.
When eczema flares up, it can make you uncomfortable and itchy (especially at night making it hard to get a good night’s sleep). You probably also feel self-conscious, which can even lead to anxiety and depression. That’s why it’s important to learn more about atopic dermatitis and do all you can to get flares under control.
The most common symptom of eczema is a dry, itchy red rash that often appears on the face (especially on the eyelids), neck, hands, inside the elbows, behind the knees, and on the feet. Thick, scaly plaques of skin may form, or the rash may form blisters or have small, rough bumps. (3)
The itching from eczema can be intense, and it doesn’t go away easily.
While it’s easier said than done, it’s important to try to not scratch because you risk making things worse. Scratching can cause the skin to swell, ooze, and become infected, or permanently thickened.
If the eyelids are affected, constant rubbing can cause some, or all of your eyelashes or eyebrows to fall out.
Because it’s a chronic skin condition, the experience of eczema is quite cyclic. It’s actually known as the eczema flare cycle — meaning that your skin begins to flare, the rash will become full-blown, and then eventually it quiets down for an unknown period of time.
Even though dermatologists will tell you that “you just have to learn to manage your skin better,” escaping the flare cycle is possible.
And it’s also important to know that getting to 100% remission is also possible (though it does take effort, time, persistence, and addressing your unique cluster of root causes underlying your skin condition).
What Causes Eczema?
First, it’s not contagious. You can’t catch it from someone, nor should you worry about close contact with others.
Eczema happens because of a unique cluster of root cause imbalances on the inside and/or outside of your body. They trigger or perpetuate inflammation and also cause a breakdown protective barrier on your skin.
This state is known as “Leaky Skin“.
Unfortunately, we don’t have all of the answers to what causes eczema. There is a ton of fantastic research currently underway. And there’s a lot that just hasn’t trickled down to your dermatologist, but you can learn about it on the Healthy Skin Show!
Here’s what we do know so far:
Your Genes Play A Role
Eczema tends to run in families, and it’s thought that a few faulty genes might trigger it.
One gene called FLG, or filaggrin, is responsible for making a protein that keeps the outer layer of our skin firm and intact.
This contributes to “Leaky Skin”. In people with a SNP in their FLG gene, that protective outer layer is not as strong, so it’s easier for bacteria and allergens to sneak in.(2)
It’s kind of like having a bad paint job on your car – eventually it starts to peel or thin out which makes it easier for water, salt and sun to damage the body of your car.
Your Environment Can Make Things Worse
When it comes to managing eczema, everything around you can be an instigator so you need to be a good detective.
Things like where you live, the climate, the type of soaps, lotions, chemicals in your water, implants (e.g. breast implants), hidden gut infections, and laundry detergents you use can make your eczema flare up or be harder to manage.
Here’s a quick rundown of some common things that are associated with more troublesome eczema: (1,4)
- Living in a city as opposed to a rural area
- Exposure to pollution or cigarette smoke
- Chronic stress from a job, family, or personal matter
- Hot temperatures
- Perfumes or fragrances
- Wool or polyester fabrics
- Certain types of metal jewelry, especially nickel
- Chemical additives found in household or personal care products, such as formaldehyde, epoxy resin, isothiazolinones (look for “thiazolinone” at the end of the word), cocamidopropyl betaine, and paraphenylene-diamine
Your Diet Might Need Some Work
In addition to the food allergies and food sensitivities, a poor diet in general (think fast food, or lots of processed foods) is associated with a higher risk of eczema.
Additionally, other potential trigger foods include:
- Gluten
- Eggs
- Dairy
- Histamine-Rich Foods
- Citrus
- Nightshades
- High FODMAP Foods
- Nickel-Rich Foods
- High Salicylate Foods
To be clear, I’m not suggesting that you remove all of these foods as excessive elimination diets can do more harm than good without the guidance of a trained nutritionist.
On the other hand, a whole-foods diet that’s rich in lean protein, fruits, vegetables, and healthy fats can be more protective. Ideally, your diet should encourage a more active and diverse gut microbiome.
Here’s my favorite Eczema Soothing Smoothies that can help you with breakfast ideas!
Since much of your immune system is in your gut, a healthy microbiome helps reduce the eczema flare cycle as well as Leaky Skin. (1)
Eczema Is Linked To Other Allergies
It’s unclear whether one causes the other, but allergies and eczema definitely have a thing for each other.
About 70% of people with eczema also have a family history of other types of allergies, (5) especially hay fever or asthma.
People with eczema are more likely to have or develop allergies to pollen, pets, or dust mites that result in hay fever or asthma.
About 30% of children with eczema also have food allergies, (1) especially to peanuts, eggs, and milk.
Stubborn eczema that doesn’t go away on its own means you’ve got to look deeper to figure out your own unique cluster of root causes.
Definitely ask your doctor to run these skin-specific labs as well as allergy testing.
Since food could be an issue, an elimination diet is also an option. I would recommend that you limit an elimination to about 30 days.
If your eczema doesn’t make a huge improvement, it’s time to ask for help so that you can get answers.
Your Immune System Probably Needs A Boost
Researchers are studying whether eczema is caused by autoimmunity, a condition in which your body starts to attack and destroy your own healthy cells. Or whether it’s just the result of an immune system that isn’t running at full throttle.
What is known is that people with eczema are more susceptible to other autoimmune diseases, like rheumatoid arthritis, psoriasis, ulcerative colitis, and Crohn’s disease. (6)
One study found that people with eczema were more likely to have 11 of the 22 autoimmune diseases that were examined. (7)
Here’s the thing about your immune system – boosting it with a healthy lifestyle, diet and the right supplements will make a huge difference in how your body reacts to eczema triggers and how you’ll feel, both physically and mentally.
How Do I Know If It’s Eczema?
Most of the time, your doctor can make a diagnosis based on your symptoms, your medical history, and of course, by looking at your skin.
A patch test is frequently done to identify specific allergens you’re reacting to. In a patch test, small strips that contain different allergens are applied to your skin for a few days.
Your doctor will be able to tell which environmental or chemical allergens you’re most sensitive to by examining any reactions on your skin. Avoiding these should make your eczema easier to manage.
A skin culture may be done to determine if a staph infection exists. Here are signs of a staph infection.
In some cases, your doctor may do genetic testing or a skin biopsy to rule out or identify other skin disorders. A blood test for total or allergen-specific IgE levels can also be done, but it’s generally not recommended to diagnose eczema.
A high IgE level suggests an allergic reaction, but it’s not always high with eczema, and it might be high because you’re reacting to something else.
Looking for tests you can do? Here’s an excellent list.
Will It Ever Go Away?
Sadly, there is no cure for eczema.
But the good news is – it can be managed (and even put into remission) with an effective plan that addresses your root causes.
Certainly, talk to a dermatologist who specializes in eczema and ask about potential irritants like soaps, lotions, or laundry detergents, and safer options. He or she may also suggest bleach bath therapy (8) to kill any bacteria on the skin (make sure you follow the instructions carefully!).
To soothe itchy skin, try colloidal oatmeal baths, cold compresses, and gentle lotions. In some cases, your doctor may recommend phototherapy, or topical or oral medications to control your eczema.
If you’ve had long-term steroid cream (or other steroid medication) exposure, it’s worthwhile to consider that your skin may have developed an addiction to steroids. This can make your case more complicated. The condition is called Topical Steroid Withdrawal (TSW). However, TSW is not a medically recognized condition yet. If you’re interested in learning more about TSW, this is a really informative documentary.
In addition to your dermatologist, make it a point to get to the root of the problem. Realize that the solution often involves looking at your skin from both the outside-in and the inside-out.
Get help from an allergist if environmental or food allergies are a factor.
Even a skilled nutritionist who understands the complexities between your gut and skin can make dietary and supplement recommendations that support your immune system.
And while you’re making the rounds, consider working with a behavioral health therapist if there’s a chance that your stress level is out of control, and wreaking havoc with your immune system.
Living with eczema can be a challenge and an ongoing battle, but it’s important to know that information and help is available. With the right approach, you’ll be able to better control your eczema, stop the itching and live your best life.
1) Nutten S. Atopic dermatitis: global epidemiology and risk factors. Annals of Nutrition and Metabolism. 2015;66(Suppl. 1):8-16.
2) Atopic dermatitis. National Institutes of Health Genetics Home Reference. https://ghr.nlm.nih.gov/condition/atopic-dermatitis#genes. Reviewed October 2017. Accessed September 18, 2018.
3) What is eczema. National Eczema Association. https://nationaleczema.org/eczema/. Accessed September 18, 2018.
4) Eczema causes and triggers. National Eczema Association. https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/. Accessed September 18, 2018.
5) Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology. 2014 Feb 1;70(2):338-51.
6) Schmitt J, Schwarz K, Baurecht H, Hotze M, Fölster-Holst R, Rodríguez E, Lee YA, Franke A, Degenhardt F, Lieb W, Gieger C. Atopic dermatitis is associated with an increased risk for rheumatoid arthritis and inflammatory bowel disease, and a decreased risk for type 1 diabetes. Journal of Allergy and Clinical Immunology. 2016 Jan 1;137(1):130-6.
7) Andersen YM, Egeberg A, Gislason GH, Skov L, Thyssen JP. Autoimmune diseases in adults with atopic dermatitis. Journal of the American Academy of Dermatology. 2017 Feb 1;76(2):274-80.
8) Atopic dermatitis: Bleach bath therapy. American Academy of Dermatology. https://www.aad.org/public/diseases/eczema/atopic-dermatitis#bleach-bath. Accessed September 18, 2018.
