All of your questions about adult eczema answered by a dermatologist

What causes eczema? What foods should I avoid if I have eczema? Is eczema contagious? Here we ask a dermatologist everything you want to know about the dreaded rash.

By Bettina Tyrrell
Eczema is the itchy and inflamed rash that not only 1 in 5 children under the age of two years old currently have, but us adults suffer from, too.
So, what is it exactly? Well, eczema is a result of a faulty skin barrier (the protective, uppermost layer of the skin) allowing irritants - think certain chemicals and substances - to penetrate through the layers of the skin. The irritants don't belong on the skin, so the body instantly triggers an immune response, releasing inflammation as well as an itchy chemical called histamine, hence, the intolerable itch!
Unfortunately, adult eczema doesn't have a cure, which means there are many eczema sufferers itching (sorry) for answers on treating, preventing and managing the skin condition.
So, to sort the fact from the fiction we asked Australasian College of Dermatologists' fellow Dr Karen Koh to answer the questions you have about adult eczema - from what foods to avoid, to how to treat it.

What are the different types of eczema?

Before diving deep into the world of eczema, it's important to understand the different types of eczema. There are eight different types of this skin condition, although, atopic eczema and contact eczema are the most common forms of the dermatitis.
"Most cases of eczema are atopic, meaning it's genetically inherited and often includes being prone to allergic conditions such as asthma and hayfever," says Dr Koh.
Contact eczema, however, occurs as a reaction to substances that come into direct contact with the skin.

What causes eczema to flare up?

From changes in temperature to feeling stressed, Dr Koh says there are numerous factors that can cause an eczema breakout.
"Changes in temperature, such as extreme heat or cold, and low or high humidity could worsen eczema. This may be due to the seasons, but also might be influenced by work environments, such as moving from a hot day outside to a cold air-conditioned office and vice versa," explains Dr Koh.
"Being unwell or rundown with viral or bacterial infections, or stressful life situations can also cause eczema to worsen," she adds.
"External factors might affect eczema as well. For example, substances that come into contact with the skin, along with oral substances like medications and supplements can also cause irritation or allergy."
And while many people may believe foods can trigger an eczema flare-up, Dr Koh says it's less common than we think.
"Certain foods might cause eczema to worsen, but this is probably only a factor in about 10 per cent of people with eczema."

What foods should I avoid if I have eczema?

As Dr Koh identified above, it's not very common for diet to be linked to eczema.
"No foods should be avoided unless there is an obvious relationship between the food being eaten and development of a rash," Dr Koh asserts.
"It's common to cut out dairy or gluten, but more often than not these are not an issue. In children with obvious eczema, sometimes certain foods irritate the skin because they're acidic (think citrus, pineapple, strawberries) and often get on to the face and hands when eating them."
"Cutting out important food groups without allergy testing is not recommended," she adds. "It's important to consult a GP, or to undergo testing with a dermatologist or immunologist before restricting foods."
Eczema rash on hands.

Why does eczema itch more at nighttime?

Eczema sufferers often claim their rash itch intensifies at nighttime. Dr Koh says "this is most likely due to overheating with heavy bedding, quilts and blankets".
Certain fabrics, such as non-breathable polyesters and synthetic materials, could make itching at night worse. Dr Koh recommends sleeping in light, breathable fabrics like cotton and linen.

I never had eczema before, why do I have it now?

Sure, eczema is more common in children and babies, but adults can be diagnosed with it, too.
"Our skin can definitely change over time," Dr Koh explains. "Often as we age, our skin becomes dry. Atopic eczema often develops in infancy or early childhood, but can also develop for the first time in adulthood."
If eczema flares up and you haven't had it before, Dr Koh advises seeking help from a doctor to determine the cause of the rash.
"If eczema is a new problem, it is worthwhile also making sure that a contact eczema is investigated; for example, if you work in a kitchen, it could be an irritation from excessive handwashing. Even new parents washing their hands after changing nappies may develop contact eczema because they're not used to washing their hands so often."
Other irritants that could cause contact eczema include allergies to a new perfume, make-up or cleanser, or the skin reacting to new jewellery or a watch band.
WATCH 15 Hacks for sensitive skin you need to know. Article continues after video...

Are there different types of eczema? For instance, is the eczema on my eyelids same as the eczema on my hands?

"Yes, the actual rash is the same thing, but if it occurs in different locations it might be a clue to the cause," says Dr Koh.
"Hand and eyelid eczema can be due to contact reactions, but also can occur in atopic eczema. If one location seems to be affected in isolation, for example eyelids, it's important to rule out substances that are applied to that skin such as eyeshadow, mascara and eye creams."
Dr Koh adds that airborne sprays, such as spray antiperspirants, hairsprays and household sprays, as well as insecticides or garden sprays, might also get on the eyelids and cause a reaction.

Are some people more likely to get eczema than others?

"Atopic eczema is genetically inherited, and is, unfortunately, reasonably common," says Dr Koh.
"There are some dry skin conditions that might predispose some people to developing eczema," she adds.
Nicole Kidman was snapped leaving trendy restaurant Zuma in London with blotchy, eczema-covered hands. Find out which celeb's also suffer from eczema here!

Is eczema contagious?

"Definitely NOT," assured Dr Koh.
"However, if the eczema gets secondarily infected with bacteria or viruses, those infections, if untreated, could be spread to another person," she adds.

Are eczema and psoriasis the same thing?

People commonly confuse eczema for psoriasis and vice versa. Dr Koh says despite their similar appearance and treatment, they are not the same issue.
"They are different types of skin inflammation with different genetic and immune reactions. However, in some locations on the skin they can look quite similar. And, in some situations, the treatment is very similar."

Can stress make eczema flare up?

"Yes. This is probably due to the immune reactions that occur with stress," Dr Koh tells us.
"People with eczema often notice their skin might flare up with stressful situations, despite their treatment. These stresses can be physical and psychological."

How do I treat eczema?

Dr Koh says there are four main principles for treating eczema:
  • Repair the faulty skin barrier
    You can achieve this by moisturising the skin regularly and avoiding harsh substances (such as soap and detergents) that will further dry out the skin and damage the skin barrier. Moisturising should be a daily habit, whether the skin is itchy or inflamed, or not. Keeping showers lukewarm (hot showers make the skin itchier!) and brief is important. Also, avoid taking long baths. Water, itself, will dry the skin by removing natural oils from the skin surface.
  • Reduce the inflammation
    This might include using topical corticosteroids (also known as "steroid" or "cortisone" creams prescribed by a GP or dermatologist) as part of a controlled and supervised regimen. According to Dr Koh, Australian studies have shown that these medications are safe to use and don't cause the side effects that many worry about, as long as they are used correctly and as directed. Different strengths of steroid cream will be needed for different locations on the skin, and for different severities. For example, a milder cream for thin, delicate skin of the eyelids, compared to the thicker skin of hands and feet. There are also prescription strength NON-steroid treatments that a GP or dermatologist can give, usually for maintenance of the eczema.
  • Become aware of triggers
    ... And avoid them! Prevent overheating at night by swapping heavy quilts for cotton or linen bedding and py,jamas. Also, wear protective gloves or equipment if external substances are an issue.
  • Visit your doctor
    Be sure to see your doctor if there is a flare-up not responding to usual treatment. Sometimes this is due to infection that might also require medical attention. Allergies may also need to be tested.

Are there any over-the-counter products that might help eczema?

When it comes to the best products available without a prescription, Dr Koh says there is one skincare saviour you should prioritise.
"The most important over-the-counter products that help are moisturisers. If the skin is very dry, the thicker the moisturiser, the better. A runny lotion contains more water that will evaporate and leave less oil on the skin to keep it moisturised. Most people with eczema need thicker creams, or even ointments to keep their skin barrier repaired."
A damaged skin barrier means irritants can get in under the surface and cause irritation, inflammation and infection.
Dr Koh advocates moisturing, but she also stresses the importance of checking the ingredients in products before applying them to the skin, especially if it's already inflamed.
"There is a confusing array of 'natural' products and additives in creams and lotions on the market today. Care needs to be taken as most of these come from plants and can cause an allergy. Always test new products on a small area first before using it all over."
"If eczema is repeatedly getting infected, the dermatologist might suggest an antiseptic wash or oil to add to the bath water," says Dr Koh.
But she warns: "These should be used according to instructions as using too much can irritate the skin as well".
While moisturising will help with eczema management, a visit to a professional is always advised.

Will sunscreen, moisturiser or make-up make my eczema worse?

PSA: you can and should use sunscreen, says Dr Koh.
"People with eczema should probably use products that are formulated for sensitive skin. Modern sunscreens usually contain a mixture of physical blockers (such as zinc or titanium oxide) that reflect ultra-violet radiation, and chemical blockers that absorb ultra-violet radiation," she explains.
"Keeping to a sunscreen just with a physical blocker is likely to be safer and better tolerated."
Read more about sunscreens with physical blockers here!
"Any cream, make-up or sunscreen can contain fragrance or preservatives (which prevent your creams going off) that might cause eczema to react," says Dr Koh, who suggests researching hypoallergenic products as they are often fragrance free.
If you have skin that is likely to react to new products, simply test on an area of skin, like the inner arm, before putting on more obvious areas. And don't forget to clean those beauty tools!
"Make sure any make-up applicators, sponges and brushes are cleaned regularly to prevent contaminants or infections," she adds.