National Eczema Week: Webchat with dermatology nurse Julie Van Onselen: Tuesday 18 September at 9pm

[RachelMumsnet]

Today marks the start of National Eczema Week and we’re running a webchat tomorrow evening (Tuesday 18 September) with Julie Van Onselen who will be on-hand to answer questions about eczema from 9pm on Tuesday evening.

Julie is an experienced dermatology nurse, who is passionate about improving care and support for people with skin conditions and in educating patients and healthcare professionals. She is a Dermatology Nurse Adviser to the National Eczema Society and provides advice on eczema to people who contact the charity’s the Helpline service.

National Eczema Society is the UK’s leading charity for people with eczema, providing independent information and support through its helpline, website, social media and publications. The charity also provides a voice for people with eczema, in research, in the development of new treatments, and in improving medical care.

Join Julie at 9pm on Tuesday evening or post your question on this thread in advance.

@bestbefore

What's the most effective way to treat mild eczema - via improvements to diet and well being or steroid creams? Mine improves massively on holiday!

Mild eczema should be treated with a good daily emollient routine, so using moisturisers and washing with emollients, to keep restoring the eczema skin barrier. If mild eczema is red and itchy a short course of mild to moderate topical steroids should be used to settle an eczema flare. If you keep mild eczema well controlled with emollients, you will find that you will use topical steroids less frequently. Dietary allergy is extremely unlikely to be a factor in mild eczema in adults; but a healthy diet is always good for skin health. You mention also that your eczema is on your hands and cleaning products irritate. Hand eczema may be an irritant eczema or a contact dermatitis (making diet even more unlikely), so I would suggest you discuss a referral to a dermatologist for patch testing. The NEs has an excellent factsheet on hand eczema with more tips available at www.eczema.org/factsheets Lots of people say their eczema improves on holiday; sometimes a change of environment, weather, softer water and just being relaxed can sometimes make all the difference to eczema.

Apologies if this double posts. I'm getting error messages.

Thanks for coming on.

My son suffers badly on his hands and back of knee creases. Can he do long term damage from overuse of the topical steroid creams? He is almost 12.

@BillywigSting

What is the evidence for dairy exacerbating eczema?

Both ds and I both suffer from it and dairy is quite a staple in our diet.

My mum is a nurse (with primary care experience) and is forever going on about the evils of dairy. She has never produced any good evidence for this claim though.

I would of course be more than willing to change our diet if there was good evidence to suggest that it might make a difference.

No amount of cheese is worth feeling like climbing out of your skin!

Hi Billywigsting Thank you for your question regarding diet and eczema - this is a very common question. Diet as an aggravating factor in eczema and especially diary is more common in children under 2 years but actually very rare in adults. It is actually better to have a healthy diet that eliminate an important food group form your diet, as unless you have a definite diary allergy, this will not help your eczema. If you would like more information on managing eczema for you and your family, please do visit the NES website at www.eczema.org Julie

@Wolfiefan

Interested in this. Suddenly my very mild eczema has become so bad in my 40s that I am on immunosuppressants. Not helping yet. Triggers are also interesting. I’m allergic to MI. Would also be interested in how it could be possible to update the knowledge of our GP community. No aqueous cream won’t solve my eczema and should only be used as a soap.

I am sorry to hear that your mild eczema has become severe. Immunosuppressant tablets are used to treat sever eczema, which as you say can become worst due to triggers and indeed allergy, such as MI. Methylisothiazolinone (MI) is an preservative, used in cosmetics, shampoos, household products and paints. This allergy is diagnosed by patch testing and thankfully is becoming less common as knowledge of MI is now changing formulations to reduce or not use MI. You mention you have not been offered further testing after patch testing; this is because patch testing is the standard test for contact allergy, so there would not necessarily be additional testing to offer you – although sometimes patch tests are repeated in future years. I agree with you about Aqueous cream, it contains more water than oil so is not an effective moisturiser but more importantly the NES do not advise as a wash as it contains a harsh detergent (SLS) and research has shown that the inclusion of SLS actually damages the skin barrier. Do look at our emollient factsheet at www.eczema.org/factsheets for more information.

@Solasshole

bestbefore -

Not sure if relevant to you but my eczema is made loads worse by cold weather so perhaps it improves on holiday for you if you're going somewhere warmer? My cousins quite bad asthma and eczema improved hugely when her family moved from Scandinavia to the UK

I made the bad decision to work in Scandinavia once too and ny hands were bleeding they were so dry and cracked 😭

Eczema is very individual and can be triggered by climate and temperature. Colder weather can cause skin dryness; but generally eczema is irritated by sudden changes of temperature, so going form a centrally heated building into the cold. Central heating and less humidity in winter is also an irritant. However, a constant warm (but not too hot) temperature in a humid atmosphere is generally less irritating for eczema. So, it is true that eczema is more like to be worst in the winter and improve on holiday in a warm climate.

@NearWildHeaven

Apologies if this double posts. I'm getting error messages.

Thanks for coming on.

My son suffers badly on his hands and back of knee creases. Can he do long term damage from overuse of the topical steroid creams? He is almost 12.

Hi NearWildHeaven thanks and no double posts and a good question. I am sorry your son is suffering badly with eczema on his hands and backs of knees. It sounds like his eczema may not be well controlled. As he is 12 years old I wonder what strength of topical steroid he is using and how much? For example a 30g tube a month - more or less? Topical steroids should be used for short term treatment bursts - 7 days one a day and then every other day (a general rule - please get this prescribing advice form your doctor), then eczema should be controlled and skin dryness prevented with emollients for washing and bathing. In my experience most people underuse topical steroids and I have actually seen only very small numbers of people with ing term steroid damage in my 25 years experience of caring for people with eczema. I hope this helps and please visit www.eczema.org/factsheets and download our topical steroid factsheet for advice on using topical steroids safety. Julie

Thank you so much. I hope the pills I’m on work and I can stop itching and bleeding.

@derxa

I'm not sure whether I've got eczema, psoriasis or seborrheic dermatitis. It's quite disgusting. There's a patch on my eyebrow, my ears are scaly and my head has a sort of cradle cap on it. Help!!

I am sorry to hear you are having problems with your scalp, which I am sure is distressing in such a visible area. The skin conditions you describe all have these symptoms, so you best advised to see your GP for diagnosis and treatment.

Thank you Julie! No, he definitely underuses the cream. But I was wary of encouraging him to use more for fear of long term damage. Sounds like I can encourage more on short term bursts only.

I'm so scared of damaging him and my knowledge on this is nil. There is no history in either my or DH's family

I have dyshidrotic eczema on my hands. I've not been able to use a steroid cream/allergy tablet since I became pregnant/now I'm breast feeding. All the doctor will prescribe is barrier creams, so I'm left with red raw, blistered, painful hands. Is there anything I can do?

I sometimes get pomphylox(sp?) on my hands and it itches like mad and nothing seems to help and I need to ride it out.
gp just shrugs, which seems a common reaction by gps.

what else can I try?
I double moistirise hands (lotion first, then thicker cream on top, hydrocortisone cream & antihistamine to stoo myself scratching down to blood in my sleep)

@IHeartKingThistle

Great idea for a webchat although so difficult to answer questions about specific cases. Such a heartbreaking thing to watch your child suffer with, and it is suffering.

I'd like to know about long-term steroid use. DS had quite strong steroid ointments when he was small (eumovate, betnovate) for his severe flare ups. He's 9 now and hasn't had bad eczema since he was about 4, which is amazing, but he still can't go in the sea on holiday as the salt water stings his skin so much, particularly on the back of his legs where he mostly had the steroids. Could this be because of the steroids, and will this always be the case?

I'm so grateful to the amazing GP we had when DS was tiny who had been through it with her DC and took it seriously.

I am happy to answer your questions and concerns regarding long-term steroid use. It sounds like you son’s eczema was treated appropriately when he was four years old and had sever eczema and now his eczema well controlled. So, I presume he has not used topical steroids in the last five years. It is important to understand that 50% of children with eczema have a with the altered filaggrin gene, who will not grow out of eczema (filaggrin deficiency means they have a faulty skin barrier for life); and this means that skin becomes sensitive due to eczema tendency and not as a result of using topical steroid treatment, so you do not need to worry in your son’s case about long term effects. Therefore his reaction to sea water is more likely to be to continuing low grade eczema and this is why continuing to use emollients for washing and moisturising is so important to continue to repair the skin barrier. You could try putting on a greasy ointment before swimming in the sea as a protective barrier but also apply sun cream over the emollient to prevent sunburn.

@frogsoup

What's your opinion of the doctor Aron regime? I am intrigued as to what the opposition from the medical community is based on. Our gp said he is against because of the antibiotic resistance aspect of long-term fucidin use, yet DD was on oral antibiotics every month or two for years because of staph overgrowth, as well as very strong steroid creams, wet wraps etc etc. There seemed to be a reluctance to look at the big picture, with repeated prescriptions of strong oral antibiotics (and even immune suppressants) accepted because they are nominally 'short term' (and often prescribed by lots of different doctors), whereas from a parental perspective longer-term use of a milder topical antibiotic seems far preferable in practice. Hope that doesn't sound too antagonistic as a question, I'm just perplexed as to why the regime hasn't been adopted more widely for uncontrolled eczema.

The NES is aware the Dr Aron regime, he is a South African private dermatologist who mainly practices by on-line consultations, so patient are not medically examined. However, parent or person with eczema will make there own choices on medical treatment and the practitioner they consult. The NES view is that this regimen is not a new treatment but involves mixing together emollients, topical steroids and antibiotics into one treatment (all the active treatments used are available separately on prescription). Interestingly this used to be common practice 40 years ago but evidence –based guidelines and clinical studies in eczema management do not recommend this method. The NICE guidelines for children with eczema recommend using emollients and eczema treatments separately (topical steroids or short bursts and antibiotics for a 14 day course, only if infection is present) in a stepped approach to treatment. Mixing of different formulations can also cause instability of treatments and encourage long term use of active treatments (particularly topical steroids). Eczema is a chronic condition and flare-ups do need to be treated, which may involve several treatment courses. The severity of eczema also needs to be matched to the most appropriate treatment and then stepped up and down. If eczema is uncontrollable, dermatology referral should be recommended.

@FlowerTink

My DD is 3 and has eczema (and asthma too which I've been told can be linked), particularly suffering on the backs of her arms, neck and legs. Do you have any tips in regards to creams or any simple tips/lifestyle changes which may help her? Where she's very young I worry about her sensitive skin.

I am sorry to hear your DD has developed eczema. Eczema and asthma are often seen together, as well as hay fever – they are all atopic conditions, which are genetically linked. If your DD has recently developed eczema, it is important that you understand how to manage and use treatments to control dry skin, itch and eczema flares. First line treatment is emollients (or washing and moisturising) and mild to modrate potent steroids for a short treatment burst. There are lots of tips concerning lifestyle and household management. For more information, please do read and download any of our factsheets at: www.eczema.org/factsheets

@NearWildHeaven

Thank you Julie! No, he definitely underuses the cream. But I was wary of encouraging him to use more for fear of long term damage. Sounds like I can encourage more on short term bursts only.

I'm so scared of damaging him and my knowledge on this is nil. There is no history in either my or DH's family

Hi again, if your son underuses topical steroids, especially if mild or moderate potencies, please don;t worry about longterm damage. Read out factsheet and if you are still concerned or want to talk about your son's eczema management, you can always call the NES helpline on 0800 0891122 or email [email protected] The NES exists to listen and support everyone with eczema. Julie

@Cismyfatarse

Why do steroid creams, even mild ones, come in such small tubes? I am 5ft 10 and that means, on occasion, there is a lot of skin to cover multiple times.

Drives me nuts.

I presume you are buying your steroid creams form the chemist, as for personal purchase topical steroids only come in 15g tubes. This is a small amount and I agree is unlikely to provide adequate treatment. I would suggest you see your GP for an eczema review and then ask for your topical steroids to be prescribed on a repeat prescription ( which would only be possible for mild and moderate steroids i.e. the strengths bought over the counter). On prescription hydrocortisone come in 50g tubes and moderate steroids, such as Eumovate in 30g, 50g and 100g.

@Wheresthel1ght

My dd has chronic atopic eczema, is under a specialist children's dermatologist however no one seems to be able to control the constant itching. She is on insanely high doses of antihistamine as well as lotions and potions.

Is there anything more we can do to help her?

Also her hands are always burning hot - is there a link to the eczema?

I am sorry to hear your DD has difficult eczema. It is good that she is being assessed and treated by a dermatology department. In sever eczema antihistamines are often prescribed at high doses to primarily help with sleep.

Antihistamines don’t necessarily control itch in eczema as itch is due to the dysfunction skin barrier, therefore a good daily emollient routine is equally important – I am sure as an expert eczema Mum you have this in place. I can’t explain her burning hands, except to say that children with eczema are prone to overheating. Again, I am sure you discuss new symptoms with your dermatologist and specialist nurses. We do have a booklet on Itching and Scratching which may give you some more tips, do have a look at our website www.eczema.org and download a copy.

@DaisyChainsForever

I have dyshidrotic eczema on my hands. I've not been able to use a steroid cream/allergy tablet since I became pregnant/now I'm breast feeding. All the doctor will prescribe is barrier creams, so I'm left with red raw, blistered, painful hands. Is there anything I can do?

Dear DaisycHainsForever I am so sorry to hear your hands are so sore and you are having difficult time with your dyshidrotic eczema (also known as pompholyx. If your hands are so sore, you should ask your GP to refer you to a dermatologist for specialist advice on management in pregnancy, generally mild and moderate steroids scan still be used in pregnancy. However, I your GP may be cautious. We do have factsheets on pompholyx and managing hand eczema on our website at www,eczema.org/factsheets which will give you some more practical tips. Don't forget to also wash with an emollient and carry round a small pot with you for washing your hands when out and about, as soap and alcohol hand gels will make your hands much worst. Good luck and I hope your hands improve soon.Julie

@moonlight1705

I've got eczema on my eyelids and have been told I can't use steroid cream there. Is there anything else to use besides emolient cream?

I am sorry to hear you have eye eczema; it is a difficult area of the body to treat. Emollients are important but if you have a flare mild and moderate topical steroids can be used for a short burst under medical supervision. A pharmacist is not allowed to sell topical steroids for this area of the body. There are some other non-steroidal creams called topical calcineurin inhibitors, which are very helpful in eye eczema but they would need to be prescribed by your GP. Do have a look at our eczema and eyes factsheet, which you can download at at www.eczema.org/factsheets

@Thishatisnotmine

How can I stop flare ups in hot weather? Dd1 is nearly 4 and apart from a couple of dry patches her eczema is so much improved. Apart from in summer when her knees, elbows and lower back get hot and then the exzema returns. We kept her in long sleeves and loose trousers a lot but she wants shorts and tshirts!

Your question describes just how individual eczema triggers are, for some it is the cold winter and for your DD1 it is the hot summer. Eczema also is a chronic condition so it will come and go. I wonder if you treat her eczema flares, as prompt treatment when she flares (remember you only need to use topical steroids for a short burst and can apply at night), may help to reduce the extent of eczema. Keep using emollients for washing and moisturising every day, in the cooler months, even if her skin is clear. Entering summer with well-moisturised skin and no dry patches will also help prevent eczema flares.

@Blameanamechange

My dc now only has eczema on the back of the hands. Was always told that water helps but it seems to me that overwashing hands or lack of drying hands properly has caused this? Doublebase handwash has helped but is there any other non prescription everyday brand that you could recommend please Julie? Thanks

It is good to hear that your DC eczema is much improved. You are absolutely correct that water alone can be drying; this is why we always say that emollients need to be used for washing, as soap substitutes. If you always use emollients for washing a pat dry thoroughly, repeated washing is not a problem. If Doublebase wash helps, I would continue using it and ask for your GP to prescribe it. Medical emollients are available to buy but make sure they contain no SLS, MI or detergent. However, if Doublebase suits your child and helps their eczema there is really no need to change.

@redsummershoes

I sometimes get pomphylox(sp?) on my hands and it itches like mad and nothing seems to help and I need to ride it out. gp just shrugs, which seems a common reaction by gps.

what else can I try?
I double moistirise hands (lotion first, then thicker cream on top, hydrocortisone cream & antihistamine to stoo myself scratching down to blood in my sleep)

Dear RedShoes I am sorry to hear about your sore hands, it sounds like your hand eczema is very disruptive. I have just answered a similar question for Daisy Chains (please do read my advice to her on hand washing too). However, my advice for you is that your hand eczema or pompholyx (greek for bubbles) i.e describing the small very itchy blisters you get on your hands) - this is active eczema which needs to be treated. You are using emollients but hydrocortisone is too weak to adequately treat this type of eczema on the much thicker skin of the hands (and feet). I suggest you return to your practice, perhaps see another GP and ask for a different treatment. You ill find our pomphoylx factsheet helpful too, download at www.eczema.org/factsheets If your pompholyx does not settle or the GP is reluctant to change your treatment, do ask for a dermatology referral. I hope this helps and good luck. Julie PS Antihistamines (especially non-sedating ones) do not necessarily treat eczema itch, it is the correct treatment that will reverse the itch, in dermatology we tend to use sedating antihistamine tablets to help with sleep.

I have discoid eczema. I have tried everything over the years and have just learned to live with it now.

I'm living with patches on my legs and feet which is can keep covered and small patch on my wrist and thumb and new patxhes have sprung up on my areolas on both breasts. Most uncomfortable. I don't use steroids on them.

I am aware that stress is my trigger. I'm currently in 3rd year of my nursing degree. I never dreamt I'd be allowed to do this degree! I digress...

I'm currently in flare not on placement. None of my creams/ointments are working. My swabs are clear. I'm just soooo tired of looking like this and trying to hide my patches.

Sorry I have had 40 plus years of living with this and I'm tired of it. Woe is me post. Sorry

@Wolfiefan

Thank you so much. I hope the pills I’m on work and I can stop itching and bleeding.

Hi Wolfiefan Yes I also hope your immunosuppressants work, remember they can take a few weeks to kick in and if they do not help your dermatologist should offer other treatment options. Good luck. Julie

@Cheekyandfreaky

I have had eczema, very severely at times, for years. I remember once, (reluctantly) an nhs dermatologist tested me for allergies and said there were none.

I ended up doing a bit of an exclusion diet and realised dairy and eggs were causing the issue. Absolutely life changing in terms of my management of both my asthma and eczema. I am 35! Is it just my experience that seems to suggest that food isn’t taken very seriously as a trigger for eczema? Is allergy testing not advanced enough?

Firstly, it is great to hear that your eczema has improved. Eczema is a very individual condition; it can also alter in severity (including improving). Dietary allergy is diagnosed by RAST (blood tests) in older children and adults, so it is likely you had this test. Food allergy is taken seriously in eczema, especially for children under two years but in reality adult food allergy in eczema is very rare. We would not advise excluded main food groups without dietary support. If this diet works for you, this is an individual choice. However, I would suggest you seek advice on calcium replacement, as depletion of calcium in your 30s could predispose you to osteoporosis when you are older.