Dry, itchy skin?
Published Saturday October 11th, 2008
As the temperature begins to drop and the moisture is seemingly sucked out of the indoor air, people who suffer from eczema need to start paying more attention to their skin, doctors say.
An estimated 15 to 20 per cent of the population has some form of eczema, also known as atopic dermatitis. People with the condition have flare-ups of itchy, dry and inflamed skin, which can thicken to become red and scaly.
Dr. Robert Jackson is an Ottawa dermatologist who has dealt with the ravages of cold and dry air in the North. For the past decade, he's been the visiting specialist who treats patients in Iqaluit during twice-yearly trips.
Atopic dermatitis shows up frequently in the North and there is almost certainly an inherited tendency, Jackson explained.
"The dry climate up there sometimes makes a difference because we know that atopic dermatitis patients have skin which is dry anyway, and if you're in a place where it's very, very dry - because although it's cold it's still very dry - that probably is a factor. But that's more of an aggravating factor. The basic reason is that there is some genetic determination."
Jackson and more than a dozen other dermatologists recently held a gathering on Baffin Island - billed as the first medical specialists meeting ever held in Nunavut - and launched a national eczema awareness campaign. The colder northern setting was appropriate for their message warning that fall and winter are critical times for patients.
"We're trying to get the message across that there's a lot that you can do yourself to look after the condition," said Dr. Larry Warshawski, president of the Canadian Dermatology Association, who attended the meeting.
"One of the main ones is just to keep yourself well hydrated, because part of the problem with eczema is that you lose the barrier function of your skin, so the skin is not as good a barrier to irritants or allergens or whatever it may be. And when it's exposed to these irritants, they can make the eczema worse," he said from Vancouver, where he practises.
"And so a simple thing like keeping your skin well hydrated or well moisturized will make your life a lot more comfortable."
Nathan Melville of Keswick, Ont., is just 3 1/2, and has had dry, flaky skin practically since birth.
"Around three months old, he started to get the rashing and the crusting, terrible itching, was up at night, couldn't sleep. We went to the family doctor and she diagnosed it as eczema," said his mother, Amanda Cresswell-Melville, who later became executive director of the Eczema Society of Canada.
"Around six months it was just out of control."
They saw a dermatologist at Toronto's Hospital for Sick Children.
"Then we started following the regimen that the Eczema Society of Canada recommended and his skin turned around, like a complete 180, so we were able to get it under control."
The routine involves daily bathing for five to 10 minutes in lukewarm water with an emulsifying oil. The child is patted dry very gently, and an emollient is applied. In addition, the society recommends emollient therapy a few times a day to increase hydration in the skin.
"And that reduces itching and can help control the eczema, in addition to your prescription products that your doctor recommends," said Cresswell-Melville.
Warshawski said the national campaign also is intended to convey to people who don't have eczema the fact that it is not contagious.
"So when they see somebody with eczema, they don't have to run away or try to avoid them," he said.
"I just recently saw a patient up in Baffin Island who was fired because of her eczema because the employers thought she was contagious."
In fact, the workplace is sometimes responsible for the condition. Eczema is primarily a condition of young people - 80 per cent of it begins before age five - and prevalence declines as they grow into adulthood, said Warshawski. But outbreaks can return in adulthood, at times in the work environment when a susceptible individual is exposed to irritants on the job.
"You can see a lot in health-care workers, for instance, because they're washing their hands all the time. It's decreasing the barrier, and making it worse," said Warshawski.
Cresswell-Melville said winter is problematic for her family (her one-year-old daughter has a mild case of eczema too) because the air is so dry.
"So we turn on humidifiers, the heat goes down a little bit at night so the children can sleep comfortably. They'll wear light cotton pyjamas, never the 100 per cent polyester sleepers, and we keep up with the emollient in the bathing."
"Treating eczema takes diligence and great effort, as it is a constant battle, but the results are worth it."
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