Up to 10 per cent of childhood eczema will carry into adulthood. These patients will continue to have ‘imperfect skin’—dry skin lacking the abilities to heal properly or fight against microorganisms. This occurs because of a lack of special proteins such as fillagrin and natural moisturising factor (NMF) due to genetic mutation of patients’ skin.
The risk of recurrence is high if their skin is not protected in the best way possible.
Moisturiser is an essential part of healthy skin maintenance and should be continued indefinitely. Dryness can predispose your skin to problems.
By focusing on protecting the skin barrier—using lots of moisturiser, avoiding contact with irritants and other measures—it is possible to strengthen imperfect skin and lead a normal life.
People with a history of atopic dermatitis should apply a cream that is strong enough to kill all the opportunistic microorganisms at the first sign of a broken or weakened skin barrier. This applies to even a tiny scratch, an insect bite, cut, abrasion or burn. The cream they use should be gentle enough to promote skin healing, with the ability to close up the ‘entry points’ of micro-organisms. Ideally it should also control itchiness. If you take such precautions, you can prevent the recurrence of these skin conditions. The most important part of any skin treatment therapy is the control of scratching and itchiness. Scratching worsens eczema, leading to increased itching and more scratching. We need to break this vicious cycle to help the skin to repair itself. Whatever it takes, people with eczema must stop scratching. Even rubbing on the lesion is bad. Antihistamines can offer some relief.
An effective treatment will promote a new healthy skin layer to replace ‘bad’ skin. New skin is very delicate and can be damaged easily by scratching. If you scratch, your skin will never have a chance to get better. It is important to stop the scratching. Scratching can happen during sleep, be habitual or subconscious scratching. These issues need to be identified and treated. It is also necessary to avoid contact with allergens. Even though skin allergy is not a cause of eczema, it can trigger or worsen existing lesions. Coming into contact with allergens leads to itchy skin, inevitably causing constant scratching. Scratching, as mentioned before, compromises the skin barrier. It interferes with skin repair and, at the same time, provides an entry point for microorganisms.
Avoid bubble bath because it causes skin dehydration. Avoid prolonged hot showers because they remove the natural moisturiser from your skin. Applying a thick layer of moisturiser before jumping in the pool helps create a second skin for regular swimmers. After the swim, apply moisturiser again to replace the natural oils lost.
Avoid contact with chemicals and wear gloves when possible. Your gloves must be dry and clean, because wet or dirty gloves are worse than no gloves at all. Avoid using soap and shower gel, if you can. Avoid skin scrubbing and use gentle cleansing agents or only water.”