Coping with eczema

This information is aimed at children aged 7 to 12 years old and can be useful by anybody who has eczema or who knows somebody with eczema.

Managing eczema involves more than using medication and creams. These are very important but coping with how your eczema makes you feel is important too.

What is eczema?

Eczema is a disease that causes the skin to be very dry and itchy. It can be very difficult to resist the urge to scratch because it feels so itchy. Some people scratch their skin until it bleeds. The skin can then become infected.

Your eczema may be better or worse at different times of the year. It may even be better or worse at different times of the day. A lot of people find their itching is worse at night and this can keep people from sleeping.

What causes eczema?

The exact cause of eczema is not known but it is thought to be a type of allergy that is passed down through families. If one or both of your parents have had eczema there is a higher chance that you will also have it.

One thing we do know is that it’s nobody’s fault that you have eczema. There is nothing you or your parents did or didn’t do that caused you to have eczema. Having eczema does not mean you are unclean and remember — eczema is not contagious. You can’t ‘catch’ it or give it to someone else.

The look of eczema

Eczema can look different for everybody. It can be found anywhere on the body, including behind the knees, in the bend of the elbows, on hands, feet, arms, legs, the body, face behind ears, or on the scalp.

Eczema can look like red inflamed patches, cracked or flaky skin, scabs, thickened areas of skin or the skin might be discoloured or have lost its colour. If the skin has become infected, it may have little fluid-filled bumps that ooze or are covered with yellow crust.

The feel of eczema

Eczema can cause the skin to feel very itchy, painful, and raw. It can cause peeling that can feel very sore. It can make the skin at your joints may be stiff and difficult to bend.

What causes the itch?

When we come into contact with things, our skin or bodies are sensitive and trigger the release of natural chemicals. These chemicals act as a barrier to protect the skin from whatever is invading it.

The problem is that these chemicals also cause itching, redness and swelling. In people who don’t have eczema, the chemicals go away. In people with eczema, the skin cells keep producing chemicals, which make the itching continue.

The problem gets worse when you scratch or rub the itchy area of the skin. Scratching annoys your skin and causes the cells to release even more chemicals. Once the skin has been broken, you are at risk of infection and it may cause a flare-up. This makes you itch even more. We call this the itch-scratch cycle.

The itch-scratch cycle:

1. Skin is irritated and begins to itch
2. You scratch your skin
3. This causes the skin to become sore and itch even more
4. You want to scratch even more

Instead of scratching your skin, you could try gently pressing, tapping or pinching your skin instead until you don’t feel like you need to scratch it. Or you could clench your fists gently or squeeze a squidgy ball for 30 seconds.

Many people with eczema say it is more helpful if the people around them suggest things they can do, such as ‘tap your skin’ or ‘squeeze your fists tight’ rather than telling them not to do things, such as ‘do not scratch’ or ‘stop scratching.’

Eczema treatments

Your dermatology nurse specialist will be able to give you more information about what happens to your skin when you have eczema and about the different treatments available for eczema. Here is a quick explanation of some of the different treatments for eczema you may already be using:

Emollients

Emollients help to keep your skin well moisturised, reducing the dry feeling and protecting the skin. They need to be used every day alongside a special bath oil and soap substitute or wash.

Antihistamines

These can help you to sleep better at night if you are having a bad itchy flare-up of your eczema. They are not used all the time.

Steroid creams and ointments

These are the medicine creams you may need if your eczema is very red and sore. They are used until the eczema is better. Sometimes you will be given a steroid with some antibiotic in it if your skin becomes infected. Your dermatology nurse will show you how to apply these properly.

Wet-wrapping

These are bandages used to control the symptoms of eczema. It helps lessen itching and help you to sleep better. The newer bandages are like t-shirts and leggings and feel much more comfortable. Ask your doctor or nurse about these.

Looking after your skin

Having a skincare routine can help your skin.

Finding the triggers

Triggers are things that cause your skin to flare. Everybody with eczema will notice that some things cause their skin to itch more.

The first step to taking control of your eczema is to avoid the things that your skin is sensitive to. But you need to find out what these triggers are.

Using a monthly calendar or diary can help you discover what might be causing your skin to flare. Each week, write down anything different that you do, such as different activities, creams, and clothes. You could also write down if the weather is very hot or cold and see if this causes your skin to flare. You could also write down any changes in feelings you have, for example, if you are worried or angry about something.

Here is a list of some of the things children with eczema have identified as triggers:

• dry skin
• stopping using creams
• new bubble bath, soap, shampoo, or other substances
• hot water
• wearing clothes made from wool, polyester, nylon, and acrylic
• getting hot and sweaty
• eating certain foods
• petting dogs and cats
• pollen
• dust
• hot weather (making me hot and sweaty)
• cold weather (making it hotter indoors)
• getting stressed (worried, angry, frustrated, upset, embarrassed)
• feeling tired or ill

Impact of eczema

Eczema doesn’t just affect your skin and body. It also affects how you feel on the inside and how you act. It can affect your feelings, your thoughts and your behaviour

Feelings

Here are things children with eczema might be feeling:

• I feel different from other children
• I am worried that my eczema will get worse and never go away
• I feel angry that I have to put on creams and can’t do what my friends are doing
• I envy other boys and girls who don’t have eczema
• I feel embarrassed about my skin
• I get upset when people ask me what is wrong with my skin
• I feel guilty when I have scratched my skin

Thoughts

Our feelings are linked to how we think about other people, the world and ourselves. Here are some thoughts that children with eczema might have:

• I’m not as good as other children
• I can’t do as well as other children
• It’s not fair — why do I have to have eczema?
• I don’t want to talk about it. I just want it to go away
• Nobody understands what I’m going through
• I can’t stop scratching. What’s the point in trying?

Behaviour

When we don’t feel good about ourselves and we think negative thoughts like those just mentioned, it can show in our behaviour. Here are a few examples of behaviours that can link to unhappy feelings and thoughts:

• poor sleep
• not joining in with friends
• not trying new things
• not talking about feelings or about eczema
• not wanting to use creams and medicines
• crying
• getting angry with other people

Ideas to help you beat the itch

Your team

Think about who can help you. On your team you might have:

• You
• Parents
• Doctor
• Nurse Specialist
• Brothers or Sisters
• Friends
• Teachers
• Psychologist
• Anyone else?

Positive thinking

Look at how eczema makes you feel and think badly and how you can change some of these negative feelings and thoughts into more positive ones that make you feel good about yourself.

Here are some ideas to help you think positive:

• Make a list of the upsetting or negative thoughts you have about eczema and work out some good positive thoughts. Practice your positive thoughts every day.
• Make a list of all the things you like about yourself and are good at.
• Ask yourself, what would I say to a friend who was feeling upset about their eczema?
• Try not to make guesses about what other people are thinking. People may not even notice your skin. They may ask you about it but it doesn’t mean they are being unkind. They may just be curious or just not understand eczema.
• It can help to have a simple explanation ready to give people if they ask about your eczema. Some children choose to say something like ‘It’s just eczema and you can’t catch it’.
• Imagine you have a coach on your shoulder reminding you that there is much more to you than your eczema and to think positively.

Distraction

Distraction can be a very useful tool to beat eczema. Distraction means concentrating on something else so that you don’t notice your skin is itching.

Here are some ideas children use to distract themselves from the itch:

• watching tv
• playing with friends
• singing songs or playing counting games
• playing on the computer
• painting or crafts

Relaxation and guided imagery

These tools use your imagination. It can help you to overcome the urge to scratch. Relaxation and guided imagery can also help you to fall asleep and to get back to sleep if you wake up at night.

Relaxation

Relaxation is a skill, like playing sport or reading, which gets better the more we practice it. If we learn to relax our muscles and our minds, we can escape the tense feelings and upsetting thoughts we might be having about eczema. To relax you might like to listen to your favourite music or story.

Guided imagery

Many children like a story to help them to relax because it’s more fun and takes your mind away from what is going on with your skin. It can be any story you like. You just need to imagine a place and all the sights, the sounds, the textures and the smells there.

Dealing with teasing and bullying

Sadly, there may be times when you experience teasing or bullying. The important thing to remember is that having eczema is not your fault. Here are a few ideas that some children have found useful if they experience teasing or bullying:

• It is very important that you let somebody on your team know if you are being bullied or teased. They will be able to help the bullying stop and will probably have some ideas about how you can respond to teasing.
• It can be very useful to think of some ways to respond to teasing. You might use jokes or ignore any comments. Some children find it helps to practice their responses with members of their team.
• Distract yourself by singing a song to yourself, saying your times-tables or making up a poem.
• Remember positive thinking. Remind yourself that some people just don’t understand eczema and that they may not know it is not contagious. Remind yourself of all the things that you like about yourself and are proud of and all the things that your friends, family and other people like and love about you.
• Sometimes, being friendly or changing the subject can be helpful. Join in with people. Try to stick with your friends.
• Remember that you are not the only person who gets teased.
• Use your body language to give yourself confidence. You could try looking people in the eye, using a loud voice and standing up tall and straight.

Scratch diary

A scratch diary lets you record how much you scratch in the morning, afternoon and evening so that you and your team can see when you are most likely to scratch and work out why. You should write down anything that helped you to stop scratching so that you can remind yourself to use these things again.