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Dr Sarah Wakelin’s Q & As for Atopic Eczema


Dr Sarah Wakelin’s answers the key questions on Atopic Eczema

1. What are the key signs of severely dry skin parents should watch-out for?

Dry skin is a common complaint nowadays and can affect babies and children of all ages.  It can also run in families and usually affects people who have a tendency to get eczema.  Recent research has shown that children with dry skin also have an increased chance of developing allergies, hay fever and asthma (atopic complaints).

Normal skin is soft and smooth with a slight shine, but dry skin feels rough and looks dull.  It may also be cracked and flaky. The skin markings may be more noticeable which can lead to a wrinkled appearance.

2. How dry skin impacts the quality of life of families you see and what advice do you give?

Dry skin is usually itchy and uncomfortable – at times it may feel tight and sore.  Itchiness leads to scratching and this causes difficulty falling asleep as well as interrupted sleep – impacting on the whole family as well as the child.

Poor sleep leads to tiredness and irritability during the day, which interferes with school and play.  Itch can cause distraction and loss of concentration and has a negative impact on wellbeing.
My advice is to focus on following a gentle skin care routine. This involves using mild cleansers, moisturisers, wearing soft breathable fabric next to the skin and avoiding harsh toiletries. Some moisturisers have added anti-itch ingredients which can help relieve symptoms.

3. What is the role and importance of moisturising the skin?

Moisturisers play a key role in managing dry skin conditions.  They help to repair damaged outer layers of the skin, replacing natural oils and locking in moisture to making it soft and supple again.  They also improve the skin’s ability to protect against infection and trauma.   Moisturising dry skin relieves itch and improves the appearance, giving it a healthy glow.

To get the most benefit, moisturisers should be applied to dry areas every day – in fact, they can be used whenever the skin feels dry to the touch. Studies have shown that using moisturisers regularly cuts down the amount of steroid needed to settle the skin in eczema sufferers. By restoring the skin barrier, they reduce the chance of an eczema flare and may prevent the onset of allergies.

4. What aggravates dry skin and how to avoid it? e.g. impact of allergens, heating, diet.

Dry skin is vulnerable to irritation from the climate, clothing and skin care products.  Cold, dry winter weather in particular dries everyone’s skin and can lead to chapping and soreness.  Low humidity environments caused by air conditioning and central heating are also a problem.

Chemicals such as soap, bubble bath and liquid soaps act as detergents, removing protective oils and moisture from the skin.  They can cause and aggravate a dry skin tendency. All soap is bad for dry skin, not just highly fragranced - this is something that people don't understand.  It is the alkalinity and detergent action of soap, rather than the fragrance per se that damages the skin. Soap also upsets the natural pH of the skin which adds to its damaging effects.

Too much contact with water also dries the skin as it washes away the natural oils.  This is why long soaks in the bath are a bad idea for dry skin and eczema sufferers.  Swimming can also cause dry skin so it is important to apply plenty of moisturiser afterwards.

Many people worry about diet and food allergies but these are not the underlying cause of dry skin.   Laundry detergents are often blamed for rashes and skin problems, but there is little evidence to support this.  The answer to dry skin problems is straightforward – it is to focus on what is coming into contact with skin – in particular, how it is washed and moisturised.

If a child has dry skin, think carefully about what skin care products are being used as these may be causing or aggravating the problem.

5. How important is following a skincare routine in managing dry skin?

Following a gentle skin care routine is the simplest and most effective way of managing a dry skin tendency.  It doesn’t need to take a lot of time – a good starting point is to choose products that have been formulated for dry skin. By switching to gentler products, the problem can usually be managed without a need for prescribed medication.  Simple changes can make a big difference to how the skin feels.

6. Do you feel regular application is an issue with emollient care? What advice do you have for parents trying to achieve regular application?

An emollient or moisturiser will not work if it stays in the pot, so it is essential that the person/child with dry skin finds a product that they are happy to use, then uses it regularly.  One of the best times to apply moisturisers is a few minutes after washing or showering when the skin is still warm and damp because they can soak in easily.  They can also be applied during a bath and many moisturisers double up as soap substitutes.  Children love to have fun and turning moisturiser time into a game will make it more enjoyable for everyone.   Draw smiley faces with the moisturiser, play counting games or name the body parts as it is applied, and encourage your child to put their own creams on, with lots of praise as they are learning to do this.   If you have dry hands or knees, why not let your child put a few dabs of moisturiser on you and reverse the roles?!

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