Dr. Catherine C. McCuaig
FRCPC, DABD, Canadian Dermatology Association President
Have you ever experienced dry inflamed itchy or burning skin?
If you’re living in Canada, you probably have! Maybe you went out for an enjoyable hike in the forest this past summer and ended up with poison ivy acute allergic contact dermatitis (eczema) with huge blisters, swelling, and pruritus. Or your skin gets so dry in the cold winter, you develop itchy red scaling patches on your lower legs that we call asteatotic eczema or eczema craquelé (like dry cracked pavement). Worse still, you may be one of the many patients suffering from atopic dermatitis (up to 20 percent of children, and 3-10 percent of adults).
What can be done to prevent skin inflammation?
Firstly, daily bathing is recommended; however, we suggest limiting time to five minutes, using tepid not hot water, and mild cleansers or syndets. This hydrates the skin and removes any debris, scales, and bacteria that could otherwise accumulate.
Following this, liberally apply a hydrating cream or moisturizer. This may be once or twice a day depending on the dryness of the skin. These moisturizers have different characteristics, depending on whether they are emollient, occlusive, humectants, or protein rejuvenators.
Minimize exposure to dry heat, smoke, and allergens such as certain pets, airborne pollens, dust mites, and occasionally food allergens.
What treatments are available if I get eczema despite using moisturizers?
Topical corticosteroids are critical for acute flares and resistant plaques. Milder ones are used on the face and folds. Calcineurin inhibitors, phosphodiesterase inhibitors, topical or oral antibacterials, and narrowband UVB phototherapy play a role. For severe cases, we’ve used off-label immunosuppressive medications such as methotrexate, mycophenolate mofetil, and cyclosporin to decrease inflammation. Now new oral and topical Jak inhibitors hold promise. In addition, more targeted injectable biologics block specific interleukins, such as IL-4, IL-13, IL-5, IL-31, and demonstrate dramatic efficacy.
My friend has psoriasis. Should he use the same creams?
Your friend can certainly benefit from bathing and moisturization as described above. However, they should consult a board-certified dermatologist for guidance as to the best medicated topicals or systemics to use. We have been fortunate to have great treatments for some time, with the use of anti-TNF agents, anti-IL 12,23, anti-IL17 and anti-IL 23 biologics. Options for eczema have only improved in the last 2 years.
So where do we go from here?
Enjoy the winter! Hopefully, you can find a winter sport that helps you enjoy the snowfall. Useful resources include the Canadian Dermatology Association website, as well as the Skin Patient Alliance of Canada, and the Eczema Society of Canada.
