Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterised by a compromised skin barrier, leading to dryness, itching, redness, and recurrent rashes. Similarly, other barrier-compromised conditions, such as dry skin (xerosis) and sensitive skin, also involve a disruption in the skin’s protective outer layer, the stratum corneum. In all these conditions, the skin’s ability to retain moisture and defend against irritants and allergens is impaired. Therefore, gentle skincare practices are of paramount importance in managing symptoms, preventing flares, and improving overall skin health.
The skin barrier, primarily composed of the stratum corneum and its lipid matrix, plays a crucial role in maintaining hydration and protecting underlying tissues from the external environment. In conditions like eczema, this barrier is defective, leading to increased transepidermal water loss (TEWL), making the skin dry and more permeable to irritants and allergens. Harsh skincare products and practices can further damage this already compromised barrier, exacerbating symptoms and triggering flares.
Cleansing is a fundamental aspect of skincare, and for individuals with eczema and other barrier-compromised conditions, the choice of cleanser is critical. Traditional soaps, with their alkaline pH and harsh surfactants, can strip the skin of its natural oils and disrupt the lipid barrier, leading to increased dryness and irritation. Therefore, soap-free cleansers are strongly recommended. Synthetic detergent cleansers (syndets), which have a pH closer to the skin’s natural slightly acidic pH and contain milder surfactants, are a much better option. Syndets cleanse the skin effectively without being overly stripping or damaging to the barrier. Bars based on sodium cocyl isethionate are often highlighted as being particularly mild and well-tolerated. For individuals with very dry or sensitive skin, lipid-free cleansers that can be used without water and gently wiped away may be preferable, as they cleanse with minimal disruption to the skin barrier and often leave behind a thin layer of moisturising ingredients. It is essential to avoid cleansers that contain fragrances, alcohol, harsh exfoliants, or strong detergents, as these can be significant irritants for barrier-compromised skin. When cleansing, using lukewarm water and patting the skin dry with a soft towel, rather than rubbing vigorously, is also important to minimise mechanical irritation.
Moisturising is the cornerstone of managing eczema and other barrier-compromised conditions. Regular and liberal use of appropriate moisturisers helps to hydrate the skin, restore the impaired barrier function, and reduce dryness and itching. The type of moisturiser can vary depending on the severity of dryness and individual preferences. Emollients, which contain lipids and oils, help to smooth the skin and replace lost oils. Humectants, such as glycerin and hyaluronic acid, attract and retain moisture in the skin. Occlusives, like petrolatum and mineral oil, create a protective barrier on the skin surface, reducing TEWL. For very dry skin, thicker, more occlusive ointments and creams are generally more effective than lotions, which have a higher water content and may contain ingredients that can be irritating. However, some individuals may find lighter lotions more cosmetically acceptable for daytime use. The key is to choose fragrance-free and hypoallergenic formulations, as even seemingly innocuous ingredients can trigger reactions in sensitive, barrier-compromised skin. Applying moisturiser immediately after bathing or showering, while the skin is still slightly damp, can help to lock in moisture. Frequent reapplication throughout the day, especially after hand washing or other activities that may dry the skin, is also crucial.
Beyond cleansers and moisturisers, individuals with eczema and other barrier-compromised skin should be mindful of other potential irritants in their environment and skincare routines. Avoidance of known triggers is essential. These can include:
Irritating fabrics: Opting for soft, breathable fabrics like cotton and avoiding wool or synthetic materials that can feel itchy or rough against the skin.
Harsh laundry detergents and fabric softeners: Choosing hypoallergenic and fragrance-free options.
Extreme temperatures and humidity: These can exacerbate skin dryness and irritation.
Sweat: Keeping the skin cool and dry, especially during exercise.
Certain soaps, detergents, and household cleaners: Wearing gloves when using cleaning products.
Known allergens: For individuals with allergic eczema, identifying and avoiding specific allergens (e.g., certain foods, dust mites, pet dander) through allergy testing and environmental control measures is important. In some cases, medical treatments prescribed by a dermatologist are necessary to manage eczema flares and control symptoms. These may include topical corticosteroids to reduce inflammation and itching, topical calcineurin inhibitors as steroid-sparing agents, and systemic medications for more severe or widespread eczema. However, even when medical treatments are used, a consistent and meticulous gentle skincare routine remains a vital foundation for managing eczema and other barrier-compromised conditions in the long term. By prioritising gentle cleansing and consistent moisturisation with appropriate products, individuals can help to restore and maintain their skin barrier function, reduce dryness and irritation, and improve their overall skin health and quality of life.