Managing the insatiable itch


Did you know that your largest organ is your skin?

This is why it’s important to keep it in good condition, because when things go haywire, it can cause more than an itch.

One debilitating skin condition associated with that insatiable itch is eczema and it’s known to cause redness, itching, infections and general discomfort and distress for sufferers.

It’s a condition that affects people of all ages – infants, children and adults alike.

Eczema triggers

Experts agree there are many triggers for eczema and skin irritation, including diet; climate and humidity levels; external irritants such as certain chemicals, soap, detergent; stress; long, hot showers; sand and dust; ducted central heating; and infection.

“Infection is a very potent trigger for eczema, particularly infection with the bacterium, Staph aureus,” Professor Gayle Fischer, Head of Dermatology at the Royal North Shore Hospital in Sydney said.

“The things that trigger that genetic response are many, but may be related to things you can’t control, like the weather.

“Eczema is nearly always worse in winter when there’s low humidity, because then the skin dries out more. But there are [also] people who are worse in hot weather, for all sorts of reasons. Some people worsen in summer because they go into chlorinated pools to swim, which dries out the skin.”

Moisturising is key

Due to the whole gamut of triggers that can irritate the skin, leading to flare-ups, skin management is crucial for someone with eczema.

While avoiding known irritants is one of the keys to prevent flare-ups, preventing dryness through the regular use of moisturisers is imperative.


“From a management perspective it’s things like simple cleansing and moisturising,” Community Pharmacist, Gerald Quigley said.

“Cleansing and moisturising is absolutely important … and the perfect time to moisturise is while your skin is damp.

“So, after you’ve dried off with your towel, that’s the perfect time and moisturisers are absorbed much more efficiently then.”

Mr Quigley also stresses the importance of moisturising all parts of the body, including the face and neck.

“Most men I see don’t apply moisturisers to the face and it’s a market that I think has been ignored by many companies,” he said. “We need to encourage men to moisturise after they shave too … to make sure they’re looking after their skin correctly.”

Eczema creams

While the importance of regular moisturising can’t be ignored when it comes to skin management, eczema treatment also involves the correct use of anti-inflammatory creams – both steroidal and non-steroidal.

“There’s now a range of steroidal and non-steroidal anti-inflammatories that are available for eczema,” Professor Rodney Sinclair of Sinclair Dermatology said.

“One of the troubles that we often see in our patients with eczema is that when the eczema disappears, they think their skin is back to normal. So, they stop their treatment and, lo and behold, it relapses in a couple of days.

“We’ve learnt over recent years that the best strategy with eczema is to keep going for four to five days beyond apparent resolution, where you continue to use your creams every day and then you may even need to use the creams once or twice a week for another six to eight weeks, even on what looks to be normal skin, as a way of reducing relapse.”

While there seems to be a fear factor associated with the use of topical steroids, the experts agree that they are safe and effective in eczema management.

The role of nutrition

“Research suggests that a diet high in fast food may increase the risk of eczema, especially in people who consume it regularly,” said Accredited Practising Dietitian Melanie McGrice, Spokesperson for the Dietitians Association of Australia.

While, as Ms McGrice points out, “authorities state there are no proven vitamin supplements that can benefit eczema, a diet rich in “omega 3 fats is one of the best dietary strategies known for improving eczema”.

“It’s believed that omega 3 is beneficial as it is known to have a powerful anti-inflammatory effect, which may help to minimise flare-ups,” she said.

“However, it’s important to note that fish and fish oil supplements have been found to trigger an exacerbation of eczema in some people.”

A popular mineral supplement for eczema is zinc.

“The theory behind this is that our body uses zinc to boost immunity and control inflammation,” Ms McGrice said.

“One study found an improvement in eczema in people who had a diagnosed zinc deficiency. However, other studies show little improvement for people who have eczema, so it’s not a common recommendation.”

According to nutritionist Karen Fischer, author of The Eczema Diet, The Eczema Detox and The Healthy Skin Diet, “inflammation uses up a lot of nutrients in the body, including zinc, biotin and vitamin C”.

However, she warns that supplements may make eczema worse due to “the additives” they contain. “High doses of B vitamins can [also] worsen the itch,” she said.

Food sensitivities

Food allergies and food chemical sensitivities can also be problematic for eczema sufferers.

According to Ms Fischer, in 51 per cent of people with eczema the condition is triggered by salicylates and in 35 per cent of cases flare-ups occur when they consume amines, which are in probiotics and fermented foods.

She adds that this generally requires the prescription of an “elimination diet that is low in amines and salicylates, and [also] free of dairy and wheat”.

Find the underlying cause

At the end of the day, as Community Pharmacist Mr Quigley puts it, “the pharmacist and pharmacy assistant can play a really important role [in trying] to understand where the problem initiated from in the first place”.

 “There are lots of things and I think we sometimes think there’s a simple treatment for everything, but we need to understand what the initial cause was in the first place.”

The message seems clear: it’s important to dig a little deeper to find the underlying cause when it comes to managing skin conditions rather than simply providing the band-aid approach.

To read the full feature as it appears in the latest issue of Retail Pharmacy Assistants magazine, visit: