Living with eczema can mean navigating plenty of unanswered questions involving the condition. You may be curious about what triggers eczema flares, how dermatologists diagnose eczema, or which other health conditions people with eczema may develop.
To get to the bottom of these questions, MyEczemaTeam sat down with Dr. Brian Kim and Dr. Heather Richmond. Dr. Kim is co-director of the Center for the Study of Itch and Sensory Disorders and an assistant professor of dermatology at Washington University School of Medicine in St. Louis, Missouri. Dr. Richmond is a board-certified dermatologist who has been practicing in the Houston, Texas, area since 2011.
“Just like with other conditions, we don't necessarily always know what triggers eczema,” Dr. Kim said. “But one definite trigger is that patients with eczema have an impaired skin barrier and immune system in the skin, so they can get what we refer to as ‘superinfections,’ such as staph or strep infection — or even a herpes virus infection — and that will definitely flare the eczema.”
In addition, Dr. Kim noted, environmental conditions can trigger flares. Dry or sweaty skin can prompt a flare in some people, and allergens may play a role as well. However, he cautioned, “There's a lot we don't know yet.” Researchers are continuing to study eczema triggers and flares.
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“The short answer is that there is no test,” Dr. Kim said. Instead, physicians will evaluate your skin during a medical exam and use clinical criteria, as well as your medical and family history, to make the diagnosis. A skin biopsy may also be necessary.
“That's part of the challenge, is that there isn't just a clear test,” Dr. Kim said. Physicians will rule out other conditions as part of the diagnostic process before coming to an eczema diagnosis.
“In general, I'm not overly impressed with at-home remedies,” Dr. Richmond said. “Sometimes, trying at-home remedies can take the focus away from topical or biologic therapies that we know are helpful.”
One exception for people with eczema, however, involves bleach baths, in which you dilute a small amount of household bleach in a tub of water and then soak in it for a few minutes. “These have really been shown to cut down on superinfections, such as staph, which will just absolutely rev up the inflammatory condition. So doing that once or twice a week and then just rinsing off with water afterwards has been shown to be helpful,” Dr. Richmond added.
The idea behind a bleach bath is to eliminate bacteria on the skin. “Whereas most individuals don't just have Staph aureus bacteria living on their skin, eczema patients can actually symbiotically live with staph on their skin, which is unfortunate,” Dr. Kim said. “So the idea is that you put bleach in the bath and you soak, and you just essentially decolonize your skin from staph.” In addition, he said, some studies suggest that bleach baths can have anti-inflammatory properties.
Always speak with your physician before trying bleach baths. While some health care providers can offer specific guidelines for how much bleach to use and how long to sit in the water, physicians will always want to check your skin first and ensure that bleach baths are safe for you.
“If you have eczema, just from a medical standpoint, you're at much greater risk for food allergy, asthma, and other atopic disorders that are in the family,” Dr. Kim said. Fortunately, some of the systemic medications that work for eczema can also help you manage symptoms of other skin conditions at the same time, he noted.
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