Allergy Today Advice Article
Don’t let eczema stop your fun this summer
Dermatologist and paediatrician Dr Diana Purvis provides expert advice on how to manage your eczema while enjoying the sun and sand this summer.
Eczema is primarily caused by the skin having a poor barrier function. This means the skin loses its natural protection against factors that can aggravate and cause inflammation, such as soap, chlorine and dust mites.
Skin with eczema is also more prone to infection, as it has less defence against bacteria and viruses. People with eczema have to be more careful when taking part in summer activities, but can still have fun!
Overheating makes it worse
Heat can increase irritation of the skin, and for people with eczema hot nights are often when itch is at its worst. Make sure your bedroom is cool and that you don’t overheat under thick bedding. Thin cotton pyjamas and sheets are often sufficient and a cool fan can help. Keep emollient in the fridge and if you wake up hot and irritated, take a cool shower or bath, and apply it.
Sweating can sting eczema and cause flare-ups. Participate in strenuous activities in the cooler parts of the day, or get involved in sports where sweating is less of a problem, such as swimming or golf. Choose clothing that is cotton and breathable.
Salt water tends to be less aggravating than chlorinated water so, if possible, find a saltwater pool or swim in the sea.
Most people with eczema can swim without major problems after taking a few precautions:
• Follow your eczema plan by using moisturisers and topical steroids to keep eczema as well controlled as possible in the days before swimming. This will reduce the stinging when you first get in the water.
Sun exposure – risks and benefits
New Zealanders have one of the highest rates of skin cancers in the world, including melanoma, so we need to be careful of sunburn, particularly in childhood. Sun exposure is also one of the most important causes of wrinkles and premature ageing of the skin.
However, ultraviolet (UV) light from the sun also has anti-inflammatory properties and suppresses the immune system in the skin.
Dermatologists harness the beneficial effects of ultraviolet light when using prescribed doses of UV for phototherapy. This involves the use of specially designed booths that deliver specific wavelengths of UV light to treat eczema and other inflammatory skin diseases.
Medical phototherapy is quite different to the light used in sunbeds. Sunbeds are not recommended for patients with eczema – or for anyone – due to the high risk of skin cancers, including melanoma, that are associated with the regular use of these.
Exposure to sun is also important for the production of vitamin D in the skin. The amount of sunlight needed to maintain vitamin D at healthy levels depends on a number of factors, including your skin colouring, the amount of skin exposed, time of year and latitude (distance from the equator).
In summer, healthy Caucasian adults need very little sun to maintain vitamin D levels: less than 10 minutes of sun exposure to the face, hands and arms each day. Reassuringly, routine use of sunscreen has not been shown to reduce vitamin D levels in adults.
• Slip on clothing which covers the main areas of sun exposure. Shirts with sleeves are preferable to singlets, and rash shirts should be worn when swimming outside. Remember, loosely woven fabrics can let light shine through to your skin, providing less sun protection. No sunscreen is designed to be put on skin with active eczema and so clothing is always preferable and should always be your first line of defence.
Holiday action plan
Many people find that a summer holiday with safe sun exposure and plenty of swimming is actually helpful to their eczema. In part, this may be due to a change of environment and the opportunity to relax.
There are several things to consider that may help make your break more enjoyable:
• Book to see your doctor a week before you go away to ensure you have adequate amounts of cream and a plan for what to do in case your eczema flares up.
Dr Diana Purvis is a paediatric dermatologist at Starship Children’s Hospital, Auckland. Article first published in Allergy Today Summer 2015. Reviewed and updated November 2018 by author.