Allergy Today Advice Article

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.

Some people find antihistamine medications can help with itch and sleep. Discuss with your doctor if a trial of antihistamine is worthwhile.

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.

Swimming

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.
• After swimming rinse off with fresh water immediately.
• Apply moisturiser before heading to the pool and reapply after swimming.
• Do not go swimming if you have a skin infection, as these are contagious.

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.

Vitamin D

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.

Sun-safe tips

• 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.
• Slop on sunscreen. If eczema is not active, using a broad spectrum sunscreen will protect against both UVA and UVB rays. Choose one with a SPF30 or more. The effectiveness of your sunscreen is reduced if it is not applied in adequate amounts, so be generous. Reapply every two to four hours. Sunscreen is particularly necessary when there is exposure to reflected light, such as from water.
• All sunscreens have potential to cause irritation or contact allergy. The reflectant creams (those with zinc and titanium as the active ingredient) may be better tolerated by sensitive skins. Sprays and gels are lighter and easier to apply but are more likely to sting than creams. Always test sunscreens on small areas before applying over your whole body.
• Slap on a hat. Hats should be broad-brimmed or Legionnaire in style and provide shade to the face, neck and ears. For infants, choose a soft fabric that will crumple when they lie down on it.
• Seek shade, especially if your skin is inflamed. Outdoor activities in summer should be planned for early morning and late afternoon when the UV index is the lowest. For infants, choose a stroller with a shade cover, and for young children, play areas with shade are preferable.
• Slip on sunglasses, which protect the eyes from damaging UV light.

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.
• Try to get your eczema under good control before you leave.
• Stock up on insect repellent, sunscreen and a spare hat.
• Ensure you have a variety of indoor and outdoor activities to choose from so you can still have fun while being sun-safe or if your eczema flares up.
• Choose accommodation with adequate washing facilities – having a bath at hand can be a bonus.
• Remember to relax – being stress-free is always helpful.

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.

December 2018