An eczema sufferer’s guide to eczema

14 min readOct 29, 2020

Why have I written this?

I had a phone appointment with my GP to check-in ahead of getting my repeat prescription for my steroid creams. I listed what I needed, he laughed, and said “patients with eczema always know what they need better than we know — that’s all fine”. And that is, generally, true. I’ve been to countless GPs who have no clue what I need and won’t listen when I tell them about my experiences. I’ve been fortunate that my dad is a dermatologist and has helped me, but I’ve still had to do a whole load of research on my own. The key thing I’ve come to learn is: everyone is different when it comes to eczema. There’s no cure for it. You have to constantly listen to your body, and do your best to figure out how you can keep it under control.

This guide is 26 years of accumulated knowledge of eczema, everything I’ve been told, and everything that I’ve tried. My experience will be different to yours and all of this may be useless to you — or it could be the holy grail of information. Nobody is ‘right’ when it comes to this. You’ve just got to give stuff a go.

TL;DR

My triggers:

Stress, dry air (aircon in particular), monosodium glutamate (MSG), alcohol, dehydration, allergies.

My routine

When I have a flare up on my body, I use an emollient (Doublebase Dayleve), then 15 mins later apply a steroid cream (dermovate) morning and night for no longer than two weeks. Plus, I use a normal moisturiser (Aveeno demexa) 6 times a day on the areas where I tend to get flare ups. If I’ve got any patches that are really sore or bleeding, I use Elizabeth Arden 8 hour cream as and when needed throughout the day. After the flare up has gone down (usually a week), I stop using the steroid. When I’m not flaring up, I moisturise in the spots where I know I get eczema morning, night, and whenever habit takes over with Aveeno and E45. I use my emollient before bed if it looks like something is going towards the eczema road.

Luckily, I very rarely get visible patches of eczema on my face. But when I do, I try to avoid steroid on my face at all costs. If I absolutely have to, I use Eumovate for a couple of days. My routine stays pretty much the same even if I’m getting a flare up — I just try to address my triggers and completely avoid makeup. In general, I avoid using any unnecessary products on my face and try to keep makeup to a minimum (just to avoid putting extra things on my skin). My daily routine is the same morning and night: I cleanse using The Ordinary Squalane Cleanser or Burts Bees sensitive facial cleanser, rinse my face using a bamboo washcloth, then use Blephasol on my eyelids (I’m prone to dry eyes which spark eczema round my eyes), put on a few drops of The Ordinary Niacinamide 10% + Zinc 1%, moisturise with Calming Cream from the Beauty of Eczema, and put Burts Bees sensitive eye cream around my eyes. I keep this in my bag and just top up during the day if I’m having a flare up (obviously easier if you’ve got no makeup on). When my skin is doing well, I swap my moisturiser to La Roche-Posay Toleriane Sensitive Fluid Moisturiser. It’s just a bit lighter and feels a little more luxurious, rather than practical.

For any products I use, I avoid anything with fragrance, sodium lauryl sulfates (SLS), or parabens (why I avoid these is in the ‘choosing a moisturiser’ section), and generally try to keep all products to a minimum. I also make sure everything is a pump dispenser rather than a pot, as pots are more likely to harbour germs (which can aggravate your eczema). If you use a pot, go in with a clean spoon.

I don’t eat any special diets but I try to keep my diet consistent. I avoid anything containing MSG but it’s tough, and sometimes I just prep to have a flare up. Dehydration is a trigger for me so I drink around 3L of water per day — you can’t expect your skin to be hydrated if your body isn’t. I don’t drink much alcohol at all — if I want a big night, it’s just damage control. I try to manage stress, but, well, you know. Sun/UV is great, so getting any flare ups in some sunshine works wonders — though it’s difficult in central Manchester.

I put a cap of Zoflora in with all my laundry and regularly Zoflora my sofa and chairs with my steam cleaner, as well as using it to disinfect any other surfaces that I touch fairly often. I also wipe down my phone, keyboard, camera with Zoflora pretty often. I’m also conscious of the fibres that touch my skin so try to keep track of if there are certain fibres that seem to make my skin itch or irritated.

The really long bit

For those of you who want everything I’ve learned about eczema in all my years of suffering with it, here you go:

What is eczema?

In a nutshell, your skin barrier isn’t working properly and it’s letting in bacteria or other things that is causing your skin to become inflamed. What causes this problem with your skin barrier varies from person to person. Eczema is chronic, and there isn’t a ‘cure’. You have to find out what triggers it for you and a way that you can manage it.

Types of eczema

There are 7 types of eczema — you can read about them in detail here. You may have one type, or may have more. I have a few types. It’s good to know what you’re dealing with so you have a better chance of identifying the trigger, but it doesn’t make masses of difference.

Atopic dermatitis — the most common one. Is caused by genes, environmental triggers, or immune issues. Often comes up in the creases of your elbows and knees. Skin gets lighter/darker or gets thicker where it comes up.
Contact dermatitis — caused by a reaction to something you’ve touched. Really itchy rashes that burn and sting. Hives pop up on your skin, you can get blisters, or skin may thicken and feel leathery.
Dyshidrotic eczema — blisters that come up on your hands or feet. May itch and hurt.
Hand eczema — your hands get red and itchy. Really common if you work somewhere where you use chemicals that can irritate your skin.
Neurodermatitis — thick scaly patches. They can be really itchy and bleed/get infected. Common if you have other types of eczema or psoriasis. Stress is a common trigger.
Nummular eczema — round, coin-shaped spots. can be really itchy. Often an allergic reaction to a bite, or chemicals.
Stasis dermatitis — lower part of your leg may swell up if you’ve been walking. You’ll likely also have varicose veins. Happens if people have blood flow issues in their lower legs.

Treatment

Standard treatment for eczema is: bring down the inflammation using steroid — this is your short term fix — once the inflammation has settled, use a moisturiser regularly to repair the skin barrier. The strategy with my eczema treatment is to hit flare ups with a relatively strong steroid for a very short amount of time, then use over the counter moisturiser/products and eliminating my triggers to maintain and manage it. I use so much Zoflora to reduce irritants getting into my damaged skin. I aim to use as little steroid as possible for as short amount of time as possible. I spent years with GPs trying to give me weak steroids like hydrocortisone but I’d end up just using the steroid for much, much longer than advised, which can cause problems greater than eczema. Always use your steroid treatment as your doctor advises, but if you feel like you need to use it for longer than an absolute maximum of a couple of weeks something is amiss, so go back to your doctor.

Side note: steroid creams go off, so if you’ve got a dusty tube in a drawer somewhere and you find that it’s not working anymore, you may just need a new tube.

Treatment is all well and good but you have to remove the cause and know what triggers you, otherwise nothing you do will keep anything at bay for long, and it may stop your treatment from being effective at all.

Eczema scarring

When eczema clears, it can leave you with some scarring or discolouration. I’ve found they tend to just go away with time — mine take about a year before they disappear completely. I sometimes put aloe on them like I would any other scar but I’ve not found a miracle cure and don’t think there is one. They’re a bit rubbish but I like to think of them as marks of achievement for successfully healing that bit of my skin, and use them as a reminder of where to moisturise regularly just in case.

Finding your trigger

There’s no point going mad treating your eczema with steroids and things if you don’t know what the cause is. Finding the cause is a true pain in the arse and where there are the most myths and opinions. Keep in mind that everyone is different and be open to trying everything. I kept really detailed journals for a long time tracking my eczema alongside my life, feelings, cosmetics, products, environment, clothes — literally everything — just to try and spot patterns. It’s a long, long process. Stick with it, it’s worth it.

Every single person I’ve met has different triggers and has responded to things differently. There is no ‘right way’ for everyone. For example, I’ve cut out dairy before and it made no difference — it actually made mine worse — but some of my friends have found it to make the biggest difference. I’ve found that my triggers are: stress, dry air (aircon in particular), monosodium glutamate (MSG — food additive), alcohol, dehydration, and allergies. The most consistent one is stress. I also found that playing with my diet and cutting things out really flared up my skin. Once I had a comfortable routine, my skin was happy — it didn’t matter what I was eating, just as long as my diet remained relatively consistent (for example, if I’d have a weekend of eating out, or going to stay with family, I’d generally flare up just due to change). And even though I generally know my triggers, I’ll still get flare ups and have no idea why.

Common triggers

Some things come up really often when you chat to people with eczema, and when you search online. Here are the things that get mentioned the most:

Stress and emotions

I can see the impact of stress on my skin almost immediately. Seriously. It’s not actually stress itself that causes eczema, it’s the hormone cortisol. There’s some complex stuff out there but there are so many papers about this link. I like the diagram in this one. This article is very in depth about the link between stress, mental health and eczema. I’ve found it to be so important to look after my mental health, because it will impact my skin. Sleep well, exercise, self care, quit the job you hate, you know the drill.

Diet

If you go down a Google hole, you’ll be told that basically everything gives you eczema and you need to spend your life savings on eczema-busting cookery books. As I mentioned above, the main thing that impacts mine is consistency — constantly changing my diet to test things made my eczema worse. Once I established just general consistency, it calmed down (it was all probably causing me stress).

Lots of people rave about positive impacts from dairy-free or meat-free diets — it’s not impacted me in any way, but it’s worth a shot if you haven’t tried. The only thing I’ve found in my diet that causes issues is MSG. I found I would flare up after takeaways and things, and MSG seemed to be the common denominator. There may be something in your diet that is causing you to flare up. Keep a diary and see if there are any patterns.

There’s a lot online about probiotics and eczema. One thing to note here — please do not start taking probiotics without speaking to a dietician. Messing around with your gut can cause some serious issues. My friend Kristy is a nutritionist and has a great explanation of probiotics here. I am of the personal opinion that the head-gut axis is probably at play and stress is generally why you get eczema and tummy issues. There’s not masses of promising research behind probiotics as a treatment for eczema. You can see a well written summary here. But if you think you may have an issue, go and see a dietician.

Chemicals and cosmetics

This bit is really important if you have contact dermatitis. Sometimes, something you touch can cause you to have a flare up — this could be physical contact with something on a surface (like a cleaning product), or something that you’ve put on your skin (like makeup or even the metal of a zip or button).

The National Eczema Association have a really good guide to this that’s extremely comprehensive and contains a lot of the things that commonly cause irritation. I would say that you should keep track of the products you come into contact with, or if you’ve noticed anything new recently.

Allergies

There’s a really strong link between allergies and eczema. Researchers used to think that all eczema was caused by allergies, but that’s no longer the case. It can flare up when you’re having an allergic reaction to something, as your body’s immune system goes into overdrive. Common allergies linked with eczema are: dust, pollen, pets, and some foods.

Steroid withdrawal

This can be a side effect of using topical steroids and it’s grim. You should not use steroids for longer than a doctor recommends. The goal is always to maintain with a good skin regimen. Steroid withdrawal is something you see when steroids have been used for a really long time, then stopped. If your skin is burning, stinging, or bright red, this could be a sign of it and speak to your doctor immediately. This isn’t something I’ve ever suffered with or had any contact with, so I can’t say more here other than: always use your prescribed steroids as advised, and aim to have a steroid free maintenance skincare routine. I couldn’t miss this out of this guide, as it’s something you’ll see very often online. There’s some good information on the National Eczema Association website.

Creams and moisturisers

Things to avoid

Fragrance — just, seriously, this is the worst for your skin.
Parabens — these go in makeup and things to help to preserve them and keep away bacteria, but they can often cause flare ups.
Sulfates—these can strip your skin of its natural oils, and therefore damage your skin barrier. Try and use a sulfate-free shampoo and body wash.

Things to look for

Aloe vera—the holy grail of ingredients, right? This is really soothing on itchy and sore skin.
Beeswax— this can help to form a barrier over your skin and lock in moisture.
Hyaluronic acid—this helps to draw moisture from the air to your skin and is great for hydration.
Niacinamide—aka vitamin B3. This has good anti-inflammatory properties so can reduce redness and help to calm flare ups down.
Shea butter—this is really rich in vitamins A & E, and can help to repair cracked skin.

The National Eczema Association have a great list of approved products for people with eczema and guidance on them.

My routine in full

Morning—body

If I’m flaring up, I use my steroid cream on all the patches. (I only do this for an absolute max of 2 weeks)
10mins later, I use emollient
10mins later, I moisturise thoroughly with Aveeno demexa
If I’m not flaring up, I just moisturise in all the places where I usually get flare ups with Aveeno demexa.

Morning — face

Start with cleansing — I use The Ordinary Squalane Cleanser or Burts Bees sensitive facial cleanser. I use Berts Bees if my skin is flaring or feels a little sensitive, as it’s more hydrating and designed for those times.
Then wash my face with a bamboo washcloth. These are usually for babies, as they’re for super-sensitive skin. Bamboo is hypo-nonallergenic and really soft. I then pat my face dry, rather than rub it.
As I also get blepharitis which can contribute to eczema around my eyes, I use Blephasol on my eyelids with a reusable cotton round.
I use The Ordinary Niacinamide 10% + Zinc 1% and Hylauronic acid 2% + B5 followed by The Ordinary B Oil. If I’m flaring up, I strip this back to just the Nacinamide and B oil.
Finally, moisturise my face. If I’m flaring up, I tend to use: Calming Cream from the Beauty of Eczema or Burts Bees sensitive day cream. If I’m not flaring up, I tend to use: La Roche-Posay Toleriane Sensitive Fluid, The Ordinary Natural Moisturizing Factors + HA. Then finally Burts Bees sensitive eye cream.

Makeup

If I wear makeup, I only tend to wear a light coverage. I stick with brands that I’ve used for a while and know are good with sensitive skin, so my go-to is Charlotte Tilbury. I won a pot of her magic cream, so I tend to use that first. It’s really nice but I don’t think I’d buy it .I usually use Wonderglow mixed with Light Wonder. Pretty much all my makeup is Charlotte Tilbury. It’s eye-wateringly expensive, but I use it so rarely, it isn’t too much of a blow and it’s never left me with a flare up.
I remove my makeup with Vaseline (yes, really, it’s the best) and my usual cleansers.

During the day

If I’m flaring up, I use Aveeno demexa or E45 at least 6 times a day on all the flared up patches and Elizabeth Arden 8 hour cream on any smaller spots (particularly my hands) that are bleeding or sore. I literally just whack on moisturiser as often as I think of it. You don’t need an expensive one, just something that does the job that you can use in large quantities.
If I’m not flaring up, I still use Aveeno demexa or E45 out of habit regularly throughout the day (though not as diligently) anywhere that’s a problem area or feels dry.

In the bath/shower

If I’m having a really bad flare up, I replace soap/body wash with my emollient.
If I’m not flaring up, I use a natural ingredient soap which I get from a local seller near me. Anything without fragrance with as natural ingredients as possible is the one.

Evening — body

If I’m flaring up, I use my steroid cream on all the patches. (I only do this for an absolute max of 2 weeks)
10mins later, I use emollient
10mins later, I moisturise thoroughly with Aveeno demexa

Evening — face

Very similar to my morning routine but with a few tweaks.

I use The Ordinary Squalane Cleanser or Burts Bees sensitive facial cleanser.
Then wash my face with a bamboo washcloth.
I use Blephasol on my eyelids with a reusable cotton round.
Followed by The Ordinary Niacinamide 10% + Zinc 1% and Hylauronic acid 2% + B5 then The Ordinary B Oil and Moroccan Argan oil. If I’m flaring up, I strip this back to just the Nacinamide and B oil.
Finally, moisturise my face with Burts Bees sensitive night cream or La Roche-Posay Toleriane Sensitive Fluid, plus Burts Bees sensitive eye cream.

Resources

There are a few great places out there to help you out.

I think the best place ever is the National Eczema Association. They have product lists, and even an app to help you track triggers. It’s a world of info from an independent body that references actual research. It’s great.

Im also a big fan of the British Skin Foundation. They have lots of useful resources and summaries of research.