Why Some Eczema Patients Worsen with Moisturizers?

Common Causes or triggers of Eczema:

There are a number of factors or triggers that could be attributed to the occurrence of eczema. Some of most common factors includes:

• Family History/genetics
• Over reactive immune system
• Weakened skin barrier
• Stress
• Food allergens such as egg, peanuts, milk, fish, soy, rice, and wheat.
• Environmental triggers

Among the environmental triggers following factors are considered to be the most important:

Fabrics:

Fabrics comes in direct contact with the body so is considered to be one of the most important triggers of eczema in sensitive individuals. Some of the most important fabric materials that are identified to be involved in the initiation of eczema attack particularly contact dermatitis, includes the following:

• Wool
• Latex (e.g. in gloves, condoms, clothes, ballons, mattresses, paints, adhesives, toys, shoe soles, baby bottle nipples and pacifiers, diapers, sanitary napkins, and other pads and elastic etc.)
• Synthetic fabrics (e.g. polyester, nylon, acrylic and fleece etc.)

Metals:

 Some of the metals can trigger the eczema attack in some individuals. These includes:

Cobalt/Cobalt Chloride: Mostly industry workers came across Cobalt chloride while working. Other people may come across it through various products like it is found in:

• Jewellery
• Cosmetics e.g. blushers, eye shadows and compact powder etc.
• Hair dyes
• Leather
• Dental alloys
• Paints
• Ceramics
• Blue tattoo pigments
• Animal feeds
• Printing inks
• Vitamin B12 tablets and injections.

Chromium Allergy:  

Chromium is found in various products of daily use such as:

• Yellow or green colored cosmetics
• Green fabric that is used to cover snooker or card tables
• Green or yellow ink used for making tattoos
• Radiator coolants
• Orthopaedic or dental implants
• Chrome tanned gloves, shoes or other stuff

Nickel Allergy:

Nickel is one the most important metal that is found in a number of materials like:

Jeweller: necklaces, necklace-clips, earrings, bracelets, watch-straps and rings, may contain nickel.

 “If a person is allergic to nickel, then he/she can use hypoallergenic stainless steel, solid gold (12 carat or more), or silver jewellery. Nickel is found in 9-carat gold and white gold. Plastic covers for earring studs can be used. Coating the stud with nail varnish is not recommended as the varnish could soon chips off leaving the nickel in direct contact with skin.

Clothing Material: Nickel is widely used in clothing such as jean’s buttons, metal zips, bra hooks, hair pins, and studs etc. Plastic or paint coated metals are safe to use in people with nickel allergy.

Nickel containing Household items:

• Knives
• Pens
• Razors
• Keys
• Rings
• Mobile phones
• Lipstick holders
• Handbag catches
• Cupboard handles
• Kitchen utensils
• Bath plugs
• Vacuum cleaner
• Scissors
• Needles
• Toaster
• Coins (money): Cashiers should use gloves

Nickel Containing Office item:

• Paper clips
• Typewriter Keys
• Other metal Instruments

Nickel Containing Foods: Any fruit, dry fruit, nuts, vegetables, spaghetti or any drink that is present in “can” should also be avoided in patients with nickel allergy.

Some people are also allergic to gold and copper (found in electrical wires, coins, plumbing pipes, jewellery, and household utensils).

Other environmental triggers include:

• Pets and insects: Pet dander, cockroaches, insect bites and stings
• Weather e.g.Temperature and seasons variations, humidity, extreme heat or cold
• Stress e.g.Life stressors, and anxiety
• Environment e.g.Pollen, dust mites, Mold, cigarette smoke
• Fragrance e.g.Perfumes, other scented products

Pharmacological and non-pharmacological treatments of Eczema patients:

• Identification and prevention of triggers of eczema.
• Adequate Hydration.
• Daily moisturization particularly after taking bath to lock the moisture in the skin, often known as soak and smear technique (preference is given to, fragrance and preservatives free, ointments over creams due to low water content).
• Antihistamines can be used for excessive itching associated with eczema and halting the further progression of allergic reactions especially in case of insect bite.
• Diluted bleach baths or intranasal mupirocin is recommended in patients with poorly controlled eczema for the prevention of cutaneous infections.
• Topical anti-inflammatory medications such as topical steroids or steroid-free products like pimecrolimus, or tacrolimus.

Topical steroids should only be used for the active lesions or prophylactically few times a week for the prevention of flare-up of eczema. Topical steroids should not be recommended for the long-term usage due to the potential risk of adverse effects. 

• Other FDA approved medication includes: crisaborole (EUCRISA®) for children >3 months of age and older and with mild to moderate eczema, and Dupilumab (S/c injection) which is used to treat adults and children 6 months of age and older with moderate-to-severe eczema that is not well controlled with topical prescription therapies, or who cannot use topical therapies.

Complications of Eczema Patients:

• Bacterial infection can occur upon eczema lesions.
• Viral infections such as Eczema herpeticum caused by herpes simplex virus-1 and eczema cosackium.

Moisturizers:

Moisturizers are the topical products used to enhance moisture in the skin while emollients are the topical products that are employed to soften and smooth the skin surface. Though both the terms emollient and moisturiser are often used interchangeably, emollients can also be regarded as a specific ingredient of moisturisers.

There are various types of moisturizers available in the market containing different ingredients that adopt diverse mechanisms for the bringing the effect of moisturization to the skin. Some of the most commonly used moisturizers and their mechanism are mentioned below:

Types of Moisturizers and their mechanism of action: