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In this episode, Dr. Zain, Heather, and Courtney dive deep into the topic of eczema, discussing its definition, symptoms, and causes. They explain how eczema is an umbrella term for a group of inflammatory skin conditions with a main focus on atopic dermatitis. The discussion covers the disruption of the skin barrier, genetic factors, and the role of the immune system in eczema. They also touch on other triggers like environmental factors, stress, and allergens. Moreover, they highlight treatment options from traditional topical steroids to the latest biologics and the importance of prevention strategies like moisturizing and avoiding hot water. Real-life case studies and practical tips for managing eczema symptoms provide listeners with a comprehensive understanding of the condition.
00:00 Introduction and Personal Stories
00:38 Understanding Eczema: Definition and Symptoms
02:42 Causes and Triggers of Eczema
05:31 Allergy Testing and Eczema
08:41 Common Eczema Triggers and Management
13:25 Symptoms and Severity of Eczema
15:24 Antibiotic Resistance in Eczema
15:42 Common Types of Eczema in Children
16:43 Localized Eczema and Its Treatments
18:12 The Itch-Scratch Cycle
19:15 Impact of Eczema on Quality of Life
20:35 Advancements in Eczema Treatments
25:21 Preventing Eczema Flares
27:05 Final Thoughts on Eczema
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
42 Skinside Out - Eczema
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Dr. Zane: [00:00:00] Speaking of metal, um, allergies, I've had patients you've had. You know, um, you know, joint replacements.
. .
Courtney: Yeah. I went down a deep dive when they put my um, the titanium rod in my arm. 'cause I was like, what if I become allergic to titanium?
Yeah. Randomly can I develop allergy? And they were like, most people don't have titanium allergies, but could I be the one? Yeah.
Dr. Zane: Yeah. I mean, I find it so satisfying when you do get a positive result. Mm-hmm. That's clinically relevant. Yeah. And you're able to change someone's life.
Heather: Yeah.
Dr. Zane: Hi everyone. Welcome to another episode. I'm your host, Dr. Zane, and today we're talking all about eczema inside and out. So today we're gonna talk about what eczema is. What the symptoms are, what the etiology is, how to treat it, and let's dive right in. So Heather, what exactly is eczema?
Heather: So eczema is a general term for a group of inflammatory [00:01:00] skin conditions. Um, the most common type we see is called atopic dermatitis, um, but they still, still kind of underlie the term eczema. Um, so eczema is this disruption in your skin barrier and your skin barrier is really important. It helps protect.
Things from the environment from getting in. So I like to describe it as kind of like a brick house. So you have the bricks things, think of that as like your skin cells, and then you have the mortar. And think of that as like your, um, lipids within your skin barrier. And so if your skin barrier is disrupted, that.
Mortar in the house is no longer there. And so things from the environment are able to get through those skin cells and cause irritation. Um, so moisture can escape more easily. Um, we can get irritants and allergens into the skin and our immune system can become overactive. Um, and that can lead to things like.
Inflammation, dryness, [00:02:00] itching, lots of different stuff. Um, most commonly they'll have a rash with it too, but um, it does present differently in everybody. So we'll talk about that.
Dr. Zane: Yeah. So a big point is that it's an umbrella term. So eczema, dermatitis, I mean, these are very general terms and a lot of people kind of throw them around, but there are many categories that fall within it, just like atopic dermatitis, allergic or irritant contact dermatitis.
So it's something that we definitely define as specifically as possible, even though the treatments can be very similar. Um, I always think it's. Nice to categorize it because that also gives us an idea of what's triggering it, what's causing it.
Courtney: Mm-hmm.
Dr. Zane: Um, so how does eczema happen? So what are some of those factors that lead to eczema?
Courtney: Um, like Dr. Zane just said, I think. Everyone's case is different when it comes to eczema. Some things that we notice that do, um, attribute to having it would [00:03:00] be, um, genetics can play a role. So if mom or dad had eczema, you know, that's common for kids to have eczema. Um, another thing is your immune system.
Um, basically when you have eczema, your immune system is over overreactive. So instead of having more of this like calm basis, it's. Becoming inflamed. It's, you know, getting angry. And so that's where you'll see that rash pop up. Um, and then obviously environmental factors too. So that's where we start looking at things like, you know, fragrances or things you're coming into contact with.
We see metal sometime. Um, all these different things that your skin is coming into contact with can essentially create that, um, reaction that you're having.
Dr. Zane: Yeah, I mean there is a really strong genetic component mm-hmm. To, um, eczema or atopic dermatitis. And there are related conditions such as asthma and allergies, and they share a very common pathway.
So you often see individuals who have one. Two or even three conditions that coexist and that is [00:04:00] not unusual. So that's why antihistamines can be helpful for all conditions. Um, you know, topical steroids can also help improve, um, some of those conditions as well, but. When we're looking at this inflammatory pathway that is going haywire, it's happening in all these conditions.
So that's why some of the medications we use do help for multiple conditions.
Courtney: I think that's why too, sometimes you'll hear eczema patients, um, feeling a little distraught over, do I see a dermatologist or do I see an allergist? And there is some overlap for sure. Um, but we'll kind of talk about. Where each one might play a role, um, in your eczema care too.
Dr. Zane: Mm-hmm. Yeah. For instance, um, my daughter, SIA, she has. Eczema. She has allergies and she has asthma.
Courtney: Mm-hmm.
Dr. Zane: And she also has food allergies. So she sees both a dermatologist myself, um, as well as an [00:05:00] allergist. And we're kind of co-managing. The various, um, you know, treatment options so that she gets the best outcomes, the best relief.
So it is something that I often co-manage with my allergy colleagues and it's a really, um, really good relationship because we often share a lot of patients and we often can, you know, help these patients not only treat their symptoms, but also how to, you know, prevent future flares, which is really important.
Heather: I think we do see a lot of people with eczema are also have allergies, whether that's seasonal or um, like contact allergies or like chemicals that you're using on your skin or coming into contact with. Um, but I think also, even if you have eczema but you don't necessarily have an allergy, you're very sensitive to a lot of products.
Mm-hmm. [00:06:00] And we. There's a way that we can test for allergies. An allergist has a way to, um, we do patch testing in our office where we're actually putting those little chemicals on your skin. Chemicals that might be in your laundry detergent or your sunscreen, or your body lotion, or body wash, anything. Um, and that can.
Allow us to hone in on, okay, is there a true chemical that is causing your rash? Or are you just sensitive to a lot of different things?
Dr. Zane: Yeah, that's a good point. So allergists do the skin prick testing, um, where they're actually applying and actually entering an allergen into the skin to see if you get a reaction.
Whereas with patch testing, which we do in our office, we actually apply the allergen to the skin for about 48 hours to see if it elicits a response. So they are different tests and they do test different things. And you know the allergies that you get from a contact to. An allergen [00:07:00] is a different type of reaction.
It's a type four reaction where it's like a delight delayed hypersensitivity reaction. Whereas, um, the ones that we see, um, you know, done by the allergists, that's a type one reaction where we're looking at IgE mediated responses. So that tends to be a little bit more, um. You know, pretty quick to come on.
And, you know, it's related to the pathway that we see with, you know, patients who have anaphylaxis. So it's a different pathway. So we do wanna make that distinction. And they also do look at serum allergens as well, so. So blood work to see levels of, you know, antibodies to various allergens. So they are different tests.
So a lot of people just throw out the term allergy tests. They're different.
Courtney: Mm-hmm. Mm-hmm. Yeah. I did the prick test back in high school and I was allergic to like 40 different triggers, like of course oak tree, which were like known for in North Carolina. Mm-hmm. Three types of grass. Cat dog dust mites.
Mm-hmm. [00:08:00] They're like, you shouldn't sleep with your cats anymore. It's probably triggering your allergies.
Heather: Yeah.
Courtney: Um, yeah. Right. I'll suffer.
Heather: I definitely have had patients say, oh, well I've had patch testing done, or I've had allergy testing done. Mm-hmm. But then they start talking more about it and they were like, yeah, and I was allergic to trees and this bush.
And I'm like, okay. Well, mm-hmm. Maybe it might be worth trying a different type of mm-hmm. Allergy testing.
Dr. Zane: And another point is, is that food allergies really have not been shown to be related mm-hmm. To, you know, eczema flares. So I know that that is a common misconception and studies have shown that. So that's another point to bring up.
Courtney: Mm-hmm. So we can talk about some other triggers, um, that we kind of look for some in the patch test and some just. In general. Um, sometimes some patients will notice more flares in the winter time, so mm-hmm. Like now where it's cold, dry air, there's less humidity and that can be really difficult because that [00:09:00] skin really does need moisturization, um, to help prevent further flares.
Detergents like Heather had mentioned, gain, I feel like is the biggest offender. I feel like un
Heather: tide tied
Courtney: tide. Whenever people come and they're like, I'm using my mountain breeze. Mm-hmm. Gain fabric, softener, those little be the scented beads. Those are all. You know, big triggers for people,
Heather: even the, um, dryer sheets.
Mm-hmm. The little fibers in the dryer sheets can actually get stuck in mm-hmm. Inside of your clothes and scratch at you all day. Um, hot water is a really big one. Yeah. Showering and hot water. Washing your hands in hot water. I like to describe that as kind of like washing butter off of a dish. So think of your.
Um, skin barrier as butter. So if you're trying to wash butter off of a dish and you're using cold water, it's not really gonna move much. But if you use hot water, it melts right off. Mm-hmm. Figuratively, if you're using hot water on your hands, your skin barrier is melting right off.
Dr. Zane: Mm-hmm. Um, so stress can also play a role with, um, you know, [00:10:00] atopic dermatitis or eczema.
Heather: Mm-hmm.
Dr. Zane: I mean, when we're stressed, we're releasing hormones, cortisol, and that can also affect, um, inflammation throughout the body, including the skin.
Heather: I actually had a patient this morning, um, her eczema was flaring and I was kind of like trying to figure out why and her, both of her parents were just in a car accident and she's been having to deal with all that for a couple months.
And Yeah. You know, we talked a lot about like the stress relief. 'cause I think it's a, it makes a huge impact on eczema.
Courtney: Yeah. I always think like the most interesting cases are, um, people who have like metal allergies or certain, like wool or different fabrics. Mm-hmm. Because sometimes you'll just see a rash that's in a really weird presentation.
Mm-hmm. And you do, you do a patch test and it ends up being, you know, nickel or gold or just some, you know. Random thing that they didn't really think of. Um, we saw a kid at one of my old practices who was getting eczema on his hands. And it, we, after many months, it came to find out it was from his controller.
His [00:11:00] game controller. Oh yeah. It was the whatever, plastic or rubber, yeah, the rubber that was, he had like a silicone or something case on it. Mm-hmm. And we ended up finding out, 'cause it was in the weirdest distribution, we could not figure it out. We were thinking pencils, but he's not ambidextrous. So like where is this coming from?
Heather: Yeah,
Courtney: yeah.
Heather: I had a patient once who had a. Rash on the back of his upper legs and we did patch testing and um, he was allergic to a couple different things, but we couldn't figure out why or if that was attributed. Sometimes we can get like, um. Incidental findings, but we did a bunch of research and he had spent so much money on a new leather couch and the finishing on the leather couch was actually what he was allergic to.
Oh, wow. Yeah.
Dr. Zane: Yeah.
Heather: Um, so he was disappointed, but he was thankful that
Dr. Zane: yeah,
Heather: his rash went away.
Dr. Zane: Speaking of metal, um, allergies, I've had patients you've had. You know, um, you know, joint replacements.
Heather: Oh yeah. Mm-hmm.
Dr. Zane: And they were either allergic to the metal or like the acrylic. [00:12:00] And that's kind of tough because they went through a huge surgery and you know, they're developing this rash and it's not going away.
And, you know, we determine that, you know, it's from the metal and the prosthesis or whatever, and. Sometimes they have to actually get it replaced. Mm-hmm. Which is crazy.
Courtney: Yeah. I went down a deep dive when they put my um, the titanium rod in my arm. 'cause I was like, what if I become allergic to titanium?
Yeah. Randomly can I develop allergy? And they were like, most people don't have titanium allergies, but could I be the one? Yeah.
Dr. Zane: Yeah. I mean, I find it so satisfying when you do get a positive result. Mm-hmm. That's clinically relevant. Yeah. And you're able to change someone's life.
Heather: Yeah.
Dr. Zane: Um, and. They've been probably suffering for, for years.
Mm-hmm. And it just really can change someone's life. Um, in residency, we actually have a patch. Test clinic with one of my attendings. Mm-hmm. And I just, we did like the patch testing, the photo patch testing, and, you know, it was pretty incredible some of the things that we found. Mm-hmm. So [00:13:00] it's, it's, it's interesting.
Courtney: Yeah. Yeah. I like the skin safe app that you guys use after patch test. Mm-hmm. Um, it's basically an app that will take the findings of the patch test reading. So whatever ends up being maybe slightly positive or really positive, you can put that in and kind of, um, gauge different products that you're using.
See what. It might be containing what you're allergic to, and I think that's been really handy for patients. Mm-hmm. To have to be able to avoid those products. Yeah.
Heather: Yeah. So what does eczema typically look like, or what kind of symptoms do most people have? So most people will be itchy. Mm-hmm. Um, usually it's worse at night.
Um, your skin is dry, flaky, red depends on the type of eczema, but it might be like patchy red or just kind of red all over. Sometimes it can look more of like a. Um, like a brownish, purple and darker skin types. Mm-hmm. Um, you can get this thing called like ification, which is this like thickened skin almost to where you can see the [00:14:00] accentuated skin lines.
Mm-hmm. It's very common on the inner elbows here. Um, and that can be from excessive scratching. Um, what else?
Dr. Zane: So we also see variety in the severity.
Heather: Mm-hmm.
Dr. Zane: So you can have like just localized patches of nummular eczema mm-hmm. To cases where you're actually inflamed throughout the body. Mm-hmm. And you have derma where you're like literally red head to toe.
Mm-hmm. Inflamed. It's actually can be in medical emergency. So you have to be admitted and you need to cool down inflammation 'cause it could cause a lot of issues.
Courtney: I wonder if that's what that um, there's like a one of those Mormon wives and you, you know, the show like. I don't watch that show. People are gonna hate me so bad.
They're gonna be like screaming at the screen. Secret Lives of Mormon wives. Yeah. There's um, a girl in there, McKayla, and she has dealt with really bad atop derm. Mm-hmm. And it is that like true Yeah. Entire body. Yeah. Um,
Dr. Zane: and I've had several patients over the years who [00:15:00] just literally cannot get it under control and.
The nice thing is we have a lot more options, which we'll get to. Mm-hmm. But I mean, these patients are miserable. Mm-hmm. And you know, they sometimes have to be hospitalized. Some of my pediatric patients, we have to like hospitalize these kids.
Heather: Yeah. You can get really bad, like crusting or oozing, you can have what we call fissures, which are really deep.
Cracks in the skin. Um, easy to get infected.
Courtney: I was gonna say it can lead to infection. Yeah, I know. Um, definitely at my previous practice we had a kid who became resistant. You know, he developed MRSA. Mm-hmm. He was getting resistant to, um, some of the antibiotics that they were using to treat him.
Mm-hmm. Um, this was kind of before biologics really. Mm-hmm. Became amped up, but. Um, yeah, it's, it's bad. Yeah.
Heather: Eczema is very common in kids. Um, we do see like classic eczema, um, where, you know, you have it on the inner arms, the back of your knees, um, but you can also see this like subclinical type of eczema on the face called psis alba, which is where you [00:16:00] get this like little fine lightened area on your cheeks.
I think we have a photo of it here, but, um, it's. It's very subtle. Um, you can kind of see like around the cheeks here. It's a very classic area, but it is technically like subclinical eczema and responds very well to um, similar treatments, but it can also just kind of resolve on its own.
Dr. Zane: Yeah, and you definitely see it more apparently in skin of color.
'cause of the contrast.
Heather: Yeah. Yeah. And in the summer. Mm-hmm. When they're getting more sun on their
Courtney: normal skin. I think sometimes people confuse it with vitiligo. But we do have patients sometimes that come in and think, oh, it's vitiligo. Yeah. Mm-hmm. Because it's the, you know, whitish discoloration and it ends up being the pits alba.
Heather: Yeah.
Dr. Zane: Yeah. Um, you can get eczema in localized areas. So there's a form of eczema called dys hydrotic eczema, where you get eczema on the hands. You can even pre present with like tiny little blisters. Mm-hmm. Fluid filled. Um, very itchy. So that's one area. You can get it, you [00:17:00] can get it in the genital areas.
Um, there's a form of eczema that you can get on the scrotum. Um, without red Scrotum syndrome, and that can be very uncomfortable. Um, you can get around your eyes. Um, eyelid, dermatitis very common, especially during allergy season. Mm-hmm. Mm-hmm. Um, seborrheic dermatitis has a preference for the scalp.
Courtney: Mm-hmm.
Dr. Zane: And that's kind of considered a form of eczema. So there are a lot of different types, um, of eczema as you can see. But when they're localized, um, sometimes they have different treatments because they're more sensitive. So your eyelid skin, your genital skin definitely is more sensitive. Mm-hmm. So we sometimes have to alter the strength of some of the medications we use, um, or use a different approach.
Courtney: Mm-hmm. That's the picture of Nummular. I feel like Nummular, um, eczema patients will come in sometimes thinking it's ringworm because it'll be that kind of circular pattern. And
Dr. Zane: what does nummular mean?
Courtney: Round
Dr. Zane: coin, like Yep.
Courtney: Coin, like [00:18:00] close enough. But they'll always think, oh my gosh, I have fungus. And then you take a look and mm-hmm.
You know? They're like, no way. There's no way. It's, yeah. They're like so relieved. They're so relieved.
Dr. Zane: Yeah. Um, and then one of the key features you talked about was the itch mm-hmm. That we see with this condition. And it can start the cycle, this itch, scratch cycle that can be really difficult to break.
And when we start scratching. It can thicken the skin and the skin is thickening because it's trying to almost form a defense. Mm-hmm. Kind of protect itself from the constant trauma, and that's called like ification. Mm-hmm. So when you see the thickened skin on areas where, you know, a patient had been scratching a lot, um.
It can be very difficult to get under control and make look normal again, because sometimes that can be permanent.
Heather: Mm-hmm. And it just creates more inflammation. Mm-hmm. Which causes more itching and then you're scratching again. Yeah. It's just never, it's a vicious cycle. Yeah.
Courtney: , Don't they sometimes call eczema? The itch [00:19:00] before the rash people, something like that. Sometimes they'll get itchy before and then they scratch, and that's when that rash. Pops up. Mm-hmm. I've heard that being used before. Mm-hmm. Where sometimes people will be itchy, they go to scratch and then yeah.
It will kind of manifest into that rash.
Dr. Zane: Yeah. And that itching really affects your quality of life.
Courtney: Mm-hmm.
Dr. Zane: We actually see that it can impact sleep. Um, you know, children especially who have really bad severe eczema, sometimes they don't perform well in school because they're sleep deprived. Um, and they're constantly in discomfort, especially in school.
So, um, it does make a big. Difference. And, you know, eczema, sometimes people will kind of poo poh it. It's like not a big deal, but it can affect your quality of life and you can just be uncomfortable.
Courtney: People say, I've heard patients say that, you know, they'd almost rather be in pain than deal with the itching.
Yeah. 'cause the itching is incessant. It's nonstop. Mm-hmm. And it's, you know, it, it reminds me of like having mosquito bites. It's. It's like my mom used to dig her nails into the mosquito bites, which probably [00:20:00] not great to do, but she'd be like, oh, it's because it's distracting you with the pain and now you're feeling pain instead of itching.
Heather: Yeah.
Dr. Zane: It feels so good to scratch sometimes.
Heather: Yeah,
Courtney: yeah. Until it starts bleeding,
Heather: it's done a lot of like mental health, um, studies and surveys on people who are itchy and it, yeah, it's pretty dramatic how
Dr. Zane: depression.
Heather: Yeah. And how many people too would say like. I would literally rather have cancer than have itching every single night because it's so, um, yeah.
Debilitating. Mm-hmm. It can affect your sleep.
Dr. Zane: Yeah.
Heather: Dramatically too. But thankfully there's a lot of really good treatments too.
Dr. Zane: Yeah. So let's move on to treatments. I mean, this has changed dramatically over the years, um, in the early days. Mm-hmm. Um, you know, topical steroids were like the mainstay of therapy.
Mm-hmm. And, you know, oral steroids and other immunosuppressants, a lot of them would. Pretty bad side effects were, you know, what we had at that time. Um, but as science advanced and we understood the, you [00:21:00] know, inflammatory pathway, we've been seeing some really interesting drugs come on the market. So let's go into that.
So mainly the biologics.
Heather: So topicals, like you mentioned, the um, steroids are kind of like tried and true. We do still use steroids a lot, but it's more of like a flare medication. You don't wanna use it long term 'cause it can't thin the skin. Um, but we try to transition over to maintaining with other.
Anti-inflammatories that are not steroids. So, um, for example, TCIs, which are, um, topical calcineurin inhibitors, um, PDE four inhibitors, which is another type of, um, cream that can be used to help that immune system overreaction to help calm the itching down. And a lot of people do really well on these.
Mm-hmm. Um, and can maintain, it kind of depends on the severity. Um, some people do need to kind of move forward with other things too. So, um. Especially if they're very itchy. We incorporate antihistamines, whether that's over the counter or prescription. [00:22:00] Um, making sure you keep your nails short so you're not creating that.
Mm-hmm. Inflammation from scratching and, um, you know, other things that we can do to help restore the skin barrier.
Dr. Zane: Yeah. And in terms of you know, newer medications, these biologics, so like I alluded to, we have a better understanding of the immune pathway and there are very popular medications that have been a game changer.
So Dupixent was probably one of those. First ones that came on the market and it was like a miracle drug.
Courtney: If you have any streaming service or watch TV ever. Mm-hmm. You have seen the commercials Mio Mio? Do you know that one?
Dr. Zane: No, I don't have cable. I actually
Heather: have
Dr. Zane: not. Oh my gosh,
Courtney: there, it's always funny.
Yeah.
Heather: I don't
Courtney: look on YouTube, Nim Luo. It's like,
Heather: yeah, I've seen the Invoke one a lot. Yeah. Oh yeah.
Dr. Zane: I've seen the Invoke one.
Courtney: I've seen the Dupixent. The Nim Luo is getting out there
Dr. Zane: now. Yeah. So there, these medications are really [00:23:00] targeted and they have lower side effects. Some of the predecessors and patients get great results with it.
Mm-hmm. And I am happy that we're seeing more and more of these pop up. Um, kind of like how psoriasis had that explosion of biologics. Mm-hmm. I think we're experiencing that with. You know, eczema now and it's fantastic. Yeah.
Heather: I think we're finding how those immune pathways really impact eczema and if we can target those, we can, you know, decrease the itch, decrease the rash.
Dr. Zane: Yeah.
Heather: Minimize flares.
Dr. Zane: And I'm excited to see what the future holds with 'em. Um, especially as we do clinical trials in our office. Mm-hmm. And, you know, hopefully, you know, having more solutions for our patients.
Heather: Yeah.
Courtney: I think they're also tackling more, you know, symptoms where early on we were just kind of tackling.
The rash in hopes that the itch gets better. Mm-hmm. But now it's almost like we're tackling the inflammation, which is helping the itch first before the rash, which I think a lot of people would almost rather,
Dr. Zane: mm-hmm.
Courtney: The itch go away. Mm-hmm. Before the rash. Mm-hmm. You know, [00:24:00] that's the uncomfortable part.
Dr. Zane: Yeah. Yeah. There's definitely a spotlight on itch now.
Courtney: Mm-hmm.
Dr. Zane: And we have patients who have. Itch only, but no rash. Yeah. And no rash. And these can be perplexing cases and you know, some of these medications have been phenomenal for mm-hmm. You know, improving that as well. Um, however, there's, I mean, these, you know, these medications are not for everyone.
And sometimes, you know, patients can't tolerate for any, you know, reason due to their medical history. Um, another old school. Treatment option that did work and does work is phototherapy as well. Mm-hmm. So, um, that's where we're using UV light, um, in concentrated doses mm-hmm. To help reduce inflammation.
And although it is an option, I'm not a huge fan of it just because of the increase in skin cancer risk, but it is an option that we have used with patients and it can help.
Heather: I did a lot of phototherapy at my previous practice. Mm-hmm. And, um. We did a lot of narrow band, UVB. Mm-hmm. Phototherapy. So there's that.
And then there's pva, which is, um, [00:25:00] Sorein and UVA. We don't really use that one much for eczema specifically anymore 'cause there's a much higher risk of increased. Mm-hmm. Um, risk of skin cancer, but narrow band, UVB, um. It does work, but I do think there are safer and more effective options, um, nowadays.
Dr. Zane: Yeah.
Heather: But I think we also have to keep in mind, um. How to prevent flares and prevent eczema too. Mm-hmm. So, um, you know, avoiding the triggers, obviously trying to shower in lukewarm water versus hot water. Um, being really good about moisturizing, the best time to moisturize is right after the shower within three minutes.
Mm-hmm. 'cause you'll help lock in some of that moisture that's already on your skin. Mm-hmm. Um, using very. Gentle cleansers, trying to focus on more moisturizers that are, um, emollient, so like ointments or creams. They tend to be a little bit more hydrating and soothing, but I think that's a non-negotiable for trying to prevent
Dr. Zane: Yeah, skip the fragrance.
Heather: [00:26:00] Mm-hmm.
Courtney: Yeah. Having a good skincare, um, routine well is essentially that foundation of. Regardless if you're on a biologic steroid, whatever. It's funny, 'cause insurance companies, even on those prior authorizations will ask that. They'll say, are they using a good skincare regimen? Like, yes. It's not working.
Dr. Zane: You don't think we, you don't think we talked about that? Yeah.
Courtney: The first thing we say.
Dr. Zane: And you know, eczema, obviously we have some medications that work from the inside out, but this is often a condition that you know, many patients can manage from the outside. And we can apply these creams, make some lifestyle choices that will help to keep it under control.
So, you know, not everyone has to be on a biologic or any other systemic therapy. Um, you know, creams, I mean, can be very effective and just moisturizing makes a huge difference. You can't imagine the number of patients I see who are like, oh, I have this eczema that's flaring. I'm like, do you moisturize? No.[00:27:00]
Yeah. You might wanna start with that first.
Courtney: Yeah.
Dr. Zane: So that can be an effective option.
Courtney: Yeah.
Dr. Zane: Um, so final thoughts on eczema. So. I just wanna really emphasize that eczema is a real condition. It's not just dry skin, it's real, and it can be quite severe. So I don't really like it when people like poo poo it.
Um, it can be extremely uncomfortable and debilitating for patients
Heather: and don't feel embarrassed by it too. Mm-hmm. I think, you know, it is something that I think people easily get conscious or self-conscious about. There is a personalized plan for you. We can definitely find different treatment options that work with your lifestyle.
Dr. Zane: Absolutely. Um, so thanks so much for listening, um, to this episode. I hope you learn something about eczema. If you have any questions, concerns, um, if you like the episode, please share. But until next time, skin side
Heather: out, out. [00:28:00]