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Eczema: How to Ditch the Itch

Eczema: How to Ditch the Itch

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Eczema: How to Ditch the Itch

189 pagine
2 ore
Jul 20, 2020


Too many people suffer unnecessarily from eczema. It’s time to ditch that itch. More than any prescription, this book will get you there. And it’ll be a fun read too!

Jul 20, 2020

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Correlato a Eczema

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Anteprima del libro

Eczema - Dr Amélie Seghers




If you want to get better, educate yourself

I.   What is this thing that makes me scratch like crazy?

What’s in a name?

How much of a troublemaker?

Predisposition, triggers and mediators

Think of your body as a temple

The Three Musketeers: eczema, asthma and hay fever

Will I suffer for the rest of my life?

Infection, inflammation and colonisation

Itchy! Scratchy! Blood!

II.   How does eczema present and how does my doctor know with certainty that I suffer from eczema?

The concept of red, itchy rashes

How does my doctor know it’s eczema if he does not do any tests?

Doctor, you say red rashes, but I see white and brown patches?

Nothing ever stays the same: the evolution of eczema during a lifetime

Sniffing and whistling

III.  The million dollar question: What triggers my eczema?

Looking for a needle in a haystack

The evildoers

  1. Why soaps are bad for your skin

  2. Washing and cleaning: how much is too much?

  3. Let’s talk about climate change

  4. Stopping pollution is the best solution

  5. Meet the AllerMates

  6. Calm the f*** down

  7. So I gave that itch a scratch

  8. Freakin’ friction

  9. Drooling

10. When bébé is sick or teething

11. Vaccines

12. Bloody mosquitoes

13. Blame it on the hormones

14. What are contact allergens?

15. Do the clothes make the man?

16. You are what you drink

17. Laughter is the only medicine with zero side effects

18. Sun, sweat and sunscreen

19. Sneaky Staphylococcus Aureus

20. Oh and what about food?

IV.  Seriously, does food play a role in my eczema?

There are different ways food can affect your skin

1. Adverse reactions to food (unofficial title: ‘the driest chapter of the book’)

Immediate (IgE-mediated) food allergy and how to test these

Skin prick test


Delayed (non-IgE-mediated) food allergy

Food intolerance

Histamine intolerance, histamine toxicity, histamine fish or scombroid poisoning

Exercise-induced food allergy

Oral allergy syndrome (pollen-food syndrome)

2. The right nutrition: it’s time to prescribe a dose of sensible eating

V.   If I can’t cure it, how can I control it?

1. Maintenance or passive treatment


Gentle and hydrating soaps

Bleach baths, really??

Eczema ‘mummification’ or the technique of dry and wet wrapping

2. Flare or active treatment

A. Active creams and how to use them

Steroid creams

Calcineurin inhibitors

Antibiotic creams

B. The concept of using creams pro-actively

C. When creams alone don’t do the trick

Behavioural therapy and psychological counselling

Light therapy

Oral antibiotics

Oral antiviral therapy

Oral steroids


Vitamin D

Immunosuppressive drugs

D. What’s on the horizon?

3. Avoidance of triggers and desensitisation treatment

4. Self-care and other lifestyle measures

5. Outside of most conventional doctors’ comfort zone

VI. Why does every doctor want to give me steroid creams when the internet says they are bad for you?

Steroid phobia: where does it come from?

Still scared?

My ‘Steroid Song’ for you



About the author/Acknowledgements


This book is dedicated to all those whose eczema is driving them or their loved ones insane.


For Papa. Indeed, it’s finally out.

For Mama. It’s ok, you don’t have to read it.

For JC and Nicolas. Now that I have dedicated this book to you, can you please buy a thousand copies each? Happy to sign them.

~ A sense of curiosity is nature’s original school of education ~

Smiley Blanton


If you want to get better, educate yourself

Very few people have never heard of eczema. But what do you actually know about eczema? While you probably have a vague idea of an annoyingly itchy, embarrassing skin disease that keeps you awake at night, you aren’t too sure why you get it or what makes it worse. Neither do you know how to best treat it. All you might know, is that when you leave your doctor’s office, you could fill a supermarket trolley with all the sticky creams bearing difficult-to-pronounce names that you have been prescribed. The information is over-whelming. You forget which cream to use where. Neither do you remember what was said about the duration of the treatment. You somehow recall that some of the creams (but forget which) can possibly thin your skin. The pharmacist might have emphasised applying a very very very thin layer. After all this confusing information, you’re not too sure whether you will apply it at all. However, the skin is not getting better and the itch drives you or your child mad. So, you visit another doctor who prescribes you a whole new range of different creams, which you simply stock up in your home pharmacy. You then start searching the internet to get answers to all your questions. And maybe that’s how you ended up finding this book, because you’re on a mission to know what eczema is all about – and how to ditch the itch for good.

I was first inspired to educate people about eczema while living and working in Singapore. Expats there use a plethora of useful Facebook groups, including the ‘Singapore Expat Wife Group’. The aim of this group is to assist and inform its members on just about every conceivable aspect of life in Singapore. From which supermarket sells tampons to where you can find a French-speaking hairdresser specialising in blondes. You name it, you find it. Just imagine the depth of collective knowledge pooled from the many women of varied nationalities and backgrounds into one place; pretty powerful indeed. Healthcare issues are a frequently returning subject in the group. Women often ask for good doctors in a specialist field, but also more specifically how to deal with a certain health problem – and eczema is a common candidate for discussion. Having a sleepless scratching baby is seriously upsetting and it is no wonder desperate parents try everything under the sun to get baby’s soft skin back (not to mention the family’s normal sleep pattern). Parents would plea for help on how to deal with their sleepless kid’s eczema. But as a doctor with a special interest in eczema, the laymen’s responses sometimes sent chills down my spine. Typical suggestions include:

- Cut out all milk products!¹

- Change washing products²

- Apply Diprosone³

- Use steroid creams

- "Don’t use steroid creams"

- Avoid showers

- Use snake powder

Thankfully, some members in the group were obviously more sensible than others and would simply recommend a visit to a doctor.

After seeing these discussions about eczema crop up again and again, I realised just how misunderstood the condition is and how difficult it is as a patient, or as the parent of a patient, to know what to believe and who to listen to. There are so many mixed messages and there is so much incorrect information circling the internet. With so many people sharing their own advice on what to do and what not to do, it can be bewildering. Eczema is a complex disease and each patient is different, with their own situational characteristics to be accounted for. This is why advice can be accurate for one person and wrong for another. There is no one-size-fits-all solution and so the appropriate course of action should be unique for each patient. Eczema is not like a urinary infection, which is easy to diagnose with a urine test and simple to cure with a course of antibiotics. Managing a condition like eczema optimally requires a certain expertise and is time consuming. Over the years, I have also noticed that many doctors don’t like to treat eczema patients. This is likely because they too don’t know enough about this complex disease. I remember when I first started as a junior doctor in dermatology thinking, oh no, not another eczema case on opening the medical records. I did not enjoy those consultations, because every patient would have another lifestyle or treatment question I was hearing for the first time and could not give a satisfactory answer to. Furthermore, the million different steroid tubes with varying strengths – or the same strengths but with different packaging – confused me as much as the patients. I think it took me a couple of years seeing daily eczema patients before I finally started to enjoy treating patients with eczema.

Upon my return from Singapore to London, I noticed the same problems. But it was worse. Not only is the disease incredibly misunderstood by both patients and healthcare workers, it is very difficult to get access to specialist care for eczema patients in the UK. There is a scarcity of paediatric dermatologists and as a result the waiting times in the public health care system can be very long; sometimes up to a year. It is heartbreaking to see that some of these little patients with troubled skin have been itching for so long, when even some over-the-counter treatments and other tips and tricks would improve their skin while they’re waiting to be seen. And if they do finally get to see an eczema specialist, the time for a first consultation is limited to 20 minutes. This is not enough time to: 1) call in your patient, 2) say hi and create a connection, 3) take a history (proper history taking for eczema is time consuming!), 4) undress⁵, 5) examine the whole body and scalp, 6) redress (often includes a nappy change!), 7) counsel and educate on eczema and lifestyle changes, and finally, 8) do all the paperwork (sadly, the paperwork is easily the most time-consuming). I am one of those doctors who like to explain things to my patients, and I grew more and more frustrated that I was not able to provide adequate education and counselling in most clinics. A better understanding of the condition is the single most important factor to achieve control of eczema. I would advocate patients to educate themselves about their condition because evidence has shown that supporting patients to be actively engaged in their own condition will improve the outcome. However, I came to realise that patients do not always get their information from trusted sources. While some neglect their own health, some, in their quest for a solution but without enough background, do the wrong thing. They turn to the internet: a powerful but dangerous tool. The information can be overwhelming, and you basically need a medical background to separate the wheat from the chaff.

As I have no power to improve access to specialist care, I decided to focus on what I can improve. I turned my frustration to a new project: writing down what I wish my patients knew about eczema. I started to pen the medical issues as well as the emotional, social and lifestyle aspects of a life lived with eczema. Because eczema is a subject in progress, I don’t have an answer for every question. The last decade has been called the ‘decade of eczema’ for good reason. Research has expanded our knowledge of the basic science of eczema. Importantly, the full spectrum of associated conditions is now better understood and new treatments are being added to the treatment arsenal as a result. When it comes to the role of food on eczema (a complex topic!), I’m sure the near future will give us more clarity, but I have tried to be as complete as possible in this book.

Too often, doctors use medical jargon which makes it difficult for patients to understand. But I have tried to cover this medical topic in an entertaining and uncomplicated way. I use stories and experience from my own practice, in the hope they will stick around longer in your mind. Sometimes they are funny. Sometimes they are a little exaggerated. Sometimes they reveal what doctors today have to deal with. But I hope they’re always informative and clear in helping demystify and manage eczema. As a medical student I was told that a doctor must have four qualities: honesty, humility, humanity and humour. I always try to keep those four qualities in mind and hope this reflects throughout the book. As doctors, we have the tendency to become more cynical over time⁶ and we can sometimes shock patients without realising it. I sincerely hope that no one will be offended by any of the words in this book.

This book was not only written to help the Singapore expat wife community give each other better advice (but I do hope next time they advise reading this

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