What causes eczema | Eczema 101 basics of eczema

What causes eczema? Eczema is thought to be have both a genetic and an environmental factor. We need to think about how we treat eczema.

You’ve read the pages. You’ve watched the webinars. You’ve still got questions about the basics of eczema.

Our world-class expert Jenna Lester, MD, has answers.

Board-certified in dermatology, Dr. Lester is an Assistant Professor of Dermatology at UCSF where she practices and teaches general dermatology and is the Founding Director of the Skin of Color Program. She was named a Watson Faculty Scholar, a prestigious award dedicated to the support of new faculty at UCSF. Dr. Lester is a sought-after lecturer, has written book chapters and published articles in peer-reviewed journals, and is currently building an academic research program in dermatology.

Ask the Ecz-perts Live: Eczema 101

Hi everyone welcome uh. Thank you so much for joining us and welcome to ask the experts live eczema 101 with dr jenna lester. This event is in collaboration with the skin of color society and has been made possible with the support of our eczema awareness month.

Sponsors sanofi genzyme, regeneron, abv, water, wipes, eli, lilly, baby, dove, dermavent and cerave. My name is Jessica Bartolini. I am nia senior manager of partnerships today’s. Event is a part of our eczema awareness month, where we are encouraging you to get eczema wise for more information about eczema awareness month and how to get involved.

Today’s Q and A is focused on the basics of eczema. What causes eczema? We will start the questions with pre-sourced uh. We will start with questions we pre-sourced from our community on our social media channels.

If you have a question that you would like to ask during this q, a please put it in the chat and we will let you know if we’re going to be able to answer it during the live session. We ask that everybody remain on mute during this time to ensure that you guys can hear both myself and dr lester and a quick reminder.

Now without further ado, i’d like to introduce you all to our expert today, Jenna Lester MD board certified in dermatology. Dr Lester is an assistant professor of dermatology, at UCSF, where she practices and teaches general dermatology and is the founding director of the skin of color program.

She was named a watson, faculty scholar, a prestigious award dedicated to the support of new faculty at ucsf. Dr lester is a sought-after lecturer, has written book chapters and published articles in peer-reviewed journals and is currently building an economic research program in dermatology, dr lester, thank you so much for being here with us today, thanks for having me, of course well, i’M just going to fire away with our very first question sure um.

What causes eczema?

The first question we have from our community is “What causes eczema?” So that is an essential question to understand and i think it helps to think about how we treat eczema as well, um and so eczema is thought to be have both a genetic and an environmental factor.

You probably have some sort of underlying tendency towards eczema um, and that could mean other people in your family. Have it so it’s, something that you’re aware you might get, but also there are people who are the first in their families to get it um and there probably is also a trigger um in your environment.

So we know that , you know excessive hand washing or exposure to dust or certain allergens. Um living in cities can be more of a trigger for eczema. So you you’re in an environment where you’re exposed to things that make it more likely for you to develop eczema, and then it reveals your underlying tendency towards having it and then and that presents as itchy inflamed skin.

It can affect people focally, so just in certain areas of the body, it can be more widespread and we know that it really can interrupt. People’s lives and be very, very disruptive. Great. Thank you so much.

What are we? We all? We know that we’ve heard there’s, seven different types of eczema. What are those seven different types of eczema, so i don’t, really think of it as a seven different types um. I i really think of um and and that’s, because the treatment of them is very similar.

So in dermatology we focus more on um morphology or shapes when we’re, describing how something looks, but not because it puts someone in a different sort of bucket or group when they’re being treated um.

You know people can have flexural eczema, which is like in the folds of the body there’s. Numbular eczema, which looks more coin, shaped there’s, um more erythrodermic eczema, which is like all over the place all over the body.

But i try not to think of it in specific categories. I know sometimes in terms of identifying yourself and identifying sort of how you think of the disease that you have it’s. It sometimes can be helpful to think of in that way, but from a dermatology perspective we often treat them very similarly, and so i don’t.

Think of like seven different subcategories. When i’m diagnosing, someone are any of these different um ways in which eczema can manifest on your body are any of them harder to to treat and diagnose than others.

So i think um one of the types that people often refer to as neurodermatitis, which in in the dermatology world we refer to as lichen simplex chronicus. I think that one is particularly hard to treat because um what lycan simplex chronicus is is is thickening of the skin.

That happens as a result of rubbing or scratching. So, usually, you have a different type of eczema and then you’re itching and understandably you scratch or rub as a result and then your skin thickens up and then within that area of thickened, skin your nerves, remodel in such a way that that That alone, that patch alone generates an itch signal.

So, even if you were to treat all of your eczema and it would all go away if you have that thickened area of skin, that can be quite itchy and it’s really hard, because the process of getting rid of that or curing.

That is softening that skin out and like making sure it sort of returns to normal, and a lot of it has to do with not scratching the area. And i never tell my patients not to scratch, because i feel like that is a very sort of condescending thing to say i think of my job as making the skin less itchy and making you not want to scratch it, but sometimes making the connection between.

Why a condition exists and what we contribute to that?

Why a condition exists and what we contribute to that can be helpful in figuring out how we can sort of disrupt that cycle. We had one community member, ask what the difference was between atopic dermatitis and neurodermatitis.

Is it the thickening of the skin that you were just talking about so um? The difference is that lycan simplex chronicus is a result of any condition that causes itching and scratching over time. So it’s almost like they would happen in sequence, with each other, so um um having a topic dermatitis that’s, not well controlled, which is leading you to itch rub scratch.

You can down the line, get thickening of the skin. There, and, and so they can coexist together, got it – are people with one type of eczema, more prone to getting other types of eczema um. So in thinking about why you get eczema with the genetic and environmental factors um, you’re.

If, if you have a genetic tendency, you can likely get several different types. So if we’re also talking about types of eczema, the different types you get can change over time. So we think of kids getting it on their cheeks, maybe in their in the folds of their body and then as adults, maybe having it in different locations on the eyelids on the hands.

So i do see this progression and it’s, probably because of someone’s underlying tendency or perhaps because of their environment. So i don ‘ T think that there’s, necessarily a causal link between one type of eczema and another, but just because you, as the person have eczema, you have things about you that make it more likely to happen in you.

So you may get another type of it are certain types of ethnicities more likely to have eczema, and if so, why? That’s, a really great question and it’s. A very there’s, a very nuanced answer and i think it’s.

Important to understand that um, race and ethnicity is in no way coded in our genetics. Race is something that was created by man. We decided that this group of people is black. This group of people is white.

This group of people is asian, so there’s, nothing about us internally. That makes it more likely for you to get it um in terms of your race or ethnicity, but um. What research has shown is that certain people may be more likely to have it, probably because of social factors.

So, where someone lives and does a certain group of people tend to live in a certain type of environment tend to have exposure to certain types of environmental triggers. So we know that that black and latino people tend to live more concentrated in cities where there’s more exposure to pollution.

We also know that, because of the way our our real estate is set up, um those groups of people tend to live closer to, for example, like pollution, generating factories, and all of that plays into someone’s likelihood of developing eczema, whereas if that Person lived in an environment where they didn’t have exposure to those things they may not ever develop it, so i think it probably has more to do where people geographically focus and what someone’s.

Individual situation is that happens to fall along racial or ethnic lines, as opposed to it being related to one’s, race or ethnicity, specifically got it great. Can you also, let me know if you i’m, not explaining things in a way that you think is understandable, because sometimes i say a lot of things.

I just want to make sure that, and anyone can ask for a clarification in the chat box too. If i say something, doesn’t make sense. Definitely thank you for that um. Okay, another person asks us. Why does my eczema flare up in the same place every time so um? This has a somewhat complex, um answer, but to simplify it a little bit.

Um eczema is caused by hyperactivity in your immune system, and so there are certain cells that are primed to generate that hyperactivity in the immune system, which in turn causes eczema, and we think that those particular cells called t cells come to the same spot in the Skin all the time, so you probably have millions and millions, and maybe billions of them around the body, but each one homes or comes to a certain area of the body over and over again, so those cells that are primed to cause eczema on your elbow are Always going to come back to your elbow and that’s, why it probably happens there over and over and then that area of skin may have more damage or maybe more prone to some of the um.

Some of the changes that we see in the skin that um contribute to eczema like mutations and certain proteins that lead to water evaporating more quickly in the area becoming more dry. That may impact certain areas of your skin more than others, which make those certain areas more susceptible to developing the visible findings of eczema.

Recommendations for Flair-ups

What would you recommend that somebody do if they notice that they only flare in the same like let’s just say five part locations on their body in between flares? What would you recommend they do to kind of rebuild those that those particular areas of skin, so there’s? A couple things um, i like to think of the skin as a brick wall and the brick wall is keeping out all the irritating things that can start to trigger the cycle that contributes to itchy dry, eczema, skin um and in eczema.

That brick wall maybe has a few more cracks in it or maybe, is crumbling in certain areas and needs to be rebuilt and so in treatment making sure you’re moisturizing and adding the proteins back to the skin that are needed to help reinforce.

That wall is really important, so um using cream-based moisturizers, i think are, is is better than lotions for most people with inflamed skin. First of all, people with eczema, probably don’t, get very moisturized from lotions.

I know i have patients that are like. I put it on and then 10 minutes later my skin is dry again, so heavier moisturizers tend to work better and that helps to reinforce that brick wall and build things up, and there also is some research to suggest that hot spot treatment um in between flares Works well and what’s hot spot treatment.

That’s when you use an anti-inflammatory, topical agent and even if you’re, not having an active flare in the spot that you know you flare frequently, maybe once or Twice a week, you put a little bit of that anti-inflammatory treatment to keep those cells that i was just telling you about kind of calm in that area and that has been shown to help um decrease the frequency of flares great.

Thank you. Um speaking of moisturizing, you know we had a community member say. How can i moisturize when i feel like everything, makes me flare yeah so that that is a shared experience? I think of many people, and one thing you have to be certain of or consider is whether you have a contact, dermatitis and contact dermatitis is when um something comes in contact with your skin, that you are allergic to and it triggers rash itching stinging.

All of that and people with eczema they um, i see contact dermatitis all the time because the skin, which normally is keeping things out, is not working in the way that we want it to and so little bits of lotion and pieces of like components of the Lotion get into the body and over time the body starts to recognize that as the enemy and so um.

You know, i think it’s, important to make sure that you’re, not flaring, because you’re allergic to something in that lotion or that cream the most the the thing that’s, probably the least Likely to cause that sort of reaction is um, petroleum, jelly or vaseline.

So if you’re looking for some alternative, that’s, a good place to start, but getting in touch with your dermatologist to see whether patch testing might be reasonable. For you is a good idea, because it could be that there’s, something in that lotion, whether it or that cream, whether it’s, a preservative, whether it’s, something else in there.

That is causing you to get irritated. That could be the problem yeah. That makes a lot of sense and that actually is a really good segue into another question: a community member had which is um diagnosed or not.

How do you know which doctor?

How do you know when you go to your hcp versus your dermatologist versus maybe an allergist to kind of get to the bottom of what’s, causing your your eczema yeah? I think, and i i think, that’s, a personal question.

Um, i think if things are very severe – and you know you’re, having trouble it’s, impacting your day-to-day life when you’re in a really severe flare, i think that’s, the time to go To a dermatologist to see you know what sort of tricks or things that we might have to get things under control um, but i think that probably varies based on where people live.

So you may not live near your dermatologist and your your closest by practitioner might be your um primary care doctor, and i think, if you have a good relationship with that person and you update them whenever you do have the chance to see the dermatologist like this Is these are the treatments that i’m doing now? They told me to do this in this situation.

That person, then, can become pretty agile at helping you through flares, like that, while you’re waiting to get into the dermatologist or it’s far enough away, that you can’t go today, um. So i think that that is kind of a personal, a personal question.

I think either one could be the right answer and certainly, if you go to your primary care doctor or your hcp um and they feel like this is severe enough to go to the dermatologist. They’ll, certainly direct you to the dermatologist um and i think allergists come into play, um more.

If you’re trying to think about, you know foods that may be triggering things or all of that um and allergists do different testing than dermatologists do for that um sort of thing yeah. That makes a lot of sense um.

So what are the different severity levels um as it pertains to eczema and what do the and what does the severity mean and how is it used to treat patients um, so there’s, a way that we score eczema based on how much of The body it’s, um, covering how much redness there is, how much itching there is, how much scale there is, and so it gives us an objective way to track how it’s doing over time.

Um – and this is often primarily a research tool – sometimes insurance companies require it um documented in order to before they ‘ Ll pay for certain medications to be used, but one of one of the ways that i find is a little bit more straightforward and more patient-centric to understand how the severe the eczema is is asking for an itch score and then asking patients to grade the severity Of their itch on a scale of zero to ten.

That actually has been shown when tracking that, over time, um to to track very nicely with the severity of eczema and rather than you know, get my calculator out and calculate everything which sometimes i do.

For specific purposes, i’d, rather ask you how you’re doing and how severe your eczema is for you today, because if you’re feeling really itchy and things feel severe to you, regardless of what that calculated score, Says i’m gonna think about how we can change our treatment approach.

Yeah. That makes a lot of sense. Um. Sorry, just going down really quick um the next question: what do you wish your patients knew or would do in order for them to get the best results from their visits with you that’s such i love that question because um, i think it All has to do with preparedness and um.

I encourage people to write questions down before they come to the doctor um, because sometimes it can be intimidating to be in the medical realm and having your questions written down. That way, you can make sure you get them answered before you leave um.

I encourage people to think of their at least when they see me think of it as an ongoing relationship. We may not solve everything in one day. In fact, we rarely do but um it’s. Just one point along the trajectory of our time that we spend together trying to figure this out and trying to help your skin improve um.

I wish people knew that consistency is really important and sometimes i think many people want to be consistent, but it can be discouraging to have a condition like this and discouraging to not notice changes day by day, even though you’re working really hard To try to do everything correctly, and i wish people knew that they weren’t alone in that, and many people expressed that same thing um, but but it’s.

It’s, an important part of treatment, and i also wish more people knew about mia and i think that in a lot of the other, chronic dermatologic conditions that i treat a lot of people say well, this support group is, you know no offense.

Dr lester, but this support group that i’m in, has been super super helpful, like in some ways more helpful than what i get from the doctor, and i’m, not offended by that at all, because i realize that i can Provide a lot of things, but sometimes talking to someone who is walking in the same shoes that you’re walking in, is a lot more helpful than hearing from someone who has a very specific perspective.

So um, i think, reaching out and getting support from people and hearing what works for them and seeing how that might help or work for you is really important yeah. I i totally totally agree um that’s.

What we’re here for um, we have a chat or a question from the chat um. Why do teeny vesicles form in dishydratic eczema and then the second part of that question is: do you have any tips for managing this type of eczema because it can be so itchy and and get really out of control, yeah, so um um answering this question.

Sort of help um the best way to do it, is to think um to think on the level of the skin. So pretend we’re like shrunk down humans on top of the skin, getting a really up close, look and even going inside at various points.

So when i was telling you about those cells earlier that are part of the immune system that get really worked up and cause the eczema in the same spot all the time when those cells come to the area, they bring a lot of fluid with them.

They bring a lot of water from other parts of the body and they make the skin swell up like a sponge, and so when the skin swells up in that area, sometimes it sort of pokes out at very specific points and that’s.

Why? You get those little bubbles filled with fluid so that those are the bubbles of dish, hydratic, eczema that occur and um, and it’s a difficult thing to manage, because it’s often happening on the hands.

You’re using your hands all the time, so it makes it hard to like constantly put on creams and protect them. Like you, might your leg, which isn’t exposed in the same way um right now, with all the hand washing due to covid exactly so, i have been seeing a lot of um a lot of people who didn’t even know They had this before because, like i was saying you can have an underlying genetic tendency, but it doesn’t come out unless you’re in the right environment for it to come out.

So i’ve had grown adults who are like i’ve, never had this before and now i’m. Doing all this hand washing and using hand sanitizer, i tell people, hand washing with soap and water over hand sanitizer.

Whenever you can, if the option is hand sanitizer or your hands are dirty, then you should use hand sanitizer, but if the option is get up and go to the sink and wash your hands with soap and water or use hand sanitizer that happens to be right.

There i would encourage you to get up and go to the sink. What putting water on your hands it sort of doesn’t really make sense, but it actually dries your hands out more. So any time you put water on your hands, which should only be when you’re, washing your hands or in the shower, you should put moisturizer on right after.

Should you wear gloves?

That brings me to my next point, which is anytime. You’re. Doing dishes anytime, you’re, doing any cleaning around the house or anything else where you’re, not actually trying to get your skin clean, you should be wearing gloves, um and that will protect your hands.

Some people find it helpful whenever, whether they’re, applying medicines or whether they’re, applying moisturizer to put um cotton gloves on for a couple hours after even overnight, to help sort of make that medicine or moisturizer sink into the hands.

More and i think if these basic strategies, aren’t really helping, you should definitely go to the doctor and see whether there could be something else like an allergy like. I was saying before just something you’re, putting on your skin, which is certainly possible, so any other tips for managing itch.

Besides, you know, moisturizing as often as possible um. I think that so a lot of people wonder about antihistamines. Are those helpful like benadryl or zyrtec stuff like that, and it can be helpful not because it’s treating the itch, but it’s, sort of putting you to sleep so that you’re um, not sensing the itch.

It’s, not it doesn’t change the process of the itch that’s happening, and sleep is really important in terms of being able to be flexible in your life and you know, stay awake in school or at Your at your job, so i think they certainly have a role when the itching is um keeping you up at night um.

So it’s not like they’re, not useful at all, but that’s. One thing that people do um and i think just making sure that that we understand why the itching is happening is really important, because when i hear about itch still going on, i think that there’s, some stone that we’ve left unturned and let’s figure out why it’s happening.

I also i have my patients use sarna lotion, a lot which can be helpful in cooling, the skin and soothing the area and can be helpful with itch.

I usually tell people to keep their moisturizers in the refrigerator because cooling them down once you apply it, it feels a lot more soothing. So these are some of my basic tricks yeah. Those are really helpful.

Yeah. I have my my moisturizers in the refrigerator, especially during the summer when it’s, really hot yeah, exactly exactly um uh, let’s, see we have another live chat. Is there anything internally? You feel helps with maintaining the skin lots of water, probiotics, etc um.

So i have, i think, by the time, if you’re, so dehydrated, meaning you haven’t drank enough water to the point where your skin is dry. I think your eczema probably will be the least of your concerns at that point, so all that to say that um, that i don’t really think that excessive hydration is going to change much on your skin um.

I think it’s good to drink water, for a lot of reasons, but i don’t draw the connection between those that much. I think the probiotics question is really interesting and that’s. An area of active research to understand what the skin microbiome as we call it, is like, and what’s, the connection between the skin microbiome or the bacteria that live on the skin, many of which helps us, some of which harms us?

What’s, the connection between that and the gut microbiome, and what bacteria live in our stomach in our gastrointestinal tract, and so it’s difficult for me to say at this point whether that actually is helpful.

But i don’t actively recommend that my patients take probiotics right now, just because i don’t have enough information that it’s, um helping um as long as it’s, not harmful. I don’t recommend against it either great um.

So we had a couple questions about eczema and genetics. For example, one woman said my two-year-old has really bad atopic dermatitis. I am pregnant with another daughter. Is there anything that i can or should do, to prevent my newborn from developing eczema? It’s similar to another community member who said um that he was told that there was a genetic component to his eczema.

Although he’s, one of six and nobody else in his family has it. So could you maybe touch a little bit about um, genetics and eczema and uh if there’s any you know factual information behind that theory yeah.

So i’d, say to address the first question. What causes eczema? First, i would say that if your baby ends up developing eczema, i don’t. Think it’s because anything you did or didn’t do um. Sometimes it’s, something that’s just gonna it’s.

It’s sort of gonna happen, and i don’t like people to feel like they have blame in this situation, especially because we don’t really have a good way of preventing it like medication. In terms of like what we can offer as a medical community, there has been some interesting research on vaseline in kids, and so part of eczema is eczema is part of something called the atopic march, which is eczema, allergies and asthma.

Often times people have One or two of these things, or maybe have all three and we sort of see them progress in a fashion that’s, why we call it march, we it marches along, so one one research study showed that simply smearing a kid you know daily with vaseline prevented those next stages in the atopic march, so essentially prevent prevented asthma from developing, which is a pretty big deal and, as i mentioned before, vaseline is a great moisturizer and really doesn’t have anything in the way of allergens in it.

So i think that’s pro that’s. The main thing that i would recommend is smear that baby with vaseline. Of course, you should check with your pediatrician first to make sure that there’s, no reason not to do that, but um that’s.

What i recommend great okay, another community member, wants to know this is from also from the chat. Is there a relationship? Is there any relationship between eczema, flares and hormonal shifts in women? There, probably is there’s, no way that there’s, no information that i have right now that i can draw it um or or draw a direct connection to it.

I do see people with different severities of their eczema when they’re pregnant, so um when during pregnancy, there’s, an abundance of hormones that exist in lower amounts. When you’re, not pregnant, and there are other conditions that have sort of an immune, immune system, sort of genesis that behave in the same way.

I don’t know exactly how what hormones may cause it to be worse or not, but i can just say from experience that i think there’s, something there yeah. I can say from experience too. My eczema was definitely much worse when i was pregnant and right after pregnancy during you know, breastfeeding and all that.

So i see a lot of women who have eczema and they have flares, and you know like from pumping or from breastfeeding, so it’s. Definitely a time when i see people with things worse, yeah makes sense. One community member is asking.

I get white patches after an eczema flare. Is this common? What causes them and is there anything that can be done about the discoloration yeah? It would be helpful to know that age of that community member, but i will say that um there’s.

Two different things that can happen that i can think of that might cause white patches. Um one is, is something called post-inflammatory hypopigmentation. So after something is inflamed, you get hypopigmentation decrease in your pigment and that’s, a reaction that your skin cells that produce pigment have, and sometimes that things get darker.

Some of my patients have, with with um chronic eczema, have darker patches of skin. We just don’t, really know how one person will respond. It could be that those cells get upset and they leak their pigment everywhere, or they just stop making it so that’s, one thing that can happen and um that does improve over time.

As does this other condition, which is more common in kids, called pityriasis alba, and it’s lighter spots on the skin that happen after more red or itchy patches were treated often, and that also resolves with time, usually around puberty.

So those are two separate reasons that can cause a similar appearance um, and i think the prognosis is good for both of them. I had to mute myself my cats, oh really putting on a show screaming at me over here.

How does eczema appear differently in black or skin of color?

Okay, so we’re. Actually going to go to a live question: um nikku, am i saying your name right? Are you there? Yes, i’m here. Can you hear me? Yes, we can hear you lovely um, so my question um is how does eczema appear differently in black or skin of color, and also, how might it be experienced differently that’s?

A really great question i think, um it’s, challenging for many people to recognize some of the hallmark features of eczema and someone with darker skin and one of them being skin, redness or skin inflammation and darker skin.

It doesn’t, always appear red, it can look purple, it can look deep red or magenta, it can even just be brown, and so that can throw some people off um when they’re looking at eczema and may make it more Challenging for them to diagnose so that’s.

One way. We also know that, especially in kids, um, black and brown, kids, their eczema, doesn’t, always appear in patches. They can get more bumpy looking eczema, so it’s. Folliculocentric eczema, meaning it’s right it’s focused around the hair follicles and that’s, a more common um clinical variation.

So a variation in appearance like you’re asking about that. We see in in kids with skin of color, and the second part of your question was um experience. How how can the eczema be experienced differently and based there?

There are many different measurement tools to understand someone’s, experience of their disease that have been developed by dermatologists over time, because you know – and this was a couple decades ago – we realized – we were treating the skin, but we weren’t Understanding how patients were showing up, given the fact that they have skin disease.

Researchers have put together one one of the main ones that we use is called the skin dex, which um helps people express through series of questions how their disease is impacting their Life and and that’s, that’s.

How the patient reports it and then i can come in and based on how things look decide how severe things are, and we know that, even at what the doctor might grade a lesser severity, patients of color um are experiencing their disease in ways.

That would suggest that it’s worse, so there’s, something about having the condition that we wouldn ‘ T expect them to feel as bad as they do, but they do based on these measurement tools that we have and i don’t.

We haven’t figured out why that is, and i think much much more research needs to be done, um to to really parse out why that’s happening, you’re, a mutant by the way. Yeah sorry get my cat out of here, um, okay, uh next question from the community uh is i keep hearing that kids outgrow eczema? Is there a study on? This is true.

I i see some kids who have eczema and then they never get it again and around puberty is the time when we see it sort of um ease up. I see kids, who have it clear through adulthood and into adulthood.

Um and – and i see you know – adults who maybe had a very mild case to the point where they don’t even remember it and have to ask their their um caregivers. Like did, i have eczema um and they’re developing.

It in adulthood so um, so i think it’s a little bit of a misconception that it happens all the time that people outgrow it. I don’t know of a study. Specifically, there may be one where, where people have looked into this um in terms of age, you can imagine that that would be a very long study having to follow people for like 40 50 years.

So it could be that someone is doing that and um and trying to get an answer. We just don’t have all the data yet, but i think people feel like they didn’t, do something right if they don’t outgrow their eczema or they don’t outgrow.

Their acne, which we’re, obviously not talking about today, but that’s, another example, but really it’s, just different for everyone, yeah yeah, i mean i personally, didn’t really have eczema. When i was younger and definitely had it more as an adult – and we certainly um connect with plenty of people who had onset of of of eczema as an adult, and we certainly see a lot of kids who do sort of magically outgrow it.

We don’t know yet if it’s necessarily going to come back or not, but exactly yeah um. We have a live question from the chat um. It’s. Our researchers seeking more people of color to diversify their studies. I love that question and i think that absolutely should be the case.

I i i’m trying to think of active projects, and there are so many going on ucsf on ucsf at any given time that there’s, no way that i can keep them all in my head, but um. But i know that this is a movement in medicine.

We’re trying to do this more because we realize the limitations of the data we get if we have a very homogeneous or uniform group of patients participating in the study so um, i i would say whenever you go to your doctor, ask if You know you know of any clinical trials, or do you know of any research going on to actively seek that out? Um, i think, is an important thing and it and it’s.

It’s, sort of luck of the draw whether you fit the profile age-wise gender previous uh treatments. There’s, all sorts of different qualifications for any given study, but i think it’s important. If you’re interested in contributing to the medical knowledge base, which i know, we all appreciate that.

You seek those opportunities out yeah and definitely can find those opportunities on nia’s website, um, not just clinical trials, but other forms Of research um so yeah, thank you ashley for that question.

Is eczema considered a first world disease?

Next question we have is they say just curious. Is eczema considered a first world disease and are disease rates going up or are they just being reported or treated more so um?

There is some like a theory about exposure to germs and how it impacts your immune system when you’re developing in our super clean environments, making us more prone to asthma and and certain sort of allergic conditions.

I’m Sure you’ve witnessed the way that um peanut allergies, the recommendations around that have changed exposure versus not early on, so i think there’s, definitely something there.

I do also think that this is something that, with organizations like mia, that are validating people’s, experience and letting them know that this is a real thing that you can have treated more people are seeking care, and so our numbers are going up For that, for that reason as well, we’re, getting better at diagnosing things, so it’s.

Probably a combination of both, i would say, but i definitely think that there’s, something about our environment, being very clean. That other researchers have decided help these allergies sort of appear later on yeah, interesting um.

I have a question. You know for a patient who’s newly diagnosed um with eczema, and they’re, leaving their first doctor’s. Appointment and they’ve, just you know gotten all this information thrown at them um.

What would you say, sort of like the top three things are that you hope they kind of take away as they start this journey um with dealing with eczema. Can you think of three things that you would hope for? Yes, there’s.

There’s, probably more than three, but i think you’re right that we that sometimes you get a deluge of information and you need you can only hold on to a few things, but i think um. The first one to know is that things don’t necessarily improve overnight and that’s.

What i was alluding to earlier about consistency and sticking with the treatment for a good period of time, which you and your doctor decide what that number is before deciding it. Doesn’t work and stopping um.

I think um, i think, be letting letting your doctor know or your care team know whenever you feel like the treatments that you’re given are either not adequate or you’ve added something else, because you in your experience.

This other thing helps with your dryness or your flaking, just letting everyone know that what what you’re doing. I must say that i learned a lot from patients about other things that they’ve added on top of the regimens that i’ve, given them because they’re helpful to them, and i then share that information with Other people.

It’s, really nice to have sort of a two-way communication street and it’s also helpful, because if we know everything you’re doing, if everything’s, fine, that’s.

Great but then, if something comes up and there’s, a change six months down the line, we can go back in our note and say: oh remember, you told me you were using tea tree oil. We know that that causes a lot of irritation, or something like that.

So i think, knowing that um, that sharing is very important and being sort of open about that and um, and then i think i ‘ Ve alluded to this already, knowing that you’re, not alone um. I think that that is really it’s hard to feel isolated.

Many people spend a lot of time trying to hide their skin and not let other people know that this is going on and that takes a lot of energy um. It takes a lot of energy to move through your day like that uh, but i think once you leave the doctor.

Hopefully you have the sense that this is obviously something they’ve treated before so. There must be other people that have it and seeking out those communities, i think, is really important. All the nitty gritty about your treatments and what to use when, and i think that’s important, but i think these sort of three more principle based things are probably a more important themes that have enduring importance throughout this journey.

Yeah, absolutely especially as it pertains to mental health, you know, which we know is, is a huge part of you know, living with with eczema yeah so having that community is, is so crucial and knowing also knowing when to ask for help, maybe as a asterisk, to Number three, because i want to stick to the rules of only picking three, but but knowing when to reach out and ask for help that’s.

Part of that two-way communication, because you know, i think our mind-body connection is really important. And if something is unresolved, i think you know we don ‘ T have studies that says this exactly, but it doesn’t mean that it’s, not happening so knowing when to ask for help.

Knowing when to ask your primary care doctor for a therapy referral or something like that, there are therapists who focus on people with chronic conditions and helping them deal with those yeah yeah.

Exactly well. Does anybody else who’s joined us live, have any additional questions that they would like to ask? You can raise your hand or put it in the chat um. I’m glad. We were able to get to everybody’s, questions they’ve, been great questions yeah.

They have been really great questions. Um, let’s, see! Oh, you’re. Welcome, oh yeah, [, Laughter, ], um, okay, then um. Well, then, i think we’ll, wrap it up um. I want to start by saying thank you so much dr lester, for joining us um for and for all the work that you do in our community and all the work that um you will inevitably do in the future for our community.

We’re, so appreciative of your time today, um to everyone who joined us uh. We hope to see you again tomorrow at 11 a.m. Pacific standard time when community member ashley and laura will host a virtual, meetup and support group.

You can get all the information you need about that, including the zoom link and all things eczema awareness month at eczema, awareness month, dot org, another big, thank you to our sponsors and uh the collaboration with skin, of color society um.

So, thank you, nia for everything you’re doing to support patients in the space between office visits. It’s, really important, yeah! Absolutely well! We’re all in this together, uh everybody have a wonderful evening and look forward to seeing you at our next virtual meetup.

This information and the video used is highly recommended by Eczemanews.com as experts to follow on your path to healthier living.

We suggest you navigate to their website for further updates they may have on this subject. https://nationaleczema.org/

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