Coping With the Emotional Impact of Eczema

Eczema does not simply involve having skin discomfort. It can have a profound impact on a person’s mental health, emotional state, and overall well-being. Eczema is a term for a group of related skin conditions that cause red, dry, itchy skin that can become scaly, blistered, crusted, or thickened.

A hallmark symptom of eczema is extreme itchiness that often keeps a person awake at night. Not only does eczema disrupt a person’s sleep pattern, it can interfere with daily life and take an emotional toll.

For example, people with eczema are often unable to wear certain types of clothing, makeup, or other cosmetics. Often, the rash appears predominately on the face, causing embarrassment and for some, extreme problems with self-image.

What Is Atopic Dermatitis?

Atopic dermatitis is the most common form of eczema. In fact, of the nearly 31 million cases of eczema in the U.S., 18 million adults and 10 million children have atopic dermatitis.

Atopic dermatitis involves dry, inflamed, itchy skin that often becomes infected. It is caused by an immune system malfunction, combined with problems with the skin barrier (the inability of the skin to maintain moisture).

The scaly, reddened rash can appear anywhere on the body, but most often appears on the face, hands, elbows and knees. In those who are dark-skinned, eczema can affect the skin’s pigmentation, turning the skin a lighter or darker shade.

Eczema is most often triggered by contact with chemicals (such as those in soaps and detergents, shampoos or perfumes). It can also be triggered by food allergies (such as allergies to milk, soy or peanuts), stress, or even the weather.

The Emotional Impact of Eczema

It’s not always obvious how much impact eczema can have on a person's daily life. Coping with eczema is something that many people with the condition (particularly young people) find challenging. The negative emotional effects of the symptoms can last for many years, even after the physical symptoms subside.

Eczema can affect people at any age, but it's usually diagnosed during infancy or childhood. Statistically, nearly 10% to 20% of all infants will develop eczema; approximately half of those who are diagnosed with the condition will outgrow it, having fewer symptoms as they age.

But some people continue to have eczema throughout their adult lifetime. Studies have found that people with eczema report that the condition negatively impacts their lives, exceeding those who have insulin-dependent diabetes.

Emotions and Childhood Eczema

Eczema has an impact on the emotional health of children, as well as on their parents and family members. Physically, any eczema breakout (small or large) can result in extreme discomfort and can sometimes be very painful.

Those with moderate to severe eczema report that the disease dramatically disturbs sleep, activities (including school and sports, and impacts their performance level in daily life). Common emotional symptoms of eczema in children, caregivers, and family members include:

• Psychosocial (mental, emotional, social, and spiritual dimensions of health and well-being) stress (which negatively impacts children with eczema as well as their parents)
• Sleep disturbances
• Anxiety and stress (reportedly impacting children as well as parents who must help their child deal with daily skin care regimens)
• Depression (commonly experienced by children with eczema)
• Social isolation (commonly experienced by children with eczema)
• Discrimination (people in public reportedly stare and react with fear to kids with eczema)

The overall emotional impact of eczema can be a lifetime of challenges in maintaining a sense of self-esteem and self-worth.

Emotional Symptoms of Eczema

Eczema is known to cause several emotional symptoms, including:

• Poor self-esteem (due to the appearance of the skin rash)
• Loss of sleep (from itching at night, possibly from depression or a combination of both)
• Frustration (because there is no simple, immediate treatment available)
• Irritability (in infants who cannot itch themselves, or verbalize their needs)
• Anxiety and stress (which are triggers for flare-ups as well as emotional responses to eczema)
• Depression (which is particularly linked with atopic dermatitis)

Overall, eczema is said to be “emotionally draining,” according to the American Osteopathic Association.

According to a survey by the National Eczema Association, over 30% of those with atopic dermatitis were diagnosed with either depression, anxiety, or both conditions. The reason for this phenomenon is not fully understood, but medical experts believe there could be a link between the way the body communicates with the brain during an inflammatory response.

Signs of Depression

Common signs and symptoms of depression may include:

• Apathy
• Irritability
• Aches and/or pains
• Loss of interest in hobbies or other interests
• Fatigue
• Trouble getting motivated
• Moving slowly
• Disruption in sleep pattern (difficulty getting to sleep, early morning waking or difficulty getting up in the morning)
• Persistent feelings of sadness, hopelessness, and emptiness
• Problems with concentration
• Changes in appetite and/or fluctuation in weight
• Restlessness, difficulty sitting still
• Being preoccupied with thoughts of death or suicide

It’s important to note that not everyone with depression will have all of the symptoms; some people experience just a few symptoms while others have many symptoms. A diagnosis of depression requires that a person has several ongoing (persistent) symptoms (listed), in addition to a low mood.

The Anxiety, Stress, Eczema Cycle

The persistent itch and ongoing sleepless nights caused by eczema is enough to cause anxiety and stress for just about anyone who suffers from the condition. The stress and anxiety can fuel the cycle of eczema flareups, because symptoms (from flareups) commonly cause a person with eczema to have anxiety and stress.

As symptoms increase, so too do the accompanying emotions of anxiety and stress, causing an unrelenting cycle that can quickly wear down a person’s emotional well-being.

Stress and Eczema

To effectively cope with eczema, it’s important to understand the link between eczema and stress, this involves the body’s fight or flight response. The fight-or-flight response is a physical reaction to an event that is seen as harmful (such as an attack or a threat to a person’s survival).

When the fight-or-flight response is triggered, stress hormones are released (such as cortisol and adrenaline). But, when the body releases too much cortisol (from frequent stress), it can result in lowering the immune system and triggering an inflammatory response in the skin. People with eczema are very sensitive to the body’s response to stress/fight-or-flight response.

Tips for Reducing Stress

Although getting rid of stress in your life certainly won’t result in a cure, it may help to alleviate some of the symptoms of eczema.

Action steps that may alleviate or lower stress include:

• Implement relaxation techniques (such as mindfulness practice, meditation, visualization techniques and more).
• Get involved in yoga or a similar Eastern practice aimed at promoting relaxation (such as tai chi).
• Establish and maintain a regular exercise routine (with permission from your healthcare provider).
• Seek out the support of others (family, friends and/or a
• formal support group).
• Explore options for individual or group therapy when needed.
• Seek medical intervention for symptoms of anxiety or depression.

Relaxation Methods for Stress Relief

There are a variety of ways to integrate a relaxation routine into your daily schedule. Some methods may work better for you than others. You may not discover which type of relaxation method works best unless you’ve tried several techniques and given each your best effort.

Some examples of relaxation techniques include:

• Guided imagery (listening to a relaxation tape while visualizing the images described by the speaker)
• Deep breathing techniques
• Formal meditation practice
• Guided meditation
• Walking meditation (letting go of thoughts while connecting with nature on a daily walk)
• Art projects (painting, drawing and more) participation

Addressing Sleep Deprivation

Many people with eczema experience sleep deprivation, which is said to be a sign that symptoms are not well controlled. Not getting enough sleep on a regular basis has a profound impact on a person’s emotional well-being (particularly for children and teenagers who are still growing and developing). Getting enough sleep is imperative for overall physical and mental health.

At night, itching can be the most problematic because there are no activities to help distract a person. Tips on improving sleep from the National Eczema Association include:

• Moisturize the skin. Bathe or shower with lukewarm water, then pat the skin and apply hypoallergenic moisturizers right away, before the skin is completely dry. This will help to trap the moisture (from the bath or shower) into the skin.
• Take anti-itching medication. Some over-the-counter medications (such as diphenhydramine) can help itching and promote sleep. But, be sure to consult with your healthcare provider before taking any medications, including over-the-counter drugs.
• Take your medication as prescribed by your physician. These may include topical (used on the skin) corticosteroids or other anti-inflammatory medications that can help stop the itching. Note, some anti-inflammatory medications can be used in combination with moisturizers to help control inflammation when the skin is moisturized. 
• Use a wet wrap, cooled in the refrigerator. This may also help relieve itching at night.

General tips on improving your sleep pattern and treatment of insomnia include:

• Go to bed and get up at the same time each night.
• Make sure the room you sleep in is dark and cool.
• Do not go to sleep watching television or looking at electronic devices (such as phones or tablets).
• Take a relaxing, warm bath before bed.
• Avoid drinking alcohol or caffeinated beverages before bedtime.

Exercise Benefits and Challenges

Regular aerobic exercise has been shown to help reduce tension, stabilize mood, promote sleep, and improve self-esteem. These benefits help contribute to a reduction in stress.

It's important to establish a regular exercise routine (with your healthcare provider’s approval). Exercise has been shown to lower stress levels, reducing flare-ups for people with skin conditions such as eczema.

Although the heat and sweating generated from a vigorous workout can contribute to eczema flareups, there are methods of managing eczema so that people who have the condition can realize the many benefits of regular workouts.

Children and Physical Activity

It’s vital for kids to engage in regular physical activity for many reasons. Not only does exercise help children burn off energy, it also lends itself to healthy development of muscles and bones and helps kids maintain a healthy height to weight ratio.

In addition, hormonal development (which naturally occurs during the teenage years) happens during sleep. A child requires a healthy sleep pattern for normal hormone development. Regular exercise has been found in studies to help to improve sleep.

Sports activities can help kids feel good about themselves. Participating in team sports helps to build healthy relationships with other kids. Setting and meeting goals (such as goals for faster running times) can help kids feel a great sense of accomplishment.

Overcoming Exercise Effects on Eczema

But what about the negative impact that exercise can have on eczema? Here are some tips from the Eczema Foundation on how overcoming the downside of exercise for those with eczema:

• Shower in lukewarm or cool water immediately after engaging in sports/exercise (to remove substances from sweat).
• Use a fragrance-free shower soap.
• Apply an emollient cream to the entire body and don clean and dry clothes.
• Don’t leave clothing in a gym bag, but rather, wash immediately after sports activities are over. Liquid detergents are better than powdered because they leave less residue. Use a fragrance- and color-free detergent.
• Explain to coaches that the rash is not contagious. This may help to alleviate any embarrassment children may experience when being called out (questioned about their rash) in a group of other children (parents should take this step for their kids).
• To combat sweating and heat (which causes blood vessels to dilate and increases sweat production and itching) wear loose clothes (made of cotton) or clothes that have breathable areas to allow heat to escape.
• Drink plenty of fluids and avoid playing sports in direct sunlight.
• Use a water spray to help bring the temperature of the skin down when you initially begin to feel hot. The water will evaporate, helping to cool off the body.
• During severe flare-ups it’s better to avoid sports that require intense activity.
• Avoid the use of deodorants/antiperspirants before exercise. Apply deodorant after sports activities, instead. Select alcohol-free and fragrance-free deodorant and stay away from those that contain aluminum salts.
• To protect the skin from sweat (or from chlorine water in a pool) use a barrier cream to don before activity, which works to seal the skin off from external exposure to water or sweat.

Support Groups for Eczema

Participating in a support group where one can share their frustrations, exchange tips for coping with eczema and offer encouragement to others, going through similar challenges, can help.

The National Eczema Association offers an online community of people with eczema who are there to share their experiences and offer hope. You can connect with the group on Facebook and Twitter and learn about the latest research and news pertaining to new developments in eczema treatment.

Psychological Therapy for Eczema

A relatively new type of therapy for people with skin conditions—such as eczema—is called psychodermatology. The therapy focuses on the psychological issues involved in skin conditions such as acne, psoriasis and eczema.

The professionals who are trained in psychodermatology specialize in addressing issues such as social anxiety and depression (common emotional symptoms experienced by many people with eczema).

This field of psychology is said to be well-established in Europe but is slow to becoming a mainstream therapy in the U.S. There are only a few psychodermatology clinics around the country. You can find a limited list of therapists who specialize in this type of therapy at the Association for Psychoneurocutaneous Medicine of North America site.