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From the Clinic #9: Atopic Eczema and Exfoliation

author/source: DrB & DrN


In clinic, when discussing scratching, it is important to discover how scratching is carried out. The use of exfoliation gloves was a recent revelation!

Together with its big brothers, dermabrasion and chemical peeling, and not to forget its country cousins, depilation and waxing - exfoliation is not recommended for anyone with atopic eczema.

With atopic eczema, skin barrier function is already inadequate. The artificial removal of a superficial layer of epidermis does nothing to improve matters! Such procedures act as a stimulation to epidermal basal cell activity. This is the skin’s natural response to assault, and this is how lichenification develops in response to habitual scratching.

Atopic eczema, both acute and chronic, shows how the skin reacts when under attack: the basal cell layer is stimulated and becomes overactive, cell division increasing to replace cells being lost at the surface. The regular and flexible structure of normal healthy skin is replaced by tougher skin that is irregular in thickness and somewhat stiff to touch, with thick bits and thin bits, and cracking in-between. Cell separation by fluid, and thickened surface layers act as a temporary buffer against the possibility of a breach of the body’s defences.

With atopic eczema the best exfoliation is the natural defoliation that occurs at a steady rate from the surface of normal skin all the time. In atopic eczema the deficient skin barrier function of the epidermis needs treating with the correct use of emollients. From time to time anti-inflammatory creams - usually topical steroids - are needed to treat the inflammation itself.

Asking about how we scratch can reveal an otherwise secret world that is living with eczema.

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