Perhaps you've only ever experienced mild eczema at certain times of the year, perhaps you've never had it all. But now you're expecting, you can add a massive flare-up to your already long list of pregnancy symptoms? Blame the hormones...
What is it?
Atopic eczema is a largely hereditary condition, meaning that if any member of your family suffers from it, you're more likely to yourself. It's linked to other conditions, including asthma, hay fever and food allergies, too. Sometimes, in pregnant women, eczema seemingly appears from nowhere. For women who have suffered from eczema pre-pregnancy, more than half will find that expecting a baby makes their eczema much worse. Only around a quarter of sufferers find that pregnancy improves their eczema.
The cause, as ever, is likely to be your pregnancy hormones, which are sending all parts of your body slightly doolally. Of course, various triggers (allergens, such as dust, for example) will be partly to blame, but the pregnancy might well be making you more sensitive to them.
If you have not suffered from eczema before, the symptoms range from mild to severe, but at any level they can be quite unpleasant. Mild cases will mean patches of dry, pink or red flaky skin, which can feel very itchy. Severe cases can mean cracked and bleeding skin, which is prone to infection.
Common places for eczema to pop up include the hands and wrists, the backs of the knees and inside the elbows. But it can occur all over the place, including the face and neck – yuk.
What can I do?
Seasoned eczema sufferers will already know about the various treatments available, but when pregnant, there are a few things to consider – in particular any medication should only be taken under the supervision of a doctor.
If an eczema flare-up has come as a nasty shock, here are some things you can do to help:
• Moisturise, moisturise, moisturise. The best way to calm down outbreaks and keep new flare-ups at bay is to keep your skin well hydrated. Aqueous creams might not be the right thing at this time because some of the ingredients might irritate the affected areas. Instead, you need a cream or an ointment specifically formulated to relieve dry skin. Although they can feel a bit gloopy, the oiliest moisturisers tend to stick better to the skin, and therefore be the most effective.
• Avoid soap. Just about all soap is drying, so use an emollient cleanser instead. They get you clean while also protecting your skin.
• Bathe or shower less often. Water is also drying to the skin, so if you can, just wash the bits that need washing and only shower or bathe every couple of days. Wear gloves when washing up, too.
• Avoid triggers. Try to work out if any particular things are making your eczema worse. Dust? Heat? A particular washing powder? Avoid them as much as possible.
• Don't scratch. As pleasurable as it is for those few seconds when you make the blessed itching go away, scratching only makes eczema worse. If you scratch, you could end up breaking the skin – and open skin is prone to infection, which is never good news. Instead of scratching, try just pressing, or gently squeezing the area and see if that helps. Or, if you can, get a cold flannel, and press that against your itchy bits.
• Keep your nails short. You could manage to not scratch all day, and then in your sleep, without realising it, manage to rip your skin to shreds! So keep your nails trimmed and clean. If night time scratching is becoming a big problem, buy some cotton gloves to put on at bed time.
Can my doctor help?
There are various things you can buy from pharmacies to help relieve eczema, but when you are pregnant, it is best to be medicated by your GP. Eczema can be miserable at the best of times, let alone when you have various other pregnancy symptoms to contend with as well, so don't hesitate to make an appointment.
Various topical steroid creams are considered safe to use when pregnant, and your doctor will explain to you how to use them. Steroid creams work by thinning the affected, thickened skin and should only be used for short period of time. Your GP will be able to assess the strength of steroid you need – ideally, you should use the lowest strength possible, but if that makes no difference, your doctor might prescribe something a little bit stronger.
Steroid creams should be used in conjunction with a regular moisturising routine – you might need to apply moisturiser three times a day, or even more. Your GP might also prescribe you with emollients and heavy duty moisturising ointments to use.
Although there are some oral medications available to treat severe eczema, it's unlikely your doctor would prescribe these to you when pregnant. It's imperative you don't bypass your GP and self-medicate – one eczema medication, called Alitretinoin, which is sold under the brand name Toctino, is known to potentially cause severe birth defects. Always consult a medical professional.
If your eczema becomes infected – if the area is inflamed and pussy – you must visit your GP. They might need to prescribe you some antibiotics which are safe to take during pregnancy, to prevent the infection from getting worse or entering your blood stream. Wherever possible, medication will be avoided when you are pregnant, but sometimes it is necessary, under strict supervision.
One other thing your doctor might prescribe, if your itching is very bad (and could therefore lead to infection) is an antihistamine, such as Piriton. This will help to calm down your itchiness, and hopefully allow you a better night's sleep. Again, while considered safe to use during pregnancy, it's always best to see your doctor for their expert advice.
If your eczema has flared up badly with your pregnancy, then there is every hope, once your baby is delivered, things will return to normal.
What else could it be?
If you have a strange red, itchy rash on your bump and perhaps also your thighs, you might have developed polymorphic eruption of pregnancy (PEP).
Visit the National Eczema Society website for further information and advice.