Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Today we're gonna dig into the real-life experiences of people living with eczema, and then take a step-by-step approach to managing the condition. According to the National Eczema Association, about 31 million people in the U.S., or 10% of the population, have some form of eczema.
We will discuss how people experience eczema throughout their lives — from newborn babies to teens to older adults. We'll also discuss various types of eczema and explore why certain types are more prevalent in specific age groups, while others are more common in individuals with allergies or asthma.
We'll also talk about treatment options, the surprising role of stress, sleep, and other lifestyle factors, and how to discuss this condition with your healthcare provider.
First, let me introduce my guest, Dr Candrice Heath. Dr Heath is a highly respected dermatologist, board certified in pediatrics, dermatology, and pediatric dermatology.
She's dedicated to taking the education she gives patients every day and delivering it to hardworking, busy individuals on the go. Her knowledge as a dermatologist, skin-of-color expert, clinical researcher, beauty expert, educator, speaker, industry consultant, and culturally sensitive communication advocate — she’s busy, yet immersed in all of the things she's passionate about.
Welcome to the WebMD Health Discovered Podcast.

Candrice R. Heath, MD, FAAP, FAAD: Thank you so much for having me.

Pathak: Before we jump into our conversation, I'd love to ask about your own personal health discovery around all of these passion areas. How did they come together for you, specifically around treating eczema?

Heath: That's a great place to start, and I always think about, you know, where my love of medicine came in initially — and that is in the care of my sister. So my sister was born with a green birthmark that covers one side of her face.
We had two doctors right at that time — a pediatrician and also my hometown dermatologist. And so it was in that office that I really had a model of being able to deliver patient care, even at that time when there was no cure for what she had. I really leaned into that and have always kept that close to my heart and in my back pocket.
And so that is how I then kind of approach what I do. I love taking care of patients with atopic dermatitis and learning more about it because it is a condition that can span all of the age groups that I enjoy — which is everyone. I love caring for a lot of people, and I think that comes from my primary care background.
So I love having the expertise in pediatrics, but then I also love taking care of the whole family as well. So it's one of the conditions through which I can kind of flex all of my muscles — my compassionate care, my understanding of a disease state that changes, you know, as you get older and may present differently.
So it just allows me to be able to take care of all those things and put all those things into play — you know, that you read about in my bio.

Pathak: I'd love to just take a step back for our listeners. Can you help us understand a little bit more about what eczema is? How do you define it? We've called it atopic dermatitis. So help us understand what we mean by that specific condition so that people who may be confused — “Is this eczema? Is this dry skin?” — what is it? Can you help us understand what it is?

Heath: When we say eczema, typically what we mean is, you know, itchy skin. Often, sometimes we even call it “the itch that rashes.” So there may be an itchy rash on the skin.
There's inflammation involved, and you end up with some sort of skin change that often is chronic but can be intermittent or even a one-time thing. So eczema — we really view it as an umbrella. If we think about someone walking down the street with an umbrella, sometimes there's just one person under that umbrella, but sometimes there are lots of people squeezed under that umbrella because that's the only one that they have — and that's kind of how I think about eczema.
Under the umbrella of eczema are people and families that have atopic dermatitis, which means that they have that itchy skin too — that inflammation, that reactive skin. But they also have an increased risk of seasonal allergies, atopic dermatitis or eczema, and asthma.
So that is called the atopic triad. If you have itchy skin or have eczema, dry or sensitive skin — these are all kind of general terms — but then you also have those things that run in your family, you might just have atopic dermatitis, a specific type of eczema.
But also, we can have people who have other forms of eczema that fit under the umbrella. So I know there are people out there that say, “Hey, you know, don't forget about me — what about my contact dermatitis?” Every time I come into contact with something that contains a specific ingredient, or I use a specific product, I kind of get this rash on my skin in the places where that thing is affecting me.
Or, “I'm washing my hands so much during the pandemic, I started to develop really dry, irritated, itchy, itchy skin.” So for those patients, they may fall into that contact dermatitis — where we have a specific trigger that can cause that to happen.
And so those are kind of two of the entities under that umbrella. And of course, you know, it gets even more complicated than that, so I don't want to overwhelm people. But let's just think of it as having two umbrellas.

Pathak: So you mentioned something coming into contact with your skin. Are there other triggers that people should be aware of so they can think about what might be causing their flare-ups of eczema?

Heath: So you know, depending on the category that you fit into, some people do have specific triggers for their eczema — whether it's coming into contact with something specific.
Or in the case of patients who have atopic dermatitis, they may even have seasons of the year where, because their seasonal allergies are out of control and there are all these other changes going on environmentally, they tend to have more flares.
The most common thing is when people experience a change in the season. The majority of patients are worse during the winter because we know that eczema affects the barrier of the skin. And if the barrier of the skin is broken and not as protective as it should be during the winter, you're really losing lots of fluids and things from the skin.
And so it's hard to keep up with that demand. But I will say — there are some special patients out there with eczema that are worse during the summer. And I’m seeing you in my practice now. Just having that sensation of sweat on your skin is causing an irritation.
So, like an irritant dermatitis — right? Irritation that’s then flaring your eczema because of all the sweat. So it's like this cycle.
Now, I don’t want my patients to have atopic derm, but I love trying to figure out why this thing happened. What was the trigger? You were doing well and everything was great — and often, sometimes I peel back the layers and the only trigger I can find is a major one. And that one is stress.
People are shocked. They're like, “You know, these medicines are no longer working,” and we’re going through the whole thing — and then, a major stressor has happened.
And that, in itself, can be the thing. If we are able to get them support around that, their inflammatory skin disease is much better once they are able to deal with that. So everything is connected.

Pathak: How would you advise someone with eczema—now they've come to you, they've been diagnosed—to think about what that skincare regimen looks like, ideally without being swayed by all of the newest products on social media?

Heath: So the way that I explain it and I talk about skincare is I do, you know, explain that the barrier of the skin is not functioning optimally. And we kind of have these breaks in the skin that we need to protect, 'cause our skin should help by retaining moisture. There are some natural oils and things that should remain on the skin to keep the skin as hydrated as possible and to attract more water to it.

But if we are using things that are really harsh, that strip the skin—so now we have a tendency for having breaks in the skin—and then if we are using things to cleanse the skin that are really gonna strip the skin and it makes your skin feel squeaky clean... Squeaky clean is not good, because that feeling means that you have really kind of removed all of the natural moisturizing factors that should remain on your skin.

And then, after we talk about selecting some gentle cleansing options, following that up with moisturizing the skin with whatever you're comfortable moisturizing with. But we want to pick things that are less likely to trigger your eczema. So for some people—for a lot of people—things with a lot of different ingredients and fragrance and things like that can often be triggers for their eczema. So we do want to try to avoid some of those things.

But I think the magic is in moisturizing when the skin is still wet. What I mean by that is, you know, leaving a little moisture on the skin. I often will tell my patients they can use a towel to kind of absorb some of that extra water. But then while the skin is still moist, getting that moisturizer on.

People say, "Well, Dr Heath, what is the best moisturizer? What is the best thing?" I say, you know what? Something that you can use consistently. So let's talk about what you like to use. And sometimes it could be a texture thing for some people, sometimes it can be a smell thing.

I really try to allow patients to have some skin in the game. I don't want people to think—walk away and say—"Oh, dang, I made all the wrong decisions for my skin." I at least try to find something they're doing to say, "Hey, you know what? You can keep this. Maybe you can just use it on special occasions, but for the rest of the days, let's keep it less Instagram-friendly and more ‘my skin needs this’ friendly."

Pathak: I'm just thinking about my teenager. She's had eczema lifelong—very different, to your point, how it presented when she was a child. Now I'm noticing she's going through a phase where she has acne, so she's using skincare products that dry her skin out—so things like benzoyl peroxide—and now her skin is just flaking like crazy.

So how do you talk to your patients when they have this sort of complex picture, or where the treatment for one condition might exacerbate the eczema?

Heath: So it's really a time to reach out to your doctor, call your dermatologist, get some help putting that plan together. 'Cause the tricky part is a lot of those products are available over the counter for acne, but you really need to look for products that are designed for people who have sensitive skin—not just what everybody else is using.

And it can still contain benzoyl peroxide, but the base that it's in could be better formulated for people who have sensitive skin. So that's a great way to consider starting your journey.

Any kind of acne leave-on treatments, you know, could be something that you talk to your doc about as an option to be able to tolerate those. But there are definitely options out there. And you're right—it does deserve a call, a visit. And sometimes those things that I suggest will change seasonally based on what's happening outside. Because if it's warm outside, you're gonna produce more oils and you can get in trouble, 'cause you're gonna be like, "Oh, I'm tolerating this. Everything's going well. I'm gonna have the best summer ever." And then the fall comes, and then all of a sudden that same plan falls apart. Why? Not because of you—because, you know, the environment has changed.

Pathak: So when someone comes to you and you are starting to think about treatments for eczema, can you help walk us through how you make these decisions? Where are you starting and where are you going?

Heath: Yeah, I think the first step is to really, really ask and query about the impact on the patient. One of the things that I've learned over the years is that I can have, you know, two patients side by side. They have the same amount of their body covered with eczema or atopic dermatitis or any other condition for that matter, and it can bother one person more than the other.

And the medication plan will be based on how much activity they're having—both volume-wise on the skin and also how often they're itchy throughout the day. So it's just, you know, there are multiple factors that go into it. But really lean in when people are asking questions in that healthcare setting.

I want you to have something that's going to work. And I definitely want to think about lowering barriers, especially when it comes to being able to access the medications as well. So I like to give people—let them know—if there are some anticipated barriers to even getting certain medications, and have a plan for walking through that process.

Pathak: So can you help us understand what classes of medications are in your toolbox—from steroids, non-steroidal options, newer treatment options like biologics? What should we know about each of these different categories?

Heath: I think the most important thing to know is that we have way more categories than we had in the past. So for the adult listeners who may have had eczema for a long period of time, or, you know, an adult who's had it for a long period of time, it is a great time to check in with a dermatologist because we do have new options.

So some of those buckets include our topical emollients. So again, moisturizing routine—I put that at the same level as a medication, as part of the plan. So that is critical. So we have things on the market that are formulated with ingredients that can help with eczema specifically.

And then also we have, you know, topical steroids. Yes, sometimes they get a bad rap, but they can reduce inflammation and really help with symptoms.

And then we have non-steroid containing medications that work through a few different pathways, so they do not contain steroids. And we've had some that have been out for a long time. And then we have some that are newer kids on the block.

And then we have injectable medications that can work on the immunologic level—kind of a fancy level—to really target some of those things that are specifically causing you to have flares. So very, very specific, fine-tuned based on what we call the pathophysiology or the science behind the condition that you have.

So there are lots of options there.

Pathak: What would you say when it comes to lifestyle factors beyond medications? So I'm thinking about—as someone who is lifestyle medicine trained and very interested in thinking about nutrition, physical activity, sleep, stress management—you mentioned earlier, can you help walk us through some of those interventions? What has the best evidence for benefit?

Heath: Oh, absolutely. I would say definitely lowering stress is a huge thing that can really make the difference when you have an inflammatory skin condition like eczema. Also, great data to support sleep — the adverse effects of not getting enough sleep when you have these conditions.

And we kind of gave some examples about that already, so hugely important. We know that exercise is critically important for our overall health in general. So it is my goal to make sure that people can feel comfortable in their own skin so that they can wear garments to exercise and feel comfortable exercising.

So you see how one thing connects to another, right? And then also we want to be aware of our environment in the parts of our lives that we can control. So, avoiding heavy carpets, if you can, you know, heavy curtains that can be filled with dust and things like that.

Do the best that you can with what you have, but also, you know, those environmental controls can be helpful too. And people often ask about food. And so with food, we know that people have used food for centuries to heal, to, you know, alter things — the way that things work in the body, etc.

So I really believe in using all the tools. If you know that when you eat this certain thing or you have a high glycemic index diet — when you eat things that really cause inflammation inside the body — for some people, they can itch more. If they completely change their diet, will they no longer have eczema?

Well, no. But if it's for that specific person, they may say, "Hey, when I'm eating this kind of way, my eczema is like 10%, 20% better," for that person. So it's really individualized, but there is also some science to that as well.

If we think about the atopic triad that we started with at the top of the call, we talked about a child developing eczema first, and then as they kind of get older, they may start to have issues with asthma. And then they develop seasonal allergies, and then they may start having issues with food allergy.

Is there an opportunity to be able to prevent that from happening? We call that the atopic march. So I am really interested, as the science rolls out, in what are the things that we can do to try to prevent — is there a way that we can kind of prevent that from happening so that we end it really early, and then we don't have people who are in their teens and adult years with these persistent atopic things, picking up more conditions along the way.

Pathak: I'd love to dig in more when you were talking earlier about some of the mental health impacts that can come from having a condition that is very visible to other people — visible to yourself — potentially making you uncomfortable throughout the night. How do you talk to your patients around some of the mental health impacts?

And I'll say this because I think sometimes people minimize the conditions that they have. So they're like, "Well, it's just eczema, it's not..." you know, insert whatever other condition you think is more serious. So how do you really talk to your patients about honoring the fact that this is difficult, and that they're allowed to have these types of feelings — and then addressing those feelings with your patients?

Heath: One of the things that I like to do is — and you really hit it on the head when you said that sometimes people minimize — I start the conversation by saying, "You know, I know that this is tough. I know that this is tough." So I acknowledge what they're going through, or that I may perceive that they're going through.

And sometimes that lowers the barrier for them to be able to say, "Yes, I'm really struggling," or, "I'm having a hard time," and that kind of thing. And I weave it in like it is a part of the treatment plan. So we talked about moisturizers, we talked about the different treatment options.

But then also, because this is a tough thing to deal with, don't forget to really think about things that you can do to help with your stress. This is a great time to connect with a therapist. Sometimes it can take a while to get in, so it's a great time to go ahead and start that process and just talk about it like it is one of those other pillars as well.

Pathak: And what are your recommendations for people that are well controlled because they've worked with their healthcare provider, they're doing well — what would you say they should anticipate to recognize that, "Oh my goodness, a flare might be coming up," or, "You know what, I've been scratching like crazy all of a sudden and now I might have some sort of infection here"?

How do you help people understand when you're potentially shifting into an exacerbation?

Heath: So, signs that there is a flare coming up. If you're having to reach for your rescue medication an increasing number of times — if you're having to reach for that rescue medication more than once a week, and it’s increasing — then that means a flare could be on the way. So basically, that's one tip.

Also, if people are experiencing any type of skin discomfort or pain that's really not their normal, then that's something to lean into as well.

Another one that I will mention in the office: If people are waking up with blood all over their sheets — which is kind of hard to imagine — but basically what that means is when they're sleeping, they're really not sleeping fully or deeply, right? They're scratching and digging in their sleep. So there's no one there to stop them, or there's no social cues or anything like that.

So if the skin is itchy, they are scratching in their sleep. To me, that means they are not well controlled. That is a flare coming. Because a lot of times, patients who have really itchy skin disorders like eczema — I can ask them, "How often are you itchy?" and they're like, "Oh, I'm fine," but they can actually be literally scratching while they're telling me that they are fine.

So we need to relate it to something that they can see: "How many times am I reaching in the drawer for the rescue medication? How many times am I waking up with blood on my sheets?" To connect it. Because some people — and this is the saddest part of eczema that makes my heart drop — is when people say that they're okay and they're fine and all of that, but they are literally digging and they don't realize it. It's become part of their baseline.

Pathak: What is the biggest area of optimism for you — where you are really looking forward to a new way that we approach eczema, a new treatment? What are you really excited about?

Heath: I am really excited about the systemic options for atopic dermatitis that have what I call good safety profiles — meaning that I'm not having to talk to families about really scary things. That I'm able to talk about the potential side effects, and it not be heart-clenching potential side effects for their child.

So I am really excited about data that comes out — and actually, some data even for the topicals that don't have steroids in them have been really impressive as well, as far as trying to get the conditions under control.

So I really want that space to push forward so that people can have options that they're comfortable with, and with side effect profiles that can help them sleep well at night.

Pathak: What do you think should be their biggest action item the next time they go in to talk to their healthcare provider about their eczema? What information should they come in prepared to share?

Heath: I would say really be prepared to ask your clinician that's in front of you if there are any other treatment options that can help your skin to be more clear, or can help you to be less itchy.

And we do have data, we can use some science that we can lean in on. And based on what you really bring up for that clinician, there could be pathways to really enhance the treatment of that specific part of your condition that's bugging you.

People often have silent concerns that they never bring up. In asking people via survey, they say, "Hey, I'm concerned about dark spots on my skin," or, "It's really impacting me." And sometimes people don't even bring it up, but it can be a huge impact for some populations — particularly patients and populations who have more pigmentation in their skin.

So there are so many layers. That’s why I say: Fill in the blank. Is there something else to make this — X — whatever the part of your condition is that you dislike the most... is it the itching? Is it the impact on sleep? Is it the dark marks? Whatever it is.

And just to say also: "I'm open to going to a dermatologist as well to really help us with this condition." And if you are afraid to talk to your primary care doctor about it because you're like, "Ooh, I don't want to offend them because they've been helping me all this time" — no, that's okay.

Really think about the way I phrase that: "To help us with this condition." Right? That’s compassionate care. That language.

Because I think patients don't really understand that we take their conditions with us home too — and we're probably not supposed to do that — but that's what really drives my research, drives my passion. They don't even know that. They have no idea.

They're probably thinking, "Oh my goodness, Dr Heath is running an hour behind again." I know — because I'm talking to somebody. They really needed me that day. So that's where I am, and I hope that those tips have been helpful for people.

Pathak: Supremely helpful. And I just want to thank you so much for this conversation.

Heath: Absolutely.

Pathak: Thank you so much for being with us today. My key takeaways from this discussion are: it's so important to understand your condition, know what it means, and how it impacts your life. Don’t minimize your symptoms. If it bothers you, it’s something you should bring up with your healthcare professional.

Eczema is an umbrella term, and it's key to understand what your subtype is, because there may be different triggers and different solutions. It’s also super important to track your triggers so that you can understand what escalates your condition, and you can take control — and that’s empowering and useful for managing your symptoms.

Keep a diary of when flares occur to help you and your healthcare professional find realistic solutions that are specific to you. We have more tools now than ever before to treat eczema, so it's really important to consult with your healthcare professional to determine which treatments offer you the most relief and address all of your symptoms.

To find out more information about Dr Candrice Heath, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.