Ask the experts Your dermatology questions answered

Happy families Learn how to tackle your kids’ eczema

Personal account ‘Sticking together is my family’s cure’

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feel better today Act now: Learn how to cope with your eczema from the people who know best

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tips

eczemaNo. 1 / January 2010

easy living the changes you can make today

Adult eczema tackle the stigma and learn to love yourself

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Learning to manage your eczema is key

Eczema can be a devastating condition but knowing how best to care for the skin will make a huge difference to the quality of life of most sufferers.

If you have eczema in your family you don’t need me to tell you that it can be difficult to manage and a challenge to live with. It isn’t an easy condition but with

proper management, eczema can for most people be controlled albeit not cured.

Even simple steps can make a sig-nificant difference:

Try emollient therapy

1 Emollients help to keep the skin hydrated and can be ster-

oid sparing. They also have a mild anti-inflammatory effect – so if the skin is becoming red and itchy it’s helpful to apply the emollients im-mediately.

The need for complete emollient therapy such as emollient washes, soap substitutes as well as creams

and / or ointments is often over-looked.

Topical Steroids

2 Most eczema will at some time require a topical steroid, but

they will only work if used correctly – and the same goes for our other treatments

Day to day practicalities

3 It is of course important to lead normal lives and not let

the eczema take control some mod-ifications are useful though – being careful about what you wear and put on or near your skin for exam-ple.

Above all the more we under-stand about eczema the easier it is to manage. And only if we know how to use our treatments are they likely to work. Taking a pill is quite easy, putting on assorted creams and ointments and adjusting your lifestyle is infinitely more complex.

This supplement containing in-formation about the latest in ecze-ma research, advice from leading clinicians in the field of dermatol-ogy and plenty of useful practical tips should assist us all in better getting to grips with managing our eczema.

“getting the child to participate in treatment can really move things forward.”

Childhood eczemathe small changes around the home that could help your kids cope

pAge 12

EczEma, 1st Edition, january 2010

Country Manager: Willem de Geer Sales Manager: simon KenneallySub-editor: danielle stagg

responsible for this issueProject Manager: rosie Barbour Phone: 02076654408E-mail: rosie.barbour@mediaplanet.com

Distributed with: the Guardian, january 2010 Print: trafford Park Printers

Mediaplanet contact information: Phone: 02076654400Fax: 02076654419 E-mail: info.uk@mediaplanet.com

We make our readers succeed!

WE rEcommEnd

ChaLLenges

Margaret CoxChief executive, national eczema society

mediaplanet wish to thank the national Eczema society for their participation in this reportthe national Eczema society is registered as a charity with the charity commission for England and Wales under no 1009671

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Question: How can the number of people suffering with eczema be lessened? Answer: Halting the rise in eczema is as much a question of education as it is treating the complex range of symptoms.

One of the UK’s leading experts in eczema says the condition is “completely treata-ble” if patients get specialist treatment.

Professor Michael Cork, a consultant dermatologist at Sheffield’s Children’s Hospital, said: “This is a devastating con-dition when it’s severe and can cause re-al suffering. But the message is it’s com-pletely treatable.

“One of the biggest problems is getting referred to an expert,” he added. “NICE guidance is that, if eczema is not under control, patients should be referred to an expert who can control it. It could be a dermatology nurse, a GP with a special interest, or a dermatologist. But it often doesn’t happen.”

Many GPs are not trained in treating eczema’s complex range of symptoms and can misdiagnose, or provide wrong treatment.

“An expert will work out the cause, then repair the defective area with emol-lient therapy, but it’s not straightforward. The common acqueous cream can make it much worse, but a non-specialist could prescribe it,” he said.

And specialist care could become even scarcer as financial pressures increase on the NHS, Professor Cork said.

It’s an important issue. Cases of atopic eczema – the most common form - have increased from 4% in the 1940s to more than 25% today. The gene pool is the same, but the environment has changed a lot. Products such as bubble baths, harsh soaps, and baby wipes, all have a damag-ing effect.

Emollients alleviate symptoms and help restore the skin barrier. But an equal-ly important issue is education.

“It’s vital to take time to listen, teach and demonstrate how to use treatments. The delivery of education programmes to

children with atopic eczema, by specialist dermatology nurses, produces a major im-provement,” Professor Cork said.

Applying treatments is complex. “It’s hard. Imagine prescribing two emollient creams, a topical steroid and calcineurin inhibitor for the face, a steroid and cal-cineurin inhibitor for the body, then a spe-cial non-dairy diet. That’s just a brief list. A specialist wouldn’t even have started to treat eczema,” he said.

The next step is to identify risky ir-ritants and allergens. “Allergens from house-dust mites may interact with the skin barrier. Dietary allergens are also im-portant in some kids,” he said.

Cosmetics should be used with care. Non-perfumed ones have a better formu-lation and have been tested for some aller-gens. Users should check labels.

Change your environment, get healthier skin

david smith

info.uk@mediaplanet.com

change

“this is a devastating condition but the message is it’s completely treatable”Professor Michael Cork Sheffield’s Children’s Hospital

A CleAn StArtBy changing your home habits you can improve your skin.Photo: oleg mitiukhin

inspiration

take care bathing

1 Keep the temperature of baths and showers down so

the water is tepid. Put moisturis-er on immediately after baths when the skin is damp and it soaks in better.

Use appropriate linen

2 Make sure that bedding and bed linen are made from

lightweight cotton, which is soft and soothing, and helps to keep the skin cool.

Watch temperature

3 Keep the bedroom cool at night. Keep the window

open to allow a breeze in if it’s summer. On really hot nights a fan might be helpful. In winter, avoid overheating the house.

Sleep solo

4 Pets are great companions, but because of potential al-

lergies, they should be left out of the bedrooms at night.

Shop wisely

5 Choose fragrance-free emol-lients intended for sensitive

skin.

dr sArAh WAkelin, consultAnt derMAtologist,

st MAry’s hospitAl, london

Top Tips for geTTing a good nighT’s sleep

4MODIFY YOUr

HABItSMODIFY YOUr

HABItS

1tIP

CLINIQUEMedical researchers apply every new Clinique formula to 600 people on 12 occasions. If just one of the 7,200 applications incites an allergic reaction, the product is reformulated. So, no matter how sensitive or irritated your skin, you can trust Clinique to deliver skincare and makeup products custom �t to your skin type, whilst also ensuring that you have the latest beauty looks.

And here are the ones we recommend you check out!

Comfort On Call Allergy Tested Relief Cream will bring immediate relief to dry, dehydrated, sensitive skin with its luxurious, ultra-moisturising formula. The easily absorbed cream helps the skin to build up its protection against potential irritants and environmental assaults whilst also helping to reduce skins visible reactivity and instances of cracked, �aky or rough skin.

Supermoisture Makeup, more than just a foundation, this long lasting formula also provides intense hydration and gives skin a radiant glow. It combines super-intense humectants with a lightweight, crème-gel and has the same soft, mousse-like consistency as soft-scoop ice cream; a treat for the skin, without the calories!

knows sensitive skin is prone to allergies, so tests all products rigorously before declaring them “allergy tested”New Vitamin C Lip Smoothie Antioxidant Lip Colour is like an antioxidant fruit smoothie for the lips. Itsvitamin-packed formula improves the condition of lips that have become vulnerable to lines and wrinkles whilst the ten shades help bring colour and shine to any complexion.

Clinique’s Redness Solutions Instant Relief Mineral Powder blends instantly into the skin to give an even tone. This is a loose powder with skin care bene�ts; it camou�ages immediately, and works overtime, to neutralise redness and make broken capillaries virtually disappear. This anti-irritant complex, creamy-textured, mineral powder feels comfortable on skin and is perfect for touch-ups during the day.

Clinique pioneered the connection between dermatology and cosmetics back in 1969, helped by dermatologist Norman Orentreich. Together they created allergy-tested, fragrance-free beauty products, which quickly became classics, and 40 years on, are still leading the way in the world of skincare, makeup and Allergy Testing.

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Some symptoms of eczema are so clear-cut parents can confidently diagnose children’s illness without a GP’s help. But other symptoms of-ten confuse even doctors into mak-ing incorrect diagnoses.

The common symptoms belong to atopic eczema, which is geneti-cally associated with a predisposi-tion towards asthma and hay fever.

“Atopic eczema is easy to spot because it’s typically found on the flexures of the elbows and knees. It’s by far the most common rash in children and accounts for roughly 75% of their eczema,” said Dr Susan Mayou, a consultant dermatologist at London’s Cadogan clinic. “It can be distinguished from dry skin be-cause of the rash and the cardinal symptom of extreme itching.”

Discoid eczema is much harder to diagnose. Whereas atopic produces

generally dry skin with patches of eczema, discoid sufferers have nor-mal skin between inflamed discs.

“Discoid eczema is often con-fused with impetigo by GPs. When it is wrongly diagnosed, it can cause delays in treatment,” said Dr Mayou. “Some GPs are good at diagnosing it, but others don’t have the specialist knowledge of dermatologists.”

Parents who suspect their child has eczema should address the pri-mary problem of dry skin.

“It’s especially important to mois-turise the skin in London where water is hard and dries out the skin even more. Parents should put oil in the bath, and use soap substitutes,” Dr Mayou said.

Many parents worry too much bathing has an adverse affect. But Dr Mayou said regular bathing was beneficial if oil and soap substitutes were used.

“It washes off creams and wash-es off bacteria, which is more prev-

alent on the skin of atopic eczema sufferers. It’s important. Scratching produces breaks in the skin so bac-teria have a portal of entry. Eczema sufferers also have less efficient im-mune systems.”

If parents have done all the above and still have a problem, they should see a GP.

Cradle cap, or seborrhoeic der-matitis is found in babies. It begins on the scalp as a red, scaly rash. The scales mount up to form a thick, yel-low layer and may spread across the body. But it typically clears up in months and doesn’t itch. Oddly, it can reemerge in adulthood – known as dandruff.

Allergic contact eczema is found mostly in adults when a patient is al-lergic to something they are in con-tact with, such as nickel, chrome, shoe dyes, or perfume. Normally it’s at the point of contact.

“But it can take some sleuthing. A girl might be allergic to nail varnish, but paint her nails carefully and it doesn’t affect her hands. She then touches her face and develops a nail varnish allergy on her eyelids.”

Question: ■■ When should I seek professional help for my child’s eczema?

Answer:■■ Many parents can correctly diagnose most symptoms but specialist knowledge can be invaluable in some cases

david smith

info.uk@mediaplanet.com

hoW We Made It

Learn how to read their body language

A shoulder to cry onthere are many options for parents with children who suffer with eczema.Photo: jelani MeMory

dr susan MayouConsultant dermatologist, the Cadogan clinic, london

inspiration

how can people spot the signs?

1 Eczema describes changes in the skin including red-

ness, blistering, oozing, crust-ing, scaling, thickening and sometimes pigmentation.

In people with atopic ecze-ma, the skin’s barrier does not work well. The main symptom is itch. Scratching may cause many changes to skin.

What should they do?

2 It is usually easy for health visitors, practice nurses or

GPs, to diagnose eczema. But the pattern in older children and adults may be different, and a specialist needed.

Is it just dry skin?

3 Skin will be red and dry. Scratch marks and bleeding

are common. During a ‘flare-up’ - you may develop small water blisters on hands and feet; af-fected areas may be moist and weepy.

In scratched areas, the skin may thicken, and become even itchier. Atopic eczema can affect any part of the skin, but is most common around bends of the el-bows, knees, wrists and neck.

What can you do?

4 Moisturise up to six times a day. Emollients also pre-

vent potential allergens such as house dust mite and pollen trig-gering eczema. Wash with soap substitute and wear gloves to protect hands. Shower well after swimming.

Wear cotton, and avoid wool. Avoid scratching. It may relieve your itch briefly, but it makes skin itchier in the long run.

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dr Mark GoodfieldConsultant dermatologist and president of the bAd

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8 · january 2010 an advertising insert by Mediaplanet january 2010 · 9an advertising insert by Mediaplanet

Eczema patients know they have ■■to use emollients to moisturize their skin every day, but too many don’t know how to use this critical tool effectively.

Susan Maguire, a professional officer with the British Dermato-logical Nursing Group, said: “A lot of people don’t know how to ap-ply emollients. It’s not easy. Often, they don’t get enough guidance about how much to use and how of-ten. ‘Apply sparingly’, what does it mean? Half a tube? A tea spoon?”

Keep on top of treatmentThe problem is not just a lack of in-formation. It also boils down to pa-tient forgetfulness.

“You can tell patients everything, then as soon as they walk out of

the door, they forget it. Back-up in-formation on how to use the emol-lients is essential to jog memories,” she said.

Emollients and mild topical ster-oids will sort out most eczema. GPs and non-specialist nurses can cope with these cases. However, chron-ic eczema requires specialist treat-ment, which is often unavailable in sparsely populated areas.

Try to experiment“Treating severe eczema is an art not a science. There’s trial and error part, which is where specialists play a key role in choosing an emollient from the huge range, or deciding when to use more potent steroids, tablets or other treatments,” she said.

Wet wraps are another crucial

tool. “A child with sore, itchy skin could be up all night scratching, with knock-on effects for the whole family. Put gloves on a child of six and the first thing they do is to take them off. Wrapping them in band-ages at night can stop them doing a lot of damage by scratching.”

Children are double-wrapped. First, wet bandages containing emollients are wrapped around the skin. A second set is added to block in moisture and provide two layers of protection from groping fingers.

For badly flared skin, wraps can be used nightly.

Maguire has also used the tech-nique on adults at weekends when they are not at work. A further treat-ment for adults is phototherapy.

“UVB narrowband light can dampen down the skin’s immune response, and it also has cleansing properties. I’ve had a lot of success with light.”, said Maguire.

It’s also important ton treat a pa-tient’ mind and Maguire regrets cuts to psychological services. “Psy-chologists did fantastic work help-ing patients come to terms with a lifelong battle to alleviate symp-toms,” she said.

david smith

info.uk@mediaplanet.com

Question: What can be done for Eczema sufferers? Answer: Mild cases of eczema can be dealt with effectively by GPs, but more serious cases require specialist treatment

TreaTmenT is an arT noT a science

Susan Maguirebritish dermatalogical nursing group

news

Know your opTionS

Know your opTionS

3Tip

find whAT’S beST for youby trying out different treatment options you’re more likely to find something that soothes your eczema. Photos: istockPhoto

tips to MiniMise flare-ups

4

1 Common triggers are extreme temperatures and humidity.

In winter when humidity is low, ex-tra moisturiser replaces lost oils.

2 In summer, counteract over-heating by wearing loose cloth-

ing keep skin cool. Avoid wool.

3 Use a soap-free wash and pro-tect hands with cotton gloves

for daily chores.

4 A recent study said stress was the major cause of flare-ups. Be

aware of what triggers stress and find ways to cope, including talking to friends, taking a walk, or listening to music.

5 Cosmetics and toiletries par-ticularly those containing fra-

grance can aggravate eczema. Check labels and patch test anything new on skin with no eczema for 24 hours before using .

6 Some people are allergic to house dust mites. Use hard

flooring instead of carpets, blinds in-stead of curtains and a leather sofa.

dr Sarah wakelin consultant dermatologist, st Mary’s Hospital, london

10 · January 2010 an advertising insert by Mediaplanet

The Government tells the public to wash hands more often to stop the spread of swine flu, but too much hand washing can cause hand ec-zema.

This is a dilemma for many peo-ple with a genetic predisposition to hand eczema. In such people, the proteins which cement the cells on the skin’s surface don’t do their job well. Excessive hand-washing breaks down the skin’s barriers resulting in dermatitis and infec-tions.

The root problem“We are washing hands a lot more, so we are getting more hand ecze-ma,” said consultant dermatologist Dr John English. “The common-est cause of hand eczema is soap, which breaks down the skin’s nat-ural barriers. This could be in the home environment, or it could be in the UK’s hospitals, where they are obsessed with bacteria,”

Dr English said alcohol gels were preferable, but British hospitals have not realised the dangers of harsh soaps.

“Our hospitals use 10 times more soap than on the continent. They buy 10 litres of alcohol gel per litre of soap; in the NHS, the ratio is a li-tre for 0.8 of gel.”

It’s not just soap. Merely dipping

hands in and out of water breaks down the skin’s protection, which is why emollients are an essential part of treatment.

Hand eczema is most common in women of child-bearing age. They are forced to do wet work – cooking, washing up, washing kids, changing nappies – which de-stroys the skin’s barrier.

The solutionWearing gloves to prevent eczema is a good idea, unless you are unfor-tunate enough to have a rubber al-lergy. It’s also a good idea to buy a dishwasher to avoid contact with detergents. Non-bio washing pow-er and a high-powered HEPA vac-uum cleaner to eliminate house-mites are other precautions worth taking.

Water softeners may also be a deterrent. A Department of Health-backed study is looking in-to why eczema appears to be more common in hard-water areas. Margaret Cox, chief executive of the National Eczema Society, said soft water needed less soap to cre-ate lather.

The home is not the only dan-ger. Hairdressers, mechanics and others are exposed to chemicals which cause eczema. If it is serious, potent topical steroids can be used on hands because the skin is thick-er than elsewhere. Phototherapy with UVA light is also effective.

See the complications of everyday life

david smith

info.uk@mediaplanet.com

Avoid harsh cleaners and deter-■■

gents. Look for alternatives with-out bleach and other chemicals.

Avoid items with alcohol and ■■

perfume. Use cotton gloves for chores.■■

Keep the house cool and main-■■

tain humidity below 40 % to pre-vent dustmites.

Buy a HEPA vacuum cleaner to ■■

get rid of allergy particles. Vacuum regularly.

Hot-wash pillows and duvets ■■

every 6-8 weeks at 55–60°C.

TIPS FOR DAY-TO-DAY LIVING WITH ECZEMA

newS

Take exTra care

See the complicationsTake exTake exT Tra

care

4Tip

“the commonest cause of hand eczema is soap.”

John englishConsultant dermatologist

Question: ■■ What ordinary tasks will exacerbate eczema?

answer:■■ Soap and water are a deadly combination for people with hand eczema

12 · January 2010 an advertising insert by Mediaplanet

Learn to manage children’s eczema

no longer a choreSpecialist products can help you and your family live with eczemaPhoto: Artem efimov

One in five children is predisposed to develop eczema. Although 50 per cent have grown out of it by the age of two and 90 per cent by the age of 15, while it is present, it can make parents despair.

But most children’s eczema is preventable, according to Professor Michael Cork, a consultant dermatol-ogist from the University of Sheffield. He says around a sixfold increase in sales of soap, bath and shower prod-ucts, and baby wipes is to blame for a huge rise in cases, from 3 per cent in the 1950s to 20 per cent today.

“This is a genetic disease, so you have to ask why it has increased to such an extent. The most likely ex-planation is something changing in the environment, which is increas-ing use of soaps and detergents,” he said. “Baby wipes containing alcohol were particularly bad. Unless par-ents can find emollient-based baby wipes, my advice is don’t use them.”

Specialist treatment is essen-tial for serious cases. But there is also a lot parents can do at home to ease symptoms, according to Dr Sarah Wakelin, a consultant der-matologist at St Mary’s Hospital, in London.

She said: “One way to minimise

scratching is to get them to pat or pinch the skin. The scratching is particularly bad when clothes are changed and cool air hits the skin, and at nighttime. So apply soothing moisturizer at these times.

“Getting the child to participate in treatment can really move things forward. The severity of scratching is lessened by keeping fingernails short, and filing sharp edges. Put on cotton mitts at night so they can’t use nails to scratch.”

Harsh fabrics like wool should be avoided. “Choose soft breathable clothing from natural fibres, such as cotton, which allow perspiration to escape and keep skin cool. Keep the room temperature cool. Keep a win-dow open in summer and turn the heating down in winter,” she said.

Bath temperatures should be tep-id and prolonged exposure to water avoided. Soap substitutes and oils replace soaps, shower gels and bub-ble baths. After the bath, emollients need to be applied when the skin is still damp as they soak in better.

david smith

info.uk@mediaplanet.com

Atopic eczema affects 20% of ■■

kids.Atopic eczema s an allergic dis-■■

ease which runs in families along with hay fever and asthma.

60-70% of atopic cases clear by ■■

teens.Causes sleep problems and af-■■

fects studying.Sensitivity can lead to low self-■■

esteem.Stress can make it worse.■■

CHILDHOOD ECZEMA

Dr Sarah WakelinConsultant dermatologist at st Mary’s Hospital, in london.

news

little StepS, big changeS

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little StepS, big changeS

5tip

Question:■■ How can i help my child with their eczema?

answer:■■ there are many things parents can do at home to relieve symptoms

researchers are developing treatments which could lead them to treating ing babies for eczema before symptoms appear

At Sheffield Children’s Hospi-■■tal, researchers are developing new treatments for atopic ecze-ma called skin protease inhibi-tors (SPI).

SPIs inhibit the high levels of proteases [enzymes which break down proteins] present in the skin of children predisposed to atopic eczema.

“The SPI would be combined with emollient wash/bath/show-er products to improve the repair of the skin barrier and reduce,” said Professor Michael Cork.

Many babies predisposed to atopic eczema have changes in the protease gene. Restoration of the skin barrier in the first six months of life, with SPIs and emollient wash products, could reduce penetration of irritants and allergens.

Professor Cork said: “Any new intervention such as SPIs should be combined with existing treat-ments, and education, to produce the greatest improvement.”

A completely new approach, Professor Cork said, could be treating babies who were predis-posed to atopic eczema before it appeared.

“This requires a diagnostic test, which should be available in the next five years. The future of treatment for atopic eczema, asthma and related diseases will be in identifying those at risk, then preventing their develop-ment or reduce their severity,” Professor Cork said.

professor Michael corkdermatologist at sheffield’s Children’s Hospital

NEwS IN BrIEf

prevention is better than cure

14 · January 2010 an advertising insert by Mediaplanet

Suzanne Johns dread-ed passing on her chronic eczema to her children and took ex-treme measures to re-duce the risk.

When she fell pregnant in her mid-twenties, Suzanne - now 39, and running a PR firm in Bradford - followed the advice of a dermatol-ogist who told her to reduce her ex-posure to allergens.

“The whole of my pregnancy I didn’t see anyone with dogs, or cats; a special ventilation system reduced dust mites, damps and molds; I took up carpets,” she said. “My behaviour was extreme, but I always said I would be devastated if I passed it on. One child, Ben, has eczema, the other, Mellissa, doesn’t. There’s a big genetic component.”

Suzanne’s nightmarish experi-ence makes it easy to see why she feared passing it on.

“It began when I was 14 on the flexions of the elbows and spread to every inch of my body. It was phys-ically and emotionally devastating.

It was like I was covered in burns. The skin was raw, but tormented me with the itch, so I couldn’t func-tion as a human being,” Suzanne said. With “thousands of insects” crawling under her skin, it was im-possible not to scratch. The relief was immense, but the damage was untold.

“I locked myself in the toilet so nobody could stop my scratch-ing frenzy. My skin would fall off. Then I would be a shaking, dither-ing mess because I’d think ‘oh, God what have I done’. There was guilt because I felt it was self-inflicted,” she said.

She tried odd home remedies. Be-lieving sulphur helped, she scraped a chimney and mixed soot with milk. She drank it hoping for a mir-acle and promptly vomited.

From her teens to late twenties, the symptoms were chronic. Aged 20, she spent a fortnight wrapped head to foot in bandages at Bradford Royal Infirmary. Aged 24, she need-ed a steroid injection to get through her wedding day.

Fighting the battle together

Suzanne Johns long battle with chronic eczema gave her the knowledge she needed to care for her son Ben when he developed similar symptoms.

Thankfully, the eczema is now mainly confined to her hands. But her experience helps her under-stand six-year-old Ben’s eczema.

“I know you are wasting your breath telling them not to scratch. Not all parents moisturize enough. I know from painful experience that the skin needs to be moist to keep it supple. Ben’s skin will never dry out when I am on duty,” Suzanne said.

Ben’s eczema started when he was three months old. Photos show him wrapped head-to-toe in band-ages, and reveal a bright red, raw-skinned face at his christening. But Suzanne’s care has been exemplary, involving emollients, bath oils, cut-ting his nails short, pressing a cold facecloth on itchy skin, and apply-ing the right steroid creams.

“It has become part of Ben’s iden-tity. He talks about it openly. He says,‘I can’t use soap mummy be-cause I have eczema’. He doesn’t see it as a problem, but as a way of life. He even puts his cream on. To-gether, we are like a little exclusive club.”

PerSonal inSight

Susan Johns eczema sufferer and mother of two says sticking together is the best way to cope

1 Common triggers are ex-treme temperatures and hu-

midity. In winter when humidity is low, extra moisturiser replaces lost oils.

2 In summer, counteract over-heating by wearing loose

clothing to keep skin cool. Avoid wool.

3 Use a soap-free wash and pro-tect hands with cotton gloves

for daily chores.

4 A recent study said stress was the major cause of flare-ups.

Be aware of what triggers stress and find ways to cope, including talking to friends, taking a walk, or listening to music.Dr Sarah Wakelin conSultant Dermatologist

tips to minimise flare-ups