Managing symptoms, treatments and triggers at school/university

The young people we talked to tried not to let their eczema ‘get in the way’ of their school, sixth form, college and/or university – though having eczema can mean there are extra considerations or difficulties. These include:

  • symptoms, such as itching, or side effects from treatments making it hard to concentrate or take part in classes
  • finding opportunities to use treatments, such as emollients, whilst at school or in lectures
  • coping with triggers related to school, including stress about exams
  • taking time off for going to GP or dermatology appointments

All these, plus more, can have big emotional impacts too – there’s more about these in ‘emotions and support for eczema at school/university‘.

Himesh has needed time off school and sixth form to attend medical appointments but tries not to let it affect his education.

Age at interview 17

Gender Male

Age at diagnosis 10

View profile

I would probably say like when I had one of my infections and had to have like, go to like dermatologists appointments, allergy appointments, general appointments it kind of took a lot of time off school which was a bit annoying cos I could have done better if that makes sense, but due to that little bit that I missed I kind of have to catch up, you know, get back to the position where everyone else is, but yeh that’s it really. But yeh I wish I didn’t have all the infections and time off school but you can’t help it really but yeh. I did try my best in school to be honest, so yeh. But I never let like eczema stop me from doing most of my education. It did kind of stop me from doing my sports and that but I tried, I tried to not let it stop me from doing my education.

Embed Print Transcript

Eczema symptoms at school/university

Symptoms of eczema, such as itchy and sore skin, can draw unwanted attention from others and make it difficult to focus in class. Aadam worried that other children thought he had fleas when he scratched his skin. Shams felt self-conscious when he had blood on his white shirts. George finds it hard sitting still for a long time, especially in warm classrooms. Molly also found her skin became itchy when she walked in the cold and then sat in a hot lecture theatre. Itchiness makes Himesh fidget more. Laura’s teachers would check she wasn’t scratching. Shams found it painful to move and, as an ‘interactive learner’, this made it difficult to engage with other people.

Being kept awake because of itchiness or discomfort has a knock-on effect the next day too (see also section on sleep). Himesh, Evie, Shams and Katie-Lauren sometimes found it hard to wake up in the mornings and could be late for school, college or university. Katie-Lauren has slept through alarms before and says she’s slower getting ready after a bad night’s sleep. Himesh has ‘nodded off’ in classes because the antihistamines he used to take made him drowsy.

Shams’ eczema causes sleep problems which has knock-on effects in school and sixth form.

Age at interview 18

Gender Male

Age at diagnosis 7

View profile

I’ve had a lot of issue with sleep. I usually have a problem with sleeping during the day even toeven till this year I still have problems sleeping at night. I sleep during the day. I’ve had problems where I’ve fallen asleep in lessons, or I zone out during lessons for about half an hour so then suddenly the teacher would call my name, or someone would say my name and I’d just pop back and be like what the hell’s going on?

Attention levels would drop or just go up and down. At some point I paid a lot of attention and at another point I would just completely blank out, don’t know what to say. And there have been issues where I have fallen asleep in exams, not major ones but sort of mock exams and so forth, where I was so exhausted I could not sleep a wink. I would rush to finish the paper just so I could sleep for the last ten minutes or so forth.

And it is frustrating a lot of the time when things like schools or doctors can’t really sympathise with the idea that, you know sometimes it is difficult to get up in the morning with it. It may be worse than usual, stuff like that. I’ve had teachers comment and tell me that, you know you’ve got eczema, and they give me an example of so and so who has something else who still gets up a morning, and will tryand give me a relative comparison to say, “Look, why don’t you just man up and do it,” and some days you can’t do that; some days it is just difficult.

Embed Print Transcript

Writing can be painful if eczema is on the hands or arm joints. Ele remembers her knuckles splitting open once when she picked up a pen. George didn’t tell his teachers that eczema between his fingers was making writing painful. Evie and Lizzie both found typing on their laptops was easier for taking notes, but wrote by hand in exams.

Eczema treatments and school/university

Putting on treatments, such as emollients and steroid creams, can be time-consuming. It can be inconvenient in the mornings, especially when in a rush to get to school or lectures. Shams tries to get up early to give him time for putting on his creams.

Side effects and the appearance of treatments can make people feel self-conscious. This can include the look as well as smell of emollients and sunburn from phototherapy. Aadam felt embarrassed when Protopic (tacrolimus) left a bruise-like rash on his face. Anissa’s wet wraps at school drew attention from others who would ask questions and sometimes make unkind comments.

It was tricky to find a suitable time and place to put on emollients in school, whereas sixth form/college and university usually had shorter days or more breaks between lessons. Evie remembers having to ask teachers permission to go put on her creams during classes. Himesh’s school had a special medical/welfare room where he could leave his emollients and top-up throughout the day. This meant he had to be quick though, even during break times, and he worried about missing out on learning. George never takes emollients to school (or on school trips) as he doesn’t want his peers to know he has eczema. Alice and Evie were happy to put on creams during university lectures, but others weren’t. Anissa and Katie-Lauren found it difficult putting on creams in public/shared toilets, especially for areas of eczema under clothes.

Anissa wasn’t allowed to put her creams on, or check they were rubbed in, at school. Things are different now she’s at university.

Age at interview 20

Gender Female

View profile

Especially with the creams being so thick as well, you can’t just be like mm [gestures rubbing], it’ll dissolve in’ or, you need to rub it in properly otherwise you’re gonna have massive white patches everywhere.

Yeah. Is that the same across like primary school, secondary school, sixth form or college?

Yeah. Yeah, if, you got, if you got a mirror out or anything or you tried to do anything no you were definitely, well I was definitely, and I know like a few friends who were definitely belike, Put that away.

You’re meant to be in class.

Has that changed since you got to uni?

Because uni’s like, for me especially, is very split up. So I’ll have, the longest class I’ll have is three hours. And within the uni situation, I can leave the room without asking permission or anything like that. You can just leave and come back and no one bats an eyelid. No one thinks about it, because at school, at college, you have to ask permission to leave the room and I think that makes a massive difference because you can just, well you can’t be extra late. But you could be late. But while you’re in that class, if you’re on a, like, you can go back and forth. You could leave early if you wanted to.

Yeah.

There’s nothing telling you that you have to ask permission for anything.

Embed Print Transcript

Using emollients before or during classes and at work can mean slippery hands, making it difficult to hold a pen or pencil. Aadam had grips for pencils which helped but he found it embarrassing asking other people to sharpen pencils for him. Katie-Lauren and Ele also found that the paper would become greasy and left moisturiser streaks on the page which ink couldn’t write over.

Triggers and school/university

Stress related to studies (especially homework, assignment deadlines and exams) is a major trigger for many people’s eczema. Georgia took some time out from her studies when it became too much to cope with eczema on top of her A-levels and a part-time job. She noticed her eczema became more irritated when she was applying for university too. Aman pointed out that summertime exams mean stress and high pollen counts, both of which trigger his eczema. Cat found university more stressful than her current job, as she said she used to be constantly thinking about her studies. She says she had less of a structured routine then so would often stay up late and her skin would get itchy.

One of Himesh’s teachers has talked about techniques for coping with stress.

Age at interview 17

Gender Male

Age at diagnosis 10

View profile

Yeh, yeh stress definitely sorry. it would definitely flare my skin up cos I’m at that point where I’m panicking I guess and I can’t control myself so I don’t know what to do so then my skin will get bad and that will lead to me itching even more and then you’re getting even more frustrated and putting more stress on me basically so it’s not a good time to be honest when I’m stressed. But I do, I’m trying to control it better now but I could still do with improvement if that makes sense so yeh.

So is that some of the techniques that your drama teacher taught you?

Yeh definitely like I think one of them was to like breath in and out until ten, slowly like cross your fingers and just like tense your whole body so you feel calm afterwards once you’ve tensed it for a couple of seconds and stuff like that so yeh. I do try to do that more often now if I get stressed but I haven’t been stressed lately so yeh.

Embed Print Transcript

Studies, work and living away from family are all sources of stress that have affected Ele’s eczema.

Age at interview 22

Gender Female

Age at diagnosis 2

View profile

Oh that’s the other thing it’s massively affected by stress so A-level’s actually because that’s when it got really bad because I was so stressed with academic work then my eczema got really, really bad and it’s, I’ve kind of not managed to get it back to the level it was at pre A-level because since then obviously I went straight to Uni and then I didn’t come home after University I went straight into the working environment so I’ve sort of got bills to pay, I’ve got rent, l’ve got all this living by myself and 300 miles away from my family. So it’s the stress kind of, stress levels haven’t really dropped so I think because it became so much more painful in those when I went into A-level’s I think that’s when it kind of took over from the cosmetic thing.

Embed Print Transcript

Physical Education (PE) was talked about by a lot of people. There were lots of reasons why sport was avoided or limited by young people with eczema. Himesh and Laura both have pollen as triggers for their eczema, so have to limit contact with grass. Swimming was often avoided because chlorine and being in water for a long time can trigger eczema. Heating up and sweating can irritate, sting and dry out the skin, and there may not be showers provided or enough time after class to re-apply emollients. Evie couldn’t take part in PE when she had an allergy patch test. Some people didn’t want to take part in sport because they felt self-conscious. Wearing a PE kit or a swimming costume meant that usually covered parts of the body were seen by others. Abid wore a vest and shorts for swimming and felt very self-conscious in the changing rooms. A few people had requested not to take part in PE or had been advised by their doctors to not avoid it. Naomi’s teacher was understanding the few times she asked to be excused because of eczema. Anissa’s PE teachers didn’t believe that eczema was a good enough reason not to take part.

School uniforms could trigger and worsen eczema symptoms. Himesh didn’t like putting on his school uniform after applying emollients because he would feel uncomfortable all day. Alice had to wear tights at school and this made her skin itchy. School jumpers can also be itchy and Naomi was allowed to wear long-sleeved cotton tops underneath hers. Aadam preferred wearing his school jumper, rather than have the eczema on his arms visible with just a polo shirt. He felt ‘ashamed’ to show his skin and, in the summer months, often crossed his arms so others couldn’t see. Schools had different policies on things like wearing make-up and facial hair, which some people talked about in relation to their eczema.

The PE/sports kit at Shams’ previous secondary school led to some difficult situations.

Age at interview 18

Gender Male

Age at diagnosis 7

View profile

Their requirement was a white t-shirt and black cargo shorts or pants, and straight away I had a conflicting issue with them because I wore a white full-length top. They only said white polo t-shirts, and I would usually get into arguments with them saying “Well, no I have to wear this, and this and that,” and usually they would [door slamming] have to push me to a certain limit where I was take themhave to physically take them to a corner and say, “Look Sir, or Miss, I have eczema; I don’t want to show it in front of these people.” Sometimes some of them, well most of them would be sympathetic with me like, “OK, I understand that’s fine.” But I’ve had on occasions certain teachers who have completely ignored that fact and said, “Well it’s just eczema [door shuts], you have to get on with it,” and they haven’t sort of considered the sort of social impact that causes when people make some comments about eczema, they don’t really understand what it feels like; how some of those comments are really sort of hurtful a bit, you know, a bit teasy at you.

Embed Print Transcript

Sarah talks about the impact of school uniform on her eczema.

Age at interview 23

Gender Female

View profile

When I was at high school, I went to a girls’ school where you had to wear a skirt and you had to wear tights with the skirt, or socks. But like obviously in winter it’s a bit cold with socks. And the tights made my eczema really bad. So I still don’t really wear tights now. But I had to get like the GP to write me a specific letter to the school to say that like I had to wear trousers instead of the skirts and tights to like let my skin breathe instead of wearing the nylon. So I was like the only girl in the whole school who had trousers on [laughs] and it’s cos I had eczema.

Embed Print Transcript

Aadam remembers being one of the first boys in his year at school to get facial hair. He balances keeping his stubble the right length so it doesn’t irritate his eczema.

Age at interview 18

Gender Male

Age at diagnosis 1

View profile

I think facial hair is one of those things that it depends how you sort of portray it or if you keep it neat, I guess. I think that’s something I did do. So, I was reluctant to shave mine all my, all my facial hair off, purely because when I had done it, it gets, especially back then, it does it does get very itchy. I mean, I shaved my neck and I shave sort of around here where I tried to shape it up. But, the itchiest places are just like above my chin and those areas. So, I don’t really shave those because I know that if I do it each day, it’ll it will be really hard to stop and it also gets bumpy and red and I don’t really want to show people that. But yeah it was a learning curve as well [laughs].

My high school. So they would, they actually ran a facial hair check around our year. And, eventually I said, okay, not that I was growing it for religious reasons, I said, I am just growing it for religious reasons. And, because I’d never actually grown it out before. Little did I know that that would also cause my face to become very hot and that would irritate my eczema too. I still had to keep it like a sweet spot between short and long which is like the most less irritating length. But my school wouldn’t understand that. So, I said, okay, I am growing it for religious reasons. They went, okay then. But then like the moustache is just irritating on your lip. And religiously as well, in my religion, which is Islam it’s not really supposed to go like below your lip, because then it gets into your mouth and then food gets stuck to it and sort of logical reasons like that. So then I trimmed my moustache and she said, oh, what about this part and I said, that’s my moustache. That’s not my beard [laughs]. And then they sort of threatened to call home and stuff. And eventually I just sort of found the sweet spot, which was stubble and I said, yeah, I shaved yesterday [laughs]. It’s grown back to stubble. Yeah, and then they never really said much about it.

Embed Print Transcript

Other triggers associated with living away at university include: drinking alcohol; socialising (including nightlife); stress (from studies and assignments but also other stresses from living away from the family home) allergens (such as dust and mould) in university accommodation; shared accommodation, with impacts on cleanliness and products (washing-up liquid, laundry detergent); changed diet; and different water hardness qualities. Another factor mentioned by some which added to the difficulties of looking after eczema was a lack of routine (such as with putting on emollients).

Maham thinks work-related stress is easier to compartmentalise than study-related stress.

Age at interview 21

Gender Female

View profile

I do like to think the most stressful stuff in my life is in the past, when it comes to, because the other thing about studying is you internalise the stress and you take it home with you. Then you’re always thinking about, Oh, I should be studying, and the guilt never goes away.

Whereas I think with a professional sort of workspace it might be as stressful while you’re at the office but it’s not a stress that you internalise in the same way so you don’t feel guilty about not working because academic guilt is directly correlated with your, is directly related to your success they say, so if I don’t study I’m not gonna be successful. Whereas with work it’s if I don’t do this I’ll do it the next day, so it’s not that bad. And you kind of leave your stress at the office and you come back and then you go back the next day and you kind of pick up where you left off. It’s not like you go home from the office and then you’re also stressing about how you failed as human being and all of that stuff [laughs]

Embed Print Transcript

Time-off from school/university

Getting medical help can mean missing out on school, sixth form/college or university. This includes repeat visits to GPs and dermatologists, going for treatments and waiting for infections to clear. Himesh wishes his doctors had given him the right diagnosis and medicine for an infection when he had to stay in hospital, as he could have been back at school sooner. Jessica’s appointments were split between her home and university cities, meaning she had to travel and plan between the two.

Aadam’s dad would pick him up from school when his eczema was sore.

Age at interview 18

Gender Male

Age at diagnosis 1

View profile

When I was in primary school, I think at least once a week I would have to go home, because of my eczema. Sitting in class, especially when you are bored you begin to scratch and I think that’s something I sort of notice now. Like you subconsciously begin to scratch and then I still do it to my face now [laughs] I have to be careful about that. But when I am not careful then I realise what I’ve done and that it’s really stinging and itchy. So my dad would always get a hard time having to pick me up. So he would have to come like out of work, usually. Because his job back then was quite flexible and it was quite fortunate to have him around, but if not him then one of my aunties would pick me up or something. And I did miss a lot of school.

Embed Print Transcript

Aadam was frustrated about having a hospital appointment with long delays the day before a mock exam.

Age at interview 18

Gender Male

Age at diagnosis 1

View profile

Something happened recently and I was not happy about it. I think this was last year. Yeah, it must have been last year. I had to go through the doctors, no no, [hospital name] eye hospital for an appointment. And, the date of it was the day before one of my exams. I was furious about it [laughs]. I said, I can’t go. They need to change it. I’ve got I’ve got an exam the next day. And my mum did try to talk to them and they just did not understand. I mean, these were my A Levels so of course, I am going to not be happy about it. I ended up having to go to the hospital and it was the day before my chemistry exam, I remember now. And, I was in there waiting for five hours. So, my appointment was at like two o’clock, no, like one o’clock and I got seen at like five thirty-ish. I can’t remember something like that. I had a huge wait and I was incredibly annoyed. So in terms of like having to go to an appointment that it doesn’t even take place on time, makes me feel a whole lot worse. The fact that they said, if I did not go to this appointment, I would be taken off the list orbe sort of unsubscribed, I guess. So I had to go to it.

That must have been so stressful.

It was a horrible time. I was not happy that day. I was in a bad mood the whole day.

Embed Print Transcript

Appointments were sometimes scheduled so that the young person didn’t miss out on school/university. This was especially important for phototherapy treatments because sessions are usually frequent (2-3 times a week). Himesh decided not to try phototherapy treatment because he didn’t want to miss any lessons. Vicky could easily walk to her phototherapy sessions and they were scheduled for after school. Cat fitted her appointments around her university lectures and it wasn’t much of a detour from her usual route home. Shams’ phototherapy sessions were scheduled for after school but it still meant he had to rush home and quickly have some dinner before travelling to the hospital.