And you said that meeting the nurse at the health care centre at university for you now, that was the first time someone had ever explained what causes eczema and what it is?

Yeah. It took 19 years, but someone finally explained. I think doctors just want to give you a cream and move onto the next person. But she, she drew up a diagram and everything and told me and it’s the first time I understood. Because no one else had ever explained it to me before.

So your parents had never sort of talked you through when you were younger or, at all?

I think they tried to, but I don’t think they really knew why I had it, because none, no one else in my family has it. So it, I guess, it’s just kind of odd that I had it and they tried, they did try, like my dad would come home with like leaflets and stuff about eczema, but they were really hard to read and stuff. Whereas she like talked me through it and drew me a diagram.

The main thing that I always remember is that I was always told it wasn’t contagious cos I know that kids at school and like my brother and stuff, there was one time I remember that we went to cross the road and mum told him to hold my hand and he wouldn’t do it because he thought he’d catch it and then she sat him down and was like, No, you can’t catch it, it is just, it’s generally hereditary and environment and stuff like that. So that’s one, that’s the main thing that I remember is that being told about it anyway is that it was, it wasn’t contagious but that there was no guarantee that it might, that it would go away and that you’ll always pretty much have it in some sense or another.

Okay. So this is a cross section magnified, of normal skin. And you can see all these cells here are all squished together nice and tight. This is a hair coming out, so you can see how small these cells are. If you think about like a brick wall, that’s a normal, that’s what normal skin looks like, the bricks are all nice and tight together. Now if you have a condition like eczema, so you’ve got inflammation, the cells become a little bit more gappy, the barrier function’s not so good, for various reasons. So that means you can lose water. And that’s what makes your skin dry, because you’re losing water from your skin. And you can also have things like infections, and allergens – not very clear – can access the skin more easily. And that means that they come through and they’re more exposed to immune cells. And that’s how you can develop over-reactions or allergies to certain things. So we know that, you know, the first thing that really needs to be done is to help keep the barrier function good. And that’s with kind of regular emollients. And reduce the inflammation, because that can also kind of lead into a vicious cycle of all these cells getting inflamed and spreading apart. And it means there’s more immune cells around, if there’s lots of inflammation. So that’s done with topical corticosteroids. So that’s why we use emollients, to help with the barrier function. And the corticosteroids to help with the inflammation in eczema.

Do you recall when you were younger what you knew about eczema, the sort of causes of it and what it actually was?

I think that my Mum probably told me about a bit about it. But I never really understood the science behind it I don’t think until, one of my, this local doctor here, when I was late teens, explained like why it was cracked skin an d like what was happening with the different layers of your skin [gestures with hand to layers]. And how, if you do one thing how it will affect it. For example, using the actual soaps that you buy, you know normal soaps. And how, if you try and moisturise and protect it and things like that, how it will improve and sort of, and that was good because it puts into like, you’re like, “Oh OK that kind of explains it,” rather than it being a sort of off, this subject that you’re not really sure about.

Well I read about recently and so, like I might be wrong, but I think I’ve read about this recently that there’s a certain type of bacteria on your hands, like you know there’s so many bacteria and things on your hands, and germs, and there’s something like one in ten thousand people have this certain bacteria, whereas every atopic asthma, sorry eczema sufferer has. So, everyone who has eczema has a certain type of bacteria a lot more, it’s a lot more common. And then things like itching moves it around so it spreads it. Although, when I read that I then thought, ‘Well so does moisturising,’ [laughs] so it’s like, what can you do? So yeh I read that recently and I think but then you can’t really, you have to use your hands so.

Have any of your GPs or dermatologists ever sort of talked to you about causes of eczema and sort of the underlying medical explanation of it?

Probably on a number of occasions, -I’ve, I think I’ve forgotten everything. Simply because it, I don’t really care anymore. It’s just a-a habit and you know what you have to do to kind of keep it in check.

And, knowing the cause of it doesn’t really make a big difference in my opinion in terms of whether, whether your daily treatment is going well or not. I think probably ruminating on that or thinking about it too much is probably not as good for you, kind of psychologically. You just kind of take every day as it comes, even as clichéd as that is. And you just, you just kind of get on with your life, really.