Aman

Aman, aged 23, learned from experience that a disciplined daily moisturising routine helps manage eczema and its various triggers. He suggests going to a dermatologist, as GPs may not be as knowledgeable about all of the treatments available.

Aman was diagnosed with eczema at a very young age. As he got older, he learnt that a disciplined daily moisturising routine is key to managing eczema. Aman identified his triggers through experience as he was growing up, although he suggests that keeping a diary of your body’s reactions might be useful. Some of his triggers include stress, coffee, exercise, spicy food, alcohol, pollen, and dog hair. He finds the Indian classification of hot and cold foods helpful, since hot’ foods like tomatoes and mangos tend to make his skin worse.

With regards to treatment, Aman has tried a variety of options. When he was younger, his parents took him to Chinese herbal therapy and acupuncture, although Aman did not find these very effective. He has taken oral steroid tablets during big flare ups in the past, but his skin has been relatively stable for the past year with the consistent use of moisturisers and steroid creams. One trick that he uses is rotating moisturisers every few months to prevent the skin from getting used to the product and becoming less effective. Aman generally sticks to prescription products because these are cheaper through the NHS and contain less chemicals and fragrances which might aggravate his skin than shop-bought brands. Aman’s says that the GPs he has seen have often lacked knowledge about eczema. He recommends that people with eczema go to a dermatologist at least once a year because of their knowledge about the condition and the wide range of treatments available. He has seen both NHS and private dermatologists, with these appointments being helpful turning points. Aman suggests going to a private dermatologist if you are under time constraints (e.g. during a big flare up).

A big change for Aman in managing his eczema was moving from university to working life. During university, his eczema followed a peaks and troughs cycle whereby he would get flare ups in stressful periods, such as exam times. Maintaining a moisturising routine and a good diet became less of a priority in comparison to attending lectures, making friends, and having fun. Since starting fulltime work, Aman’s life became more regimented and consistent. This makes it much easier to maintain a daily moisturising routine and a healthy diet, and as a result, his eczema has stabilised. He sometimes wears a tighter layer under his work shirts to help lock in the moisturiser throughout the day. He also keeps a short beard because shaving his face irritates his skin. Aman recognises that having eczema can sometimes make people feel self-conscious and avoid certain social situations. However, he feels strongly that eczema shouldn’t limit you and he has learned to accept his eczema, becoming more confident as a result.

Skin conditions are a frequent topic of conversation for Aman and his family.

Age at interview 23

Gender Male

I mean a few members of my family have eczema. So m-my dad has it occasionally, my sister had it occasionally and my uncle has psoriasis, which is a kind of generally a lot worse. So immediate family like it always used to be a, a topic as you’re growing up, you know, how’s your skin, what’re you doing, because you don’t have to discipline to go through and do, do all the things that you need to do day to day by yourself. So you need a, a lot of support from your parents to just go through the kind of process of keeping yourself moisturised and up to date and that. As I’ve got older, it’s become less of a kind of concern, unless I’m experiencing a big flare up, people’ll be saying, well, you know , what’s up, basically. And that’s, you know, I’ll kind of know the reasons myself. But I, I haven’t massively talked to family about it, recently.

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Aman says the doctors he saw whilst at university were more aware of the distress related to eczema than previous doctors.

Age at interview 23

Gender Male

Have any of your doctors whether it’s GPs or dermatologist ever talked to you about sort of the emotional and psychological impact eczema could have?

As I was growing up, not too much. In university and stuff like that, yes, a lot more, because you’re at a bit more of a fragile time I think. Cos you, you move away from your parents and you don’t you have that, you don’t have that same support network that you would at home. So, they’ve only talked about the times where I’ve gone in at a flare up stage in the middle of exams thinking, oh god, you know, this is just the worst thing ever. And, yeah, having that kind of calming down moment where y’know, they say it’s not really the end of the world, even if you fail your exams, what was more important is, is your own health. And so that kind of puts it in perspective and I wouldn’t necessarily say that doctors speak or think about that as much as they could do.

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Aman finds he has more of a routine for looking after his eczema now he’s working.

Age at interview 23

Gender Male

because you’re working, you adopt a different ethic to your life, because you know I’ve to be somewhere for a certain time, put some effort in and it affects the rest of how you behave because you know well if I have to get up at seven then I need to be in the shower for this time and I need to do this beforehand. So your routine becomes a bit more regimented than it would be otherwise. So university you could get up at whatever time you wanted and you wouldn’t necessarily if you had five minutes to dash to a lecture be bothered as much about your skin. But I feel you probably are a lot more when you’re in your working life.

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Aman thinks you have to be careful about what you believe online but that it can be a good source of emotional support.

Age at interview 23

Gender Male

when you have your flare ups, y-you inevitably drop to a low enough level that, that you kind of think, well, you know, oh god, [laughs] how else can I re-, how get help or treatment if what I’m using at the moment isn’t really helping. So, yeah, there are a number of online forums. Most of them tend to have as many scary stories as, as good ones and there’ll be people promoting certain products and people absolutely hating them. So take everything with a pinch of salt like that and, and I certainly did. But in general it’s nice t-to even just vent and get your feelings out there if you, if you think, well, okay, you know, today is a really bad day. My skin’s feeling absolutely horrible. And that kind of takes it out a little bit, because you generally don’t have anyone to vent your frustrations to because it’s a problem that’s on you. And, yeah, that kind of psychologically becomes a bit difficult when, when you’re experiencing a flare up or your skin’s quite bad.

So you would post on some of the groups if you were having…

Yeah

a bit of a low day?

Not regularly, I would say, if that, that would be like you know, kind of I’m surfing the internet and I’m feeling like my skin’s horrible and generally you’re kind of searching for different treatments or things like that. And you kind of get linked to something. So I’ve not been a regular poster or of anything like that. But I haven’t really found any useful websites or communities where people are talking about it. There are a few I know out there. But as soon as your skin gets better, you inevitably just leave it, because you don’t think about it anymore. And it’s only at the times where you’re feeling bad about it that, that you go and check in and say, oh, well you know, this is what’s happening. And people generally are quite friendly and, and helpful.

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Aman says the doctors he saw whilst at university were more aware of the distress related to eczema than previous doctors.

Age at interview 23

Gender Male

Have any of your doctors whether it’s GPs or dermatologist ever talked to you about sort of the emotional and psychological impact eczema could have?

As I was growing up, not too much. In university and stuff like that, yes, a lot more, because you’re at a bit more of a fragile time I think. Cos you, you move away from your parents and you don’t you have that, you don’t have that same support network that you would at home. So, they’ve only talked about the times where I’ve gone in at a flare up stage in the middle of exams thinking, oh god, you know, this is just the worst thing ever. And, yeah, having that kind of calming down moment where y’know, they say it’s not really the end of the world, even if you fail your exams, what was more important is, is your own health. And so that kind of puts it in perspective and I wouldn’t necessarily say that doctors speak or think about that as much as they could do.

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Aman rotates using different emollients to keep them working well for his skin.

Age at interview 23

Gender Male

One of the things I’ve found throughout like kind of years of use is, moisturisers, if you if you switch to a new one, generally it’s quite effective for a number of months. And then that kind of tails off as either your body gets used to having that specific moisturiser and kind of taking it in too quickly and, and then, it ends up getting dry again. So, so switching around your moisturiser whether you use Diprobase or whether you use Aveeno or the whether you use a, so I’ve switched onto Cetraben, which is a, similar kind of moisturiser. But switching around, generally, does make a difference. And so, if you have a kind of rotation of moisturisers or, or treatments I get the feeling your body gets used to it. I don’t know what the medical explanations could be. So switching around kind of shakes things up a bit and, and generally improves things for quite a period of time. So, that’s just through my own experience. I don’t know how it would be with other people.

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Aman tried acupuncture and Chinese herbal medicine as a child, but didn’t find them helpful in the long-run.

Age at interview 23

Gender Male

That was mostly when I was a kid. Cos my parents we-weren’t too happy with, with whatever the results of the conventional therapies were. So there’s, I remember going to [city] to see some Chinese doctors and, and they prescribed me some like herbs and all sorts of teas and different things that they put on the skin. And, I think it would have a small effect, it wouldn’t really have anything more than that. I did try acupuncture for, for one or two sessions and again, never really carried it on, but I didn’t really see too much effect from it. So, I think the things that’s helped it most has been going to an actual dermatologist where they know a lot about skin and, and know a lot about different types of eczema and the products that are available, because your Chinese doctor doesn’t know that. Your alternative therapist doesn’t know that. Your normal doctor doesn’t know that and pretty much any of the dermatologists does. So, so that’s the one thing that I’d say has really helped it the most.

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Aman talks about ideas on qualities of different foods and the impact it could have on eczema.

Age at interview 23

Gender Male

I think you learn to associate different food types w-with how it affects your skin as well. So, tomatoes, if I’m eating a lot of those they’ll generally bring out a kind of rash or make my skin a little bit worse. So, yeah, there’s a, there’s this Indian concept of hot and cold foods, which I actually think it applies quite well. So things like mangoes and tomatoes and all of these kind of things are quite hot. Even though, I’m not sure whether I believe it too much [Laughs] it’s so different food types affect your body differently as well. And I think as long as you know how, how these foods affect your body then you can kind of keep it in check and keep it in control.

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Seeing a dermatologist was a turning point in terms of information and treatment for Aman.

Age at interview 23

Gender Male

And one thing I found especially was with the GPs they’re not always as knowledgeable as you think they are. So, growing up, you just kind of take it as a given that your GP knows everything about every condition. And then, kind of come 14, 15 you start realising well, they’re just prescribing me the same thing over and over again and seemingly expecting a different response. So, if I was going to give any advice that I’d say, go and talk to a dermatologist, because they’ll know exactly what your skin needs and the different types of eczema and will have different types of treatment for it. Whereas, a doctor might only recommend hydrocortisone or one specific treatment. And, so the times when I’ve been to a dermatologist they’ve really kind of [laughs] I’ve said, Well you know, the doctor told me to use this, and they’ve basically turned around and said, Well, you know, that’s not really going to affect it because you’ve got this type of eczema or It’s a bit too bad for that kind of cream. It’s not really gonna have an effect.

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Aman doesn’t remember the details of eczema causes because he feels these make no difference to the day-day experience of living with the condition.

Age at interview 23

Gender Male

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.

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Seeing a dermatologist was a turning point in terms of information and treatment for Aman.

Age at interview 23

Gender Male

And one thing I found especially was with the GPs they’re not always as knowledgeable as you think they are. So, growing up, you just kind of take it as a given that your GP knows everything about every condition. And then, kind of come 14, 15 you start realising well, they’re just prescribing me the same thing over and over again and seemingly expecting a different response. So, if I was going to give any advice that I’d say, go and talk to a dermatologist, because they’ll know exactly what your skin needs and the different types of eczema and will have different types of treatment for it. Whereas, a doctor might only recommend hydrocortisone or one specific treatment. And, so the times when I’ve been to a dermatologist they’ve really kind of [laughs] I’ve said, Well you know, the doctor told me to use this, and they’ve basically turned around and said, Well, you know, that’s not really going to affect it because you’ve got this type of eczema or It’s a bit too bad for that kind of cream. It’s not really gonna have an effect.

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