Eczema And Physical Activity

Introduction

Regular exercise is really important for us to maintain our health - both physical and mental. However, it is often easier said than done. There can be many hurdles to exercising, and in order to overcome these hurdles, we must first acknowledge and address them. 

What is eczema?

Eczema is an inflammatory process that occurs in the skin.1 While skin is made up of many layers of cells, there are two main layers - the dermis and the epidermis. The epidermis is the layer we can see, and the dermis is the layer directly underneath it. When someone has eczema there is a disruption in the epidermal layer of the skin. There can be many causes for this disruption, including:

  • Systemic allergic response
  • Infection (can be bacterial, viral or fungal)
  • Contact with allergens2

Eczema usually occurs on flexural surfaces of the body. This means it is usually found on the inside of joints, such as the elbows, or behind the knee. It is sometimes present on the hands and face, and can be present all over the body in certain cases. 

Symptoms

  • Intense itching over affected areas. This can lead to troubled sleep. 
  • Changes to the colour of the skin in the affected areas. This usually starts with redness. However, if someone has long-standing eczema, this can cause darkening of the skin (hyperpigmentation) or lightening of the skin (hypopigmentation).
  • Flare-ups - periods of time when the eczema worsens and then resolves. 

What happens to the skin during exercise?

When we exercise, there are various processes that occur throughout our body to help it cope with the increased physical demand. These processes affect pretty much every part of the body, including the skin. So what exactly happens?

It becomes red and flushed

Exercising leads to an increased demand for oxygen and glucose in the cells, as well as the need to remove waste products. This is done through blood circulation, which is why our heart rate increases when we exercise. 

In order to keep up with increased demand, the body starts to metabolise more, which as a result generates more heat. In order to cool down the body and avoid overheating, the vessels close to the skin relax to create a greater surface area from which the heat can escape. It also leads to more blood flow to the skin than usual, which causes the skin to appear red. 

Sweat gathers on the skin’s surface

Sweating helps to keep the body cool, as the heat generated is used to evaporate sweat from the body. It is also helpful in the removal of toxins.. Sweat is composed of various elements, including water, urea, lactate, and minerals such as sodium and potassium. 

There are two main types of sweat glands - eccrine and apocrine. Eccrine glands are found all over your body and produce most of the sweat that is generated. Apocrine glands are bigger and located in areas that are typically associated with being sweaty, like the armpits, groin, and breast. Apocrine glands release more concentrated secretions, and are usually located closer to hair follicles. 

Sweat dehydrates and irritates the skin

While sweat is a great mechanism for keeping us cool, it can be problematic if there is a disruption to the skin layers. For people with eczema, sweating can sometimes cause issues. Due to the composition of sweat, it can cause irritation to the skin, especially if the epidermal layer has been disrupted. Skin is a barrier for our body, and when there is a disruption in the layers of the skin, it can lead to exposure of the internal layers that are usually protected. Also, for someone who has a damaged epidermal layer, sweating can cause irritation. 

The exact mechanism of this is not fully understood, however there are some theories relating to this:

  • Excess sweat - people who have eczema can develop thicker skin due to chronic itching. This can lead to an increase in sweat glands in that area, causing more sweat to be produced.
  • Exacerbation by minerals - salt that remains on the skin after the water evaporates can lead to the activation of nerves that cause an itchy feeling. 

Tips for working out with eczema

All of that seems very doom and gloom, but don’t worry! There are ways to overcome these difficulties if you have eczema. The first is to consider the type of exercise you are doing, and how to minimise the impact it will have on your skin.

Wear loose clothing over the areas where you experience eczema

Loose clothing gives the skin more space to breathe. As a result, there is less irritation to the epidermal layers, leading to less itching. Loose clothing also allows sweat to evaporate better, ensuring that it isn’t sitting on the skin for prolonged periods of time. 

Moisturise often, especially before exercise

Eczema is usually treated with emollients. This helps to keep the skin healthy and prevents damage. During exercise, the skin goes through a lot, so it is important to help it however you can.

Pause the workout to take care of your eczema

The body has ways of signalling when it needs attention. The same applies for your skin. If you feel a particular area flaring up during your exercise regime, you should pause and give it some attention. Some helpful ways to manage a flare-up during exercise include:

  • Moisturising the affected area.
  • Taking regular breaks.
  • Using an ice pack or a cooling towel to cool the area.

Other considerations

  • Consider the form of exercise you are doing - try out a few different types of workouts, for example going to the gym, swimming, or running and see what suits your skin best. 
  • Shower as quickly as possible after exercising (and moisturise!)
    • However, try to avoid very hot showers, as this can cause further exacerbation of eczema. Ideally, shower at a warm temperature and gradually cool it down throughout the shower.
  • Eat well.
  • Keep yourself well-hydrated.

Conclusion

Despite the fact that sweat can cause irritation, there are plenty of benefits to exercising! Exercising can help to minimise stress, both psychologically - as it can help boost self-esteem and confidence - and physiologically. This can help to reduce the number of flare-ups you experience.3 

References

  1. ‘Eczema’. The Free Dictionary. The Free Dictionary, https://medical-dictionary.thefreedictionary.com/eczema. Accessed 7 Nov. 2022.
  2. Eczema Pathophysiology | World Allergy Organization. https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/eczema-pathophysiology. Accessed 7 Nov. 2022.
  3. Lambert, Alice. ‘Stress and Eczema’. National Eczema Society, 8 Sept. 2021, https://eczema.org/information-and-advice/triggers-for-eczema/stress-and-eczema/.

Bazegha Qamar

Bachelor of Medicine, Bachelor of Surgery - MBBS, Medicine, University of Leicester

I am a medically trained doctor, currently working part time in hospital in various medical specialities. I have been working for 3 years, with a year of experience in teaching whilst also working in a busy psychiatric hospital. I have a keen interest in medical education, for both colleagues and also the general public.

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