How This Outdoor Enthusiast Successfully Managed Backpacking with Eczema
Amanda Campbell shares how she successfully managed her eczema during one of the toughest backpacking hikes in the United States.
Published On: Mar 29, 2024
Last Updated On: Sep 18, 2024
This latest edition of Ask the Ecz-perts focuses on how people of every gender can handle eczema on sensitive areas such as the nipples and genitals. Our expert discusses how to handle itching, what lotions and medications you can use and precautions you can take to prevent flares in these areas.
Our expert is Dr. Peter Lio, a dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern University, and also the co-founder and co-director of the Chicago Integrative Eczema Center.
Dr. Peter Lio: Eczema involving the nipples is actually very common. It can affect any age group and can be worsened by rubbing or irritation from clothing. It’s important not to scratch, pull or pick [at the nipples] because the tissue there is more delicate in some ways and is liable to [break] open, which can lead to infection.
Importantly, we want to try to use the same principles that we would use to treat eczema on any other part of the body: [using] gentle skincare, good moisturizing [practices] and anti-itch/anti-inflammatory topical medications, when necessary.
Dr. Lio: The nipples are more sensitive than other parts of the body, but they are probably not as sensitive as something like the area around the eyes or lips. However, it’s not a bad idea to use the same guiding principles that we would for those most sensitive areas.
Typically, I prefer to use heavy ointments that are more protective. Lightweight lotions (that contain a lot of water) are easier to apply, but tend to protect less, and sometimes can cause stinging and burning.
We also want to avoid or minimize super-potent topical steroids. The tissue [on the nipples] is somewhat delicate and generally more mild preparations are fine. Topical nonsteroidal agents are ideal here, as well. Things like tacrolimus and crisaborole can be very helpful.
Dr. Lio: [That is] a very common and yet surprisingly difficult problem, to be sure! It can drive people crazy trying to get it better, and there are many factors that can make it worse such as, personal care products, detergent residue in clothing and the heat and humidity in the [private] areas.
It’s such a common problem that a wonderful paper published back in 1983 listed 10 rules designed to help with itch in the anal and genital areas.1 Some of the highlights from the paper include:
Dr. Lio: We have to be most careful as the skin of the genital area is extremely thin and unlike that on the rest of the body. It’s important to check with a licensed healthcare provider, and ideally one who understands the nuances of treating these areas, before using any prescription medications to those areas.
Like with the nipples, heavier ointments tend to be better tolerated and more protective rather than lightweight lotions or creams.
It is very important to avoid getting medications, or even non-prescription topical preparations, in the vagina, mouth or anus, as the tissue is very different inside.
Dr. Lio: Very gentle is the key! Harsh soaps can cause dryness or irritation of the sensitive skin on the private parts, so things that are designed for sensitive skin are best. I’m a proponent of oil-based cleansers and many companies now have them available. A great place to start is the National Eczema Association’s Seal of Acceptance™ Product Directory.
Dr. Lio: Yes, soft cotton underwear is best. For many patients, synthetics are irritating and sometimes they can retain more heat and moisture in the area.
For more information, listen to Dr. Peter Lio talk about ways to treat and manage eczema on nipples and genitals on our podcast, Eczema Out Loud.
Dr. Peter Lio is a clinical assistant professor of dermatology & pediatrics at Northwestern University Feinberg School of Medicine, and co-founder and co-director of Chicago Integrative Eczema Center.
References:
1. Alexander-Williams J. Causes and management of anal irritation. Br Med J (Clin Res Ed). 1983;287(6404):1528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1549920/pdf/bmjcred00581-0040.pdf. Accessed February 6, 2023.
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