If you’re living with rheumatoid arthritis (RA), you may also have a skin condition called eczema, or atopic dermatitis. Researchers have found that people with eczema may be at a higher risk of developing RA.
“Is eczema related to having RA?” one myRAteam member wrote. “I know mine gets so bad it bleeds and itches like crazy.” Another member said, “I have both RA and eczema, and so does my son.”
People develop eczema when their immune system becomes overactive, setting off inflammatory processes that attack the skin. Symptoms vary among types of eczema, but most people with eczema experience severe dryness and intense itching and pain.
RA is also an inflammatory autoimmune condition in which the body’s immune system attacks the joints, resulting in pain, swelling, and deformity.
|What you should know about eczema and itching attacks in RA|
Read on to learn more about how the two conditions are connected, as well as strategies to keep eczema flares in check.
Eczema drives inflammatory reactions in the body, with the immune system attacking the skin repeatedly. These reactions use certain cells of the immune system called T cells. Health care experts suspect this long-term dysfunction causes T cells to release proteins (called cytokines), which can lead to both eczema and rheumatoid arthritis. This is how the two autoimmune diseases relate to one another.
One study found that when a person has eczema, their risk of getting RA is 72 percent higher than for people without eczema. This higher incidence (risk) exists regardless of age, sex, socioeconomic status, or availability of health care.
According to the study, people who apply topical steroid treatments directly onto their eczema skin lesions have a higher risk of developing RA. People who instead received oral steroids didn’t have the same increased risk.
Although people with eczema face a higher risk of developing RA, it’s still not common. One study found that only 2.9 percent of people have both RA and eczema.
Researchers have not found any genetic mutations linked to the higher risk between eczema and RA, however. Therefore, it appears that genetics do not link the two autoimmune diseases to one another.
People with eczema can take certain precautions to decrease the number of flare-ups that they experience. This will help to improve quality of life. There are several strategies for decreasing eczema episodes.
Applying moisturizer at least twice per day to affected areas can help prevent flare-ups. Select a type of lotion, cream, or ointment that will help lock in the moisture of the skin barrier.
Stress, dust, sweat, detergents, soaps, and pollen can all trigger an immune response, leading to an atopic dermatitis outbreak. Certain foods, such as wheat, soy, milk, and eggs can all act as allergens and create flares in children, infants, or adolescents. Some people have found success in keeping a diary of their triggers. Once you’ve discovered your triggers, see if you can find ways to limit them.
When taking a bath or shower, limit your time to no more than 15 minutes. Also, it’s important for people with eczema to use warm, not hot, water for bathing.
Use only mild soaps when bathing or showering: Antibacterial and deodorant soaps can dry the skin and strip away natural oils on the skin barrier.
Afterward, it’s important to carefully dry the skin with a soft towel after bathing. Put on moisturizer while your skin is still damp with water to lock in the moisture.
As an alternative to a regular bath, the American Academy of Dermatology recommends a bleach bath to help limit eczema flare-ups. Add a half cup of common household bleach (not concentrated bleach) to a 40-gallon bathtub, after filling the tub with warm water. Soak either just the skin lesions, or from the neck down, for about 10 minutes, no more than two times per week.
Before trying a bleach bath, check with your doctor first.
A person who has an active eczema outbreak can treat the skin lesions in a variety of ways, which may also help to lower their risk factors for RA. Dermatologists recommend the following medications and therapies in order to treat active eczema and improve quality of life.
A health care provider may prescribe one of the following types of medications for your eczema to help reduce flares and your chances of developing RA.
Certain creams can relieve itching (pruritus) and help heal the skin. A dermatologist or primary care doctor can prescribe a topical corticosteroid cream that goes directly on the skin lesion. Apply the corticosteroid after moisturizing. Do not overuse this type of drug because it can thin the skin as a side effect.
There are other creams, known as calcineurin inhibitors, which act as blockers of your immune system. Examples of these include Protopic (tacrolimus) and Elidel (pimecrolimus).
If your skin has a bacterial infection or an open sore, a doctor can prescribe an antibiotic cream. They may also suggest oral antibiotics to fight an infection that accompanies the skin disease.
Some drugs taken by mouth can control the inflammatory response associated with eczema. If your eczema is moderate to severe, a doctor might prescribe prednisone, a common type of oral corticosteroid. These types of drugs can only be used for a short period of time due to possible serious side effects.
Clinical trials have led to a newly approved injectable biologic (monoclonal antibody) called Dupixent (dupilumab) for treating eczema. Doctors prescribe this for people with severe atopic disease who have not responded well to other medications.
In addition to medications, a health care provider may suggest one or more of the following therapy treatments to bring relief.
For severe atopic dermatitis, a health care worker can wrap the skin lesions with wet bandages and topical corticosteroids. Hospital staff sometimes perform this therapy, but you can ask your doctor how to carry out this technique at home.
When topical therapies do not work, or people have a quick flare-up after treatment, doctors may recommend this treatment. Light therapy exposes the skin to specific levels of either natural sunlight or artificial ultraviolet rays. This treatment can improve quality of life, but may cause early skin aging and a higher risk of skin cancer.
Learn more ways to manage eczema flares year-round.
If you have a history of eczema and you undergo RA treatment, it’s important to know that certain medications for RA — called tumor necrosis factor-alpha (TNF-alpha) inhibitors — can cause eczema flare-ups. Examples of this type of medication are Remicade (infliximab), Enbrel (etanercept), and Humira (adalimumab).
One study reported that 26 percent of study participants stopped their TNF-alpha blocking drug because it caused a skin disease to emerge, such as eczema or psoriasis. However, people can take topical corticosteroids to limit their eczema while on a TNF-alpha inhibitor.
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