Guest Interview

Improving Self-Esteem for Teens

Improving Self-Esteem for Eczema Teens series with Annie Fox

Annie Fox, M.Ed. is an internationally respected educator, award-winning author and a trusted online adviser, specializing in helping teens become people of good character who’ve got the social courage to do the right thing online and off. Annie is a return guest to my blog, who previously shared on her own teen eczema experience here.

This was originally a two-part series which had since been combined into one longer informative post.

Dermatologists recognized Self-Esteem concern for Teens

Marcie Mom: Dermatologists have told me that self-esteem is a concern for teenagers with eczema, and even asked me to do a teen graphic book (I did one for the toddlers here). Let’s try to tackle self-esteem in parts, so let’s get started!

What is Self-Esteem?

I understand that it’s very much to do with how one views himself/herself, can you explain this giving an example relevant to teens?

Annie: How one views oneself (on a physical level as well as on a personality/character level) is self-perception. Self-esteem, is the value we place on who we are. People with “low self-esteem” tend to shy away from challenges (speaking up, reaching out to others in friendship) because they may experience feelings of not “measuring up” for whatever reason. Most teens across the board, report feel ‘insecure’ to one degree or another at one time or another. They may think: “I’m not __________ enough.” You fill in the blank (hot, cool, smart, athletic, thin, rich, good, etc.)  Obviously if a teen has a physical condition (like eczema) that is noticeable, it can make that girl or guy feel self-conscious. And that’s likely to have a negative impact on self-esteem.

But if that teen has a strong support system, among family and friends, plus personal strengths in the areas of abilities, talents, etc. then that can be a powerful counter-balance to whatever feelings he/she may have about the eczema.

What can you do about Self-Esteem?

Marcie Mom: Now, knowing what is self-esteem, I’m assuming the whole point is we can do something about it, something to improve it even for teenagers with eczema that is apparent on their skin.

What can a teenager do for himself to improve his self-esteem? And is there anything a parent can help in?

Annie: Real self-esteem comes from within. And typically that means a sense of satisfaction in one’s abilities. When a teen has opportunities to pursue his/her interests (sports, music, writing, dance, theater, art, etc.) then he/she is likely to have many moments of joy and pride. He/She may think “I can do that well!” and those occasions will build self-esteem. Does that make the eczema better? Probably not. But it will make it easier for the teen to deal with whatever emotions come with the territory, Teens with real self-esteem may feel “down” about the way their skin looks, but they don’t stay down for long.

Sharing about Teen Eczema

Marcie Mom: For a teenager with eczema, do you recommend that he/she take a different approach to let his/her friends know, depending on their personality? Or is there no need to openly share about eczema?

Annie: When I was dealing with eczema as a teen, I regret not ever having an open conversation with any of my friends about the conditions. We were close friends and shared so many teen secrets, hopes, dreams, but I somehow decided that I couldn’t talk about my eczema. Looking back, I realize that was a mistake on my part. My friends would not have rejected me. Rather than expending all that energy “hiding” the rashes on my arms or on my neck, if I had chosen to talk about it with a few close friends, I could have relaxed when I was with them.

So, yes, my advice is, that if you’ve got eczema, it’s not your fault and you’ve got nothing to be ashamed of! Educate people and you will find it easier for yourself in social situations.

There is power in honesty.

Social Media Posting on Eczema

Do you think that posting pictures of his/her eczema on facebook will help or worsen the pressures the teen is facing?

Annie: I don’t know the answer to that one. Facebook is a very public forum. And there is a group mentality of cruelty on social media. My gut reaction to your question is “no.” I don’t think that would be helpful. In fact, I think it would result in certain people using a teen’s honest posting as an opportunity to be disrespectful and insensitive. It’s a personal choice, of course, but I doubt that one would get the kind of universal acceptance that one was looking for. And then what? You’re left feeling hurt, embarrassed, and upset.

‘Cool’ with Eczema? How should Teen Respond to Outside World?

Marcie Mom: Now a tricky question – if a teenager is really bothered by his eczema and feels bad about it, should he hide it by appearing not bothered and ‘cool’ about his skin? Is it even possible to do so?

Annie: I’m not a fan of pretending… even though I was voted Class Actress my senior year in high school. That gives you an idea of what a very skilled “pretender” I was! But like I said before, pretending to be something you’re not expends a lot of emotional energy. It is also very stressful because, actually, to “appear” not bothered about your skin when you are actually extremely bothered… is probably going to stress you out even more! And one thing we know about stress is that it contributes to inflammation! Instead of pretending anything, and stressing yourself out, I would strongly suggest that any teen with eczema, look into studying meditation. There are simple beginning breathing techniques to calm the mind and body. And from there you can learn more about how your mind works and how thoughts (worries about your social standing and the way your skin looks, etc) can be managed so that they don’t control you.

Marcie Mom: Finally, I may not have asked the right questions, as it’s based on what I’ve learnt from other parents. Is there any aspect of teen eczema and self-esteem that I’ve missed out asking?

Annie: You’ve asked very thoughtful questions, Marcie. I thank you for this opportunity to share some of what I know with teens and their parents.

Marcie Mom: Thanks Annie for taking time to share your journey with us, teenage years are so difficult even for those without eczema and those with eczema would certainly appreciate your advice.

Living with Eczema

SOMEONE has Eczema and managed her Teenage years


Annie Fox, M.Ed., shares how she managed her eczema during her teenage years
Annie Fox, M.Ed., shares how she managed her eczema during her teenage years

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Annie Fox, M.Ed., to share how she managed her eczema during her teenage years. Annie is an internationally respected educator, award-winning author and a trusted online adviser, specializing in helping teens become people of good character who’ve got the social courage to do the right thing online and off. She also shares tips on improve self-confidence for teens here.

Marcie Mom: Hi Annie, thank you so much for for taking part in my blog series ‘Someone has Eczema’, a series which I hope will encourage many others with eczema who have similar struggles with various aspects of life. You had eczema from 3 years old to teenage years, can you share with us how severe your eczema was during the teen years?

Annie: Because it’s been quite a few years since I suffered from eczema, I really have to think back. And I appreciate the opportunity to revisit this time in my life through your questions. I remember feeling very self-conscious during the summer when everyone was wearing shorts and sleeveless tops. (I had eczema behind my knees and on my arms. Sometimes it would flare up on my neck.) During my teen years there was always that thought, before I chose something to wear “How can I hide this?” I also tried to use a “cover-up make up” which irritates the skin and usually makes things worse. I remember during my piano lessons, trying to hide from my teacher, the eczema on the backs of my hands by pulling my sweater sleeves down over my hands.

Marcie Mom: Teenage years are difficult for most people, for the adjustments they have to make during high school years. Dermatologists have told me that self-esteem is a concern for teenagers with eczema. As you are also helping teens, can you help parents to understand what are the pressures facing a teenager, and a teenager with eczema?

Annie: As a teen I was very aware that my mom was probably as self-conscious about my eczema as I was. She often told me, “Don’t scratch!” I can still hear her saying that after all these years! LOL. She didn’t understand how itchy the condition can make you feel and that the scratching, for me, was often an unconscious response. I’d be scratching my arm and I wouldn’t even be aware I was doing it. Until she reminded me… again and again. It’s not helpful for parents to be watching their teens so closely. Teens are often self-critical enough. They do not benefit from having yet another “critic” on their case. Stress has been found to have a connection with inflammation. For that reason alone, it would be extremely beneficial for parents to do whatever they can to add to the calmness in the family rather than add to the stress your teens are feeling about their appearance and whether they “measure up” to their peers or to your standards for them. Be compassionate. If your teen’s eczema is a problem for you (because you’re embarrassed, etc.) then you, the parent, ought to get some support in dealing with your anxiety about the condition. That way, you can be most helpful as a support person for your teen.

Marcie Mom: I’ve worked on a Teen Eczema series in this blog with dermatologist Dr Lynn, who has explained how puberty affects our skin, the common skin conditions for a teenager and how sports and skincare/shaving affects eczema. Annie, how did you manage your eczema during your teen years and did the additional skincare effort/routine/prevention create social/ emotional issues?

Annie: None of the prescribed skincare efforts helped for me. Fortunately I have a very outgoing personality and I, as mentioned, I was adept at “hiding” my eczema. I doubt that very many of my friends in high school even knew that I had it. The emotional part of it (which was the major piece) was something I “managed” through my creativity. I wrote poetry and prose. I composed music. I did a lot of theater in middle and high school. All of these avenues allowed me to step outside of myself and were very helpful whenever I felt sorry for myself because of the eczema.

Marcie Mom: One final question – how would you advice a teenager with eczema to manage the social/emotional side of eczema, and communicating with his/her friends about it?

Annie: I think today’s social climate makes it easier for teens to be real with each other. Think about it, everyone has something that makes him/her different. And as a culture we tend to be more open and accepting of those differences than we were when I was a teen. Today it’s not unusual for a teen to say to his/her peers: “I am gay.” Or “I have ADHD.” Or “I have Aspergers.” Or any of a hundred conditions/syndromes. Being straight up honest with friends is the best way to manage stress and anxiety. Then you can just be yourself and not hide.

Marcie Mom: Thanks Annie for taking time to share your journey with us, teenage years are so difficult even for those without eczema and those with eczema would certainly appreciate your advice.

Doctor Q&A

Teen Eczema – Acne, Sports, Skincare & Shaving

eenage eczema with Dr Lynn Chiam dermatologist Singapore

This blog has covered lots on children with eczema, but as they grow older, eczema may present a different set of challenges and in a different form (for instance, due to puberty). MarcieMom is privileged to have Dr Lynn Chiam of Children & Adult Skin Hair Laser Clinic, a consultant dermatologist who subspecializes in paediatric skin conditions, adult pigmentary conditions and laser dermatology .

Puberty, Skin Changes and Eczema

As children move into pre-teen years and into puberty, what are some of the body changes that may trigger eczema?

Dr Lynn Chiam: As young children move into pre-teen and pubertal years, there are changes in the body’s hormonal profile and maturing of the sexual characteristics of the body. Sex steroids modulate skin thickness as well as immune function. It had been noted that under the age of 10, eczema occurs equally among boys and girls. However, from 10-18 years, eczema becomes more prevalent among girls. During adolescence, more girls develop eczema and more boys outgrow it. This suggests a role for gender-specific pubertal factors.

Are there certain parts of the body that are more prone to eczema at the onset of puberty? And is there any difference noted between eczema in a teenage boy versus a teenage girl?

As children mature, it has been noted that females with eczema had more problems with issues of clothes and shoes than boys. Significant itch and sleep disturbance affected both genders. The areas of the body affected by eczema remain similar between the two genders during puberty. More studies are needed evaluate the effects of hormonal changes on eczema.

In infants and toddlers (0-2 years), eczema tend to affect the face and scalp while in childhood (2-12 years), it affects the flexures (inner aspect of elbows, neck, back of knees), wrist and ankles. In adolescents, eczema tend to affect the eyelids, neck and flexures (inner aspect of elbows, back of knees).

Acne, Oily Skin & Warts

MarcieMom: Apart from eczema, other common skin problems in teens include acne, oily skin and warts. Can you briefly explain each of these conditions? 

Also, can a teenager with eczema (i.e. dry skin) also suffer from acne or oily skin? And if yes, what’s your advice to managing two or more skin conditions?

Acne – Acne can occur in adolescents and adults. It usually starts during the teenage years and is thought to be related to hormonal changes during this period. Most people will suffer from some form of acne during their teenage years.

Acne can be divided into predominantly comedonal (whiteheads) or predominantly inflammatory with papules (zits) and pustules (zits filled with pus). Large and deep zits can result in permanent scarring.

Acne can be triggered by oily skin, oily face creams, smoking and stress. Mild acne can be treated with creams containing benzoyl peroxide, antibiotics and tretinoin. Moderate acne may require oral medications such as antibiotics and oral hormonal tablets. Severe acne can be treated with oral isotretinoin. Oral isotretinoin is usually well tolerated and can result in long term cure. However, it must not be taken in pregnancy.

Oily Skin in Teenagers

Oily skin – Oily skin (seborrhea) is a common cosmetic problem that occurs when oversized sebaceous glands produce excessive amounts of sebum. Sebum is the cause of oily skin and scalp. Increased facial sebum is also associated with the development of acne.

Sebaceous glands are microscopic glands in the skin that secrete sebum, which is made of fats, wax and the remains of dead fat-producing cells. Excessive sebum gives the appearance of shiny and greasy skin. In humans, they are found in greatest abundance on the face and scalp. Sebum is odourless but bacterial acting on it can produce odours.

Skin oiliness may vary according to age, gender, ethnicity and hot humid climate. During puberty, the activity of sebaceous glands increase because of heightened levels of the hormone known as androgens. In skin pores, sebum and keratin can create a “microcomedone” or “whitehead”.

A person with eczema can certainly suffer from acne as well as oily skin. 

A person with eczema can certainly suffer from acne as well as oily skin. As he enters puberty, a teenager with eczema can develop oily skin on his face (where the sebaceous glands are concentrated) while other parts of the body (with less sebaceous glands) remain dry. The increase in facial sebum can trigger acne.

In a person with eczema and acne, it is important that if he applies steroid creams to his face for his eczema, he avoid applying them over the acne-prone areas. This is because steroid creams can make the acne worse. Alternatively, he can use creams like Tacrolimus or Pemecrolimus to control his eczema as they are non-steroidal in nature and do not aggravate acne.

He should also use anti-acne cream only to the areas with pimples and avoid the eczematous areas as some anti-acne cream can cause skin dryness. Wash the acne prone areas with anti- acne wash while using a gentle soap for the rest of the face. Clean away excess oil from the face whenever possible. Do consult a dermatologist for advice and treatment.

Warts and HPV

Warts – Warts are growths on your skin are caused by an infection with human papilloma virus, or HPV. Types of warts include:

  • Common warts, which often appear on your fingers, toes and on the knees.
  • Plantar warts, which show up on the soles of your feet.
  • Genital warts, which are a sexually transmitted disease.
  • Flat warts are skin- coloured and can appear in any area of the body.
  • Periungal warts prefer to grow at the sides or under the nails and can distort nail growth.

Warts are contagious and may spread from one area of the body to another or to others. There is no way to prevent warts.

In children, warts often go away on their own. In adults, they tend to stay. If they hurt or bother you or if they multiple, you can remove them.

There are many ways of treating warts. They include freezing it with liquid nitrogen, applying chemicals, electrosurgery (using heat to burn the warts away) and laser treatment.

Sweat & Sports on Eczema

Marcie Mom: Sweat can be a trigger for eczema and teenagers are at a very active stage of their life. If a child’s eczema is often triggered by sweat, would you advise parents to encourage their child to take up an indoor sport?

Are there certain sports that you think are better suited to eczema children? For instance, is swimming or squash or gymnastics more suitable than soccer or tennis?

Dr Lynn Chiam: Sweat and heat can be a trigger for eczema. However, it is best for a teenager with eczema to lead as normal a life as possible and participate in the sport he likes. Unless the eczema is very severe and difficult to control, I will not limit the choice of sports the teenager chooses. It is more important to know about good skin care and to apply creams correctly, which will help improve eczema, than to totally avoid certain sports.

If a teenager chooses to engage in a sport that’s outdoors and sweat a lot, what advice would you give him/her to manage the eczema?

Swimming for long periods during a bad flare of eczema is not advisable as the swimming pool water may cause more skin dryness.

I will advise that if you participate in a sport that will cause you to sweat a lot, to take a damp cloth to wipe away the sweat immediately after exercising followed by drying the skin with a dry cloth. If possible, take a shower using gentle soap shortly after the exercise and apply moisturizer immediately after bathing.

Cosmetics for Eczema

Teenagers may start to use (i) cosmetics, (ii) hair gel, (iii) anti-perspirant or (iv) wax arms/legs or shave. What would be your advice to a teen with eczema who wants to do the above (i) to (iv)?

Cosmetics contain fragrances and preservatives which may lead to allergic contact dermatitis (a rash due to allergy to the ingredients). A person with eczema has poor skin barrier function and may be more prone to skin irritation caused by cosmetics. If a teenager’s eczema flares with the use of cosmetics, it is important that she sees a dermatologist to do a patch test to check if she is allergic to the ingredients found in the cosmetics. If so, she will need to avoid that particular ingredient by reading the product labels of the cosmetics she uses. Always do a test spot by placing a small amount of the cosmetic on the inner aspect of the wrist. If there is no reaction after 1-2 days, then the cosmetic can be used on the face. Try to avoid using cosmetics over the areas affected by eczema. Cosmetics with a high water content are at a risk of being contaminated by bacteria and can pose a health risk to the user.

Try to avoid using cosmetics over the areas affected by eczema.

Hair Gel on Scalp Eczema

If a teenager’s eczema affects the scalp as well, it is advisable not to use hair gel when there is a flare of the eczema. If the scalp is not affected, it is recommended that a small amount of the hair gel is placed on a small area of the scalp first and to watch for any reaction. If there is no reaction after 1-2 days, then the hair gel can be used on the whole scalp. Always wash away the hair gel at the end of the day.

Anti-Perspirant and Allergic Contact Eczema

Anti- perspirant contains fragrances and preservatives can lead to allergic contact dermatitis. Again, do a test spot on the inner aspect of the wrist. Do not use the anti-perspirant if he develops any reaction.

Shaving and Micro-tears

Shaving and waxing of unwanted hairs can lead to micro-tears in the skin. Patients with eczema have an impaired skin barrier function and can easily get skin infection through these micro- tears. It is not advisable to shave or wax your hair if there is a flare of eczema. Laser hair removal, which does not cause micro-tears in the skin, is a more suitable way of removing unwanted hairs for patients with eczema.