Maham

Age at interview: 21

Brief Outline:

(Text only clips) Maham has had eczema since she was a baby. She notes that maintaining a routine and communicating effectively with healthcare professionals is crucial in eczema management.

Background:

Maham is 21 years old, single and of Pakistani descent. Her most recent employment was as a research intern.

More about me...

Maham has had eczema since infancy. Her first major flare-up was during her GCSEs due to stress. She experienced another big flare-up during her second year at university. She thinks this was down to an increase in stress when she switched degrees, living in dusty student accommodation, an unhealthy diet and a lack of sunlight whilst studying for exams. Maham finds that university-related stress is often “internalised” in contrast to her experiences of work where you can “leave your stress at the office” at the end of the day. Other triggers for Maham’s eczema include coffee and some brands of chocolate. She also avoids using cheap showergels and make-up, opting instead for high quality cosmetics. She wears cotton clothes because synthetic materials irritate her skin. Although eczema has not hindered Maham’s social life, it has impacted on her energy levels so that it is difficult to study or do household chores. 

 Maham thinks that treating eczema is often “fire fighting”, whereby there are attempts to treat the symptoms without really addressing the causes or triggers. In addition to a prescribed moisturiser, she uses steroids to tackle inflammation. However, she worries about skin thinning and accidental contact with her eyes when using steroid creams. She uses a calamine lotion to cool her skin and reduce itchiness. She also takes a daily antihistamine tablet and increases the dose when she experiences a flare-up. However, she finds that the increased intake of medications can make her sleepy during the daytimes. Maham uses a pillbox to organise and remind her to take the medication, a strategy that has worked well for her. She says that support from her family and friends have helped her maintain her eczema treatment routine.

Maham found that specialist skin care was more accessible in Pakistan than in the UK. Her GPs in the UK were reluctant to give her a dermatology referral and, as a result, Maham paid to see a private dermatologist. It difficult for her to build a relationship with an individual GP because she had to switch GPs based on their availability. She also found that GPs were often pressed for time which meant they were unable to answer all of her questions. Maham found that her appointment with the private dermatologist was much more informative because they had the time discuss possible triggers and all available treatment options. She suggests that GPs are useful in emergency situations when treatment is needed quickly, such as when eczema becomes infected, but that seeing a specialist will be more suitable for long-term eczema management. 

Maham’s advice to young people with eczema is to maintain a routine of moisturising often and taking medicine as it is prescribed. She suggests keeping a diary to help identify food triggers and discover which treatments are effective. Maham also suggests booking a longer timeslot when making a GP appointment and writing down a list of questions beforehand. Her advice to healthcare professionals treating young people with eczema is to recognise the effect of skin conditions on the whole of a person’s life. 

Fasting for Ramadan helped Maham work out some of her dietary triggers.

So I was fasting this month, last month, because it Ram-Ramadan and, and that meant the whole month I was, the fasting in England is very difficult because it’s like, you eat in, at sort of sunrise and you open your fast at sunset, which meant in the, in British summer time it’s 3am to 9.30pm I wasn’t eating any food.

And that was good for me because it meant that I could isolate all of the food in my life and then I’d, I was only having one meal a day because around 9, 9.30 if you’re eating and then by 3am you’re not really hungry again. So I was only eating one meal a day but that meant I could really isolate … exactly what triggers my eczema had. 

So if I had a coffee during the fast time then and I’d get a reaction then I’d know that coffee is, is a trigger for me, then so on and so forth. So that was an experience I had that really helped with the food. So I wouldn’t, I wouldn’t suggest that people should fast, but I would say that [uh] isolation diets are something that people do so they’ll only have rice for like a couple of days and then they’ll see if they get a reaction and they’ll only have whatever else and then they can figure out if food is a trigger. 

Yeah. Yeah.

So I found the isolation diet was helpful. It, it’s quite an extreme thing to do but it’s …it, if food does seem like a trigger then it might be a good idea.

Maham takes in a list of questions to structure the topics covered in her medical appointments about eczema.

The problem I’ve found is that when I go in I have quite a long list of questions to ask so I say, “Oh I’m gonna talk about this, I’m gonna talk about that”, and then when I go in, because it’s just all quite hurried I either forget all the things I wanted to ask, or I’m just like, “OK”. They say, “Do you have any more questions?” and I say, “No, I don’t”, but I actually do but because their clock is ticking they don’t want me to sit around and wait until the question comes back to me. So then sometimes I sort of would go in with a list of questions so that I wouldn’t forget. 

But most times I would just go in and then I would forget what I wanted to ask them and then… It’s also if you go in with four problems but you’ve only told them you’re coming in for one…So I’d be like, “Oh, I’d like to see someone”. They’d say, “What, what’s the matter?” And I’d say, “Eczema”, but then I’d also have like, I don’t know maybe something else on the side, then you say, “Oh, I’d like to ask you one more thing”, and then they say, “OK, sure”. And then you say, “One more thing”. And then they say, “OK”. And then you’re kind of embarrassed to ask the fourth time. So I’d find, yeah, just sort of initiating the conversation would be a little bit more difficult but towards the end I’d just go in with a list of questions and then they’d know that I had this agenda in mind. And that was a bit easier.

Maham talks about her worries around steroid creams.

So one of them is vision, and even though I try to sort of not touch my eyes, touch my face, anything like that, I feel like my vision has gotten a little bit worse over the last year and I don’t know why that is. And I have been meaning to go to a doctor, a optician and see what’s happening with my vision. But, yeah, I think in my be that even if I try to avoid touching my eyes if it’s on your hands and if you apply it somewhere then you might rub your eyes accidentally or something. And then, people say it thins your skin, some people say it doesn’t, and there’s a little bit of, I don’t know what the consensus is on that but I, so the, the main worry is just that it’s a skin thinner.

But I don’t know if it actually does thin my skin.

Fasting to Ramadan helped Maham work out some of her dietary triggers.

So I was fasting this month, last month, because it Ram-Ramadan and, and that meant the whole month I was, the fasting in England is very difficult because it’s like, you eat in, at sort of sunrise and you open your fast at sunset, which meant in the, in British summer time it’s 3am to 9.30pm I wasn’t eating any food.

And, and that was good for me because it meant that I could isolate all of the food in my life and then I’d, I was only having one meal a day because around 9, 9.30 if you’re eating and then by 3am you’re not really hungry again. So I was only eating one meal a day but that meant I could really isolate…

…exactly what triggers my eczema had. 

So if I had a coffee during the fast time then and I’d get a reaction then I’d know that coffee is, is a trigger for me, then so on and so forth. So that was an experience I had that really helped with the food. So I wouldn’t, I wouldn’t suggest that people should fast, but I would say that [uh] isolation diets are something that people do so they’ll only have rice for like a couple of days and then they’ll see if they get a reaction and they’ll only have whatever else and then they can figure out if food is a trigger. 

Yeah. Yeah.

So I found the isolation diet was helpful. It, it’s quite an extreme thing to do but it’s... it, if food does seem like a trigger then it might be a good idea.

Maham thinks work-related stress is easier to compartmentalise than study-related stress.

I do like to think the most stressful stuff in my life is in the past, when it comes to, because the other thing about studying is you internalise the stress and you take it home with you. Then you’re always thinking about, “Oh, I should be studying”, and the guilt never goes away.

Whereas I think with a professional sort of workspace it might be as stressful while you’re at the office but it’s not a stress that you internalise in the same way so you don’t feel guilty about not working because academic guilt is directly correlated with your, is directly related to your success they say, so if I don’t study I’m not gonna be successful. Whereas with work it’s if I don’t do this I’ll do it the next day, so it’s not that bad. And you kind of leave your stress at the office and you come back and then you go back the next day and you kind of pick up where you left off. It’s not like you go home from the office and then you’re also stressing about how you failed as human being and all of that stuff [laughs]

Maham thinks work-related stress is easier to compartmentalise than study-related stress.

I do like to think the most stressful stuff in my life is in the past, when it comes to, because the other thing about studying is you internalise the stress and you take it home with you. Then you’re always thinking about, “Oh, I should be studying”, and the guilt never goes away.

Whereas I think with a professional sort of workspace it might be as stressful while you’re at the office but it’s not a stress that you internalise in the same way so you don’t feel guilty about not working because academic guilt is directly correlated with your, is directly related to your success they say, so if I don’t study I’m not gonna be successful. Whereas with work it’s if I don’t do this I’ll do it the next day, so it’s not that bad. And you kind of leave your stress at the office and you come back and then you go back the next day and you kind of pick up where you left off. It’s not like you go home from the office and then you’re also stressing about how you failed as human being and all of that stuff [laughs]