Eczema, a constellation of conditions that makes a person’s skin dry, itchy, red and scaly, affects an estimated 30 million Americans. It can shame and isolate people who have it.
And right now, the disease is having a moment in the sun thanks to its major role in HBO’s “The Night Of,” a crime drama mini-series that features a character who is heavily defined by having eczema.
Played by John Turturro, lawyer John Stone is a disrespected “bottom feeder” attorney who usually hangs around NYPD precincts waiting for easy cases. He catches the trial of a lifetime when he wins the trust of Nasir Khan, a Pakistani-American college student accused of the grisly rape and murder of a white woman from the Upper West Side.
While Stone investigates, questions witnesses and visits Khan in prison, he’s also constantly having to soothe his inflamed skin. It’s mostly on his feet, but it’s creeping up his legs and has spread to his neck and back. Peter Moffat, the writer who created the U.K. series on which “The Night Of” is based, has eczema himself and wrote it into the original show, but U.S. writers Richard Price and Steven Zaillian said they expanded eczema’s role in their version after doing more research on it. In a panel, Price called the disease a “metaphor for the frustrations of finding a solution and the entire judicial system.”
Experts aren’t sure what causes eczema, but they think it’s caused by a combination of both genetic and environmental factors. For instance, if you have a family member with the condition, you’re more likely to have it, too. Eczema also tends to co-occur with conditions like asthma and hay fever, suggesting that a disordered immune system may contribute to the condition.
Dr. Jon Hanifin, a dermatologist at Oregon Health & Sciences University who focuses on eczema, is an avid fan of “The Night Of” thanks in no small part to the prominent role the condition plays in the show. Here are four things he noted about eczema and its portrayal on the show:
1. The show accurately depicts the worst things about eczema: ugliness and extreme itchiness.
When we first meet Stone, we also meet his skin condition. He wears sandals to let his feet “air out” on the advice of a doctor, and scratches his skin with a chopstick, to onlookers’ disgust.
“I’m ready to jump out a window,” he moans to a dermatologist after being chastised for scratching his feet with the chopstick.
Hanifin says that Stone’s constant scratching is typical of people with eczema, even though it’s against doctors’ advice.
“Patients’ concerns are mainly itch and unsightliness, which he demonstrates quite well,” Hanifin said. “The pain comes from the scratching— they prefer pain to the incessant itch.”
2. Doctors can have radically different approaches to eczema treatment.
In episodes three and four, Stone visits different dermatologists who suggest completely different treatments for his skin. The first doctor tells him to buy the vegetable shortening Crisco, apply it to his feet, wrap them in saran wrap, and then put his sandals on. The second doctor throws out all the medicines Stone has been using and prescribes a strong steroid medication that has side effects like acne, hair loss and shrinking testicles.
What gives? Well, for one, there’s no standard approach to the treatment of eczema, or, in Stone’s case, atopic dermatitis, the most common type of eczema. There is also no cure for eczema.
”These encounters illustrate the difficulty many doctors have in dealing with eczemas, reflecting poor education,” Hanifin says. “We’ve tried to suggest a standard approach, but most [doctors] just blunder on.”
A 2010 paper published in the journal Clinical, Cosmetic and Investigational Dermatology outlines escalating approaches intended to calm the condition: topical corticosteroids to suppress inflammation as a first line of defense, then topical calcineurin inhibitors to suppress the immune system as a second line treatment. Keeping the skin moisturized should always be a priority, the authors note, and if topical therapies fail, light therapy could help. Light therapy, or phototherapy, increases the body’s vitamin D production and bacteria-fighting systems, notes the National Eczema Association.
Other complementary treatments, according to the NEA, include strong immunosuppressants typically used to prevent organ transfer rejections, as well as bleach baths — something Stone’s second dermatologist recommends in episode four.
As a character, Stone has tried it all, and his eczema continues to get worse. In life, this can be very real: Of the approximately 11 percent of adults who have an eczema diagnosis, about one-quarter have “chronic, unremitting symptoms.”
“Just level with me,” Stone asks the second dermatologist in the show. “Is there any fucking hope?”
3. Eczema is not contagious, but stigma about the disease is real.
After Stone scratches his feet with his chopstick, he uses the same chopstick to scratch his neck. Later in the show, it’s revealed that his eczema has spread to his neck and back, which may suggest to viewers that Stone spread the disease to other parts of his body.
But in fact, eczema can’t be spread in an infectious way from body party to body part unless the skin lesions are infected with staphylococcus bacteria, Hanifin explains. Instead, what Stone experiences is “flaring,” or escalating breakouts triggered by any number of irritants, including stress, allergens or even a change in the weather.
The misconception that eczema is contagious can cause people with eczema a lot of emotional suffering, as an anonymous user wrote in an online eczema support group:
Just recently, I had a classmate ask me if my eczema was contagious because she had bad rashes… She told a couple of people that I gave her those rashes. I was so embarrassed and mad and sad… I just cried… I get scared that nobody will want me or love me.
4. People with eczema need social support.
Skin lesions from atopic dermatitis are unsightly and can disgust or scare people who don’t know much about eczema. Because of this constant social rejection, people with severe eczema may benefit from social support groups, as Stone does — provided they aren’t dominated by people with wrong beliefs about the disease, says Hanifin.
Reddit user Kratozio, a self-described 21-year-old viewer with eczema, commented on the show’s subreddit that depictions of the support group in “The Night Of” are both helpful and terrifying to him — a window of what may be in store for him in the future:
As someone who has [eczema] on his feet and hands, and wakes up having scratched the inflicted areas in his sleep and has constant cuts and itchy areas because of it, I really relate to that aspect of the character and love that I can identify with the frustration he must feel. However, the scene with him at the support group absolutely terrified me that one day I could reach the level of distress that those characters must feel.
The National Eczema Association has both online and in-person support groups. And shows like “The Night Of” can also play a role in helping to support people with eczema, Hanifin says.
“I think it’s good for people to see the problems that a guy with eczema has in his adult years, in a crucial [body]part,” Hanifin said. “The poor guy has a tough enough life, and then he has to sit there and scratch his feet, which can be very debilitating and hurtful. It’s great that they’re showing this.”