How to treat eczema
Eczema also known as atopic dermatitis is a type of chronic skin inflammation. People with eczema have dry, irritable skin, and itching contributes to skin changes. Eczema is treated by avoiding irritants to the skin and using moisturisers, medicated ointments or creams
Avoid irritants, allergens
It’s important to try to avoid anything that tends to aggravate your eczema. Common environmental irritants include soaps, bubble baths, shampoos, solvents, wool, nylon, grass and sand. Pollens, house dust mites, animal dander (small scales from the skin and hair of animals) or even certain foods can also aggravate eczema if you are allergic to them.
Overheating that can also make your eczema worse should be minimised. Always bathe in warm, rather than hot water. In winter, turn down the heater and don’t use an electric blanket. Air-conditioning and fans are helpful during summer.
Normal soap is alkaline and can further dry out your skin. Soap and detergent-based shampoos should be avoided, and instead soap and shampoo substitutes should be used.
Bath oils (e.g. Alpha Keri bath oil, DermaVeen shower and bath oil and QV bath oil) can also be helpful, but you should be careful as they make the bath slippery. Bath oils can also be used if you prefer to shower- spray the oil onto wet skin immediately after the shower and then lightly dry the skin with a towel. Shorter or less frequent baths/showers can also help treat dry skin.
Moisturisers or emollients
Moisturising your skin is one of the easiest and most important measures in preventing itching and scratching, as well as reducing eczema flare-ups. As eczema is a chronic condition, it is important to incorporate regular moisturising into your daily skin care routine. Be careful to avoid moisturisers that contain perfumes and preservatives which can irritate the skin.
Moisturisers should be applied frequently for very dry skin at least twice a day all over the skin. Ointments tend to be more effective than creams or lotions for very dry skin. It’s best to apply the moisturiser or emollient straight after a shower or bath to help seal in the moisture from bathing.
Wet dressings help to relieve eczema symptoms in some people. Wet dressings are often used in severe flare-up of eczema, generally for a few days. Keep wet dressings for around 15 minutes, 3 to 4 times a day.
Creams or ointments containing corticosteroid are commonly used for exacerbations of eczema. It relieves itching by reducing inflammation in the skin and is very effective and safe.
Using high-strength steroid creams over long periods is associated with local side-effects such as thinning skin, stretch marks and dilated blood vessels. So, you should use the lowest strength and smallest amount that works adequately. Facial skin is particularly susceptible to steroid side-effects.
Immunomodulators such as pimecrolimus cream (brand name Elidel) can be used in the treatment of eczema. They control inflammation and can be used to treat eczema symptoms and reduce exacerbations if a steroid cream cannot be used. However, because of concerns over cancers of the lymphatic system and skin, pimecrolimus is not recommended for long-term continuous use.
Antibiotics and antiseptics
It is fairly common for skin that is affected by eczema to be susceptible to infection. If infection occurs, your doctor may prescribe antibiotic cream or tablets to treat the infection. Tablets are usually prescribed because they are more effective than creams. Adding antiseptic solution to your bath water can prevent and treat skin infections, but make sure that the concentration of antiseptic is not too high as it may irritate the skin.
Sedating antihistamines (antihistamines make you drowsy) may be used to relieve itching that is disrupting sleep. Their benefit is mainly due to the sedating effect. They rarely completely suppress itch so they should be taken at night. Oatmeal bath additives and pine tar preparations may also help to relieve itchy skin.
Supplements such as evening primrose oil, fish oil and borage oil have been touted as possible treatments for eczema symptoms. However, there is a lack of evidence from patient studies to show that nutritional supplements are effective in treating eczema. There is also no scientific proof that vitamin or mineral supplements are effective treatments for eczema.
Treatment for chronic, severe eczema
Tablets that suppress your immune system can be tried if you have severe eczema. These medicines have some potentially serious side-effects and are only available for adults on prescription from a specialist. They are usually used only when other treatments have failed.
Phototherapy using ultraviolet light is another form of treatment for chronic, severe eczema. Phototherapy involves controlled exposure to ultraviolet light for a few minutes, 2-3 times a week. This treatment is expensive as well as time-consuming, and can have possible long-term side-effects, including premature skin ageing and skin cancer.
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