Preventing and Treating Eczema

The Best Treatments for Eczema

Woman using eczema cream
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If your skin has patches that are itchy, dry, scaly, hard, red, and/or possibly blistered, you may have eczema. Eczema is a general term for inflammation of the skin for which there is no cure, but there are treatments available. Atopic dermatitis is the most common type of eczema.

Preventing and Coping With Eczema

These are some important ways to help prevent and cope with eczema:

  • Eliminate the triggers. Avoiding the triggers of itching should be the first priority if you have atopic dermatitis. Environmental triggers can be decreased by avoiding wool, nylon, and stiff or irritating clothing that may irritate your skin and promote sweating. Instead, wear cotton clothing that has been washed with a mild detergent such as Drift or Snow, or use a double rinse cycle. Use caution with fabric softeners, which may irritate your skin.
  • Keep your house at the right humidity. In the summer months, using an air conditioner prevents sweating and removes excessive humidity. In the winter months, use a humidifier to prevent your skin from getting dried out.
  • Avoid getting sunburned, and use sunscreens. Be aware that many of the prescription medications, such as topical steroids, may make your skin more sensitive to the sunlight and therefore worsen your eczema. Avoid traumatizing your skin by keeping your fingernails short and your hands clean to avoid scratching and infecting your skin.
  • Get tested for allergies. If you have significant atopic dermatitis, you should be evaluated for allergy testing to common aeroallergens and common food allergies. Avoiding allergens such as animal dander, dust mites, and cockroaches can improve your atopic dermatitis. Eliminating foods to which you are allergic will also improve your eczema.
  • Maintain good skin care. Good skin care starts with adequate moisturizing and hydration, which decreases itching and formation of eczema. Hydration of your skin is maintained by the twice-daily application of skin moisturizing creams like Keri, Lubriderm, Nivea, Nutraderm, and Eucerin. Less expensive moisturizers include generic forms of Johnson and Johnson’s Baby Lotion, which is actually more of a cream, available at discount retailers. Vegetable shortening such as Crisco is another good, inexpensive moisturizer.
  • Avoid lotions if possible. They contain too much water, which results in drying out your skin. The difference between a lotion and a cream is that a cream has a slightly greasy feel to it even after it has been applied to your skin. Avoid pure petroleum jellies such as Vaseline which don't moisturize your skin unless they're placed on top of a moisturizer or moist skin.
  • Bathe correctly. Bathing can be helpful if you do it the right way and harmful if you don't. Avoid extremely hot or cold water showers or baths. Try to bathe daily, and soak in the water until your fingertips start to wrinkle. Blot your skin dry with a towel (rather than rubbing), and apply a moisturizing cream from head to toe, focusing on problem areas, within three minutes of getting out of the bath or shower, while your skin is still moist. If your skin is allowed to air-dry before the moisturizer is applied, your eczema could get worse.
  • Try an antihistamine. Your itching may be at least partially controlled with the use of low-sedating antihistamines during the day, such as Zyrtec (cetirizine), Allegra (fexofenadine), or Claritin (loratadine), or with sedating antihistamines such as Benadryl (diphenhydramine) or Atarax (hydroxyzine) at night. Since histamines aren't the cause of the itching, antihistamines may or may not help in your specific case.

Treatment of Atopic Dermatitis

Once your eczema has worsened as a result of uncontrolled itching and scratching, medications are needed to control the problem. Topical medications are used for all but the worst eczema flares and include topical steroids and a new class of medications called topical calcineurin inhibitors, such as Elidel and Protopic.

Treatment options include:

  • Topical steroids. These medications are the first line therapy for atopic dermatitis and are available in lotions, creams, ointments, and solutions (for the scalp), and most are by prescription only. Low concentration forms are available over-the-counter. In general, medications in ointment forms are stronger than cream forms, which are stronger than lotion forms. Topical steroids should be used in the lowest strength possible, for the shortest time possible, as side effects such as thinning of your skin, pigment changes in your skin, and absorption into your body are possible.
  • Topical calcineurin inhibitors. These relatively new medications, Elidel® and Protopic®, are approved for short-term use in children older than 2 years of age for atopic dermatitis. They do not cause thinning of or pigment changes in the skin and can be used safely on your face. These medicines can help reduce the number of topical steroids needed when used for mild symptoms.
  • Diluted bleach baths. If your atopic dermatitis is severe, your doctor might recommend that you take a bath in diluted bleach twice a week to help control your symptoms, particularly if you keep getting skin infections.
  • Oral steroids. Rarely, short courses of oral steroids are required to achieve control of a severe flare of atopic dermatitis. Extreme caution should be used, as while eczema typically gets better on the oral steroids, a “rebound effect” can occur with worsening of your symptoms soon after the steroids are stopped. If oral steroids are required, the dose should be tapered slowly to minimize this risk.
  • Oral and topical antibiotics. In some cases, worsening atopic dermatitis can be a result of a skin infection or colonization with a common bacterium, Staphylococcus aureus, and a course of antibiotics against this type of bacteria is required. It's usually safe to continue the use of topical steroids even if the eczema is infected. Topical antibiotics are typically enough for localized infections of eczema while oral antibiotics may be needed for infections involving larger areas of skin.

Source:

Schneider L,  Tilles S,  Lio P, et al. Atopic Dermatitis: A Practice Parameter Update 2012The Journal of Allergy and Clinical Immunology. February 2013;;131(2):295-299.e1-27. doi:10.1016/j.jaci.2012.12.672.