How to Care for Your Skin If You Have Eczema

Moisture is your friend but water may not be

woman looking at skin in mirror
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Caring properly for skin with eczema is a delicate matter. Using the wrong soap or moisturizer can end up causing flare-ups or painful itching. To reduce to risk of these, you need to find a product and cleansing routine that can ensure both proper moisturization and the avoidance of ingredients that can inflame or damage skin.

How Washing Can Worsen Eczema

People with eczema have what some might call "leaky skin," meaning that the barrier function of the skin does not work as it should.

Typically two things can happen when eczematous skin is improperly washed:

  • Anything that goes on the skin soaks into the deeper layers and inadvertently triggers an immune response. This only worsens the condition.
  • The skin loses both water and the natural oils that normally moisturizes it, leading to greater cracks and flaking.

Improper washing can leave the skin in worse condition than before and make it even more sensitive to anything that comes into contact with it.

Is Water Good or Bad for Eczema?

You would think that the simple act of putting water on skin would be a good thing, but the opposite is true. Water evaporates after coming to contact with skin and takes ways many of it natural oils (known as natural moisturizing factor, or NMF) that are meant to protect it. Therefore, the more you soak your skin with water, the drier and more damaged it becomes.

Clearly, you can't avoid water or the practice of showering.

In the end, the main issue not to become hydrophobic but to practice good skin care whenever you do wash.

There are five basic tenets of "water-smart" cleansing:

  • keeping the water temperature tepid as hot water takes away more oil
  • keeping your showers short and avoiding any soaking of the skin
  • using antibacterial gels for hand washing as the alcohol base does not bind with NMF
  • patting the skin dry with a towel rather than rubbing it vigorously
  • using a good moisturizer immediately after washing

Choosing the Right Cleanser and Moisturizer

The effect of soap on the skin is not good for people with eczema. Most soaps, especially bar soaps, strip the skin of moisture and dry it out. By contrast, liquid cleansers contain emollients that replace lost moisture, feeding rather than stripping the skin.

When choosing a moisturizer, it is important that it not contain perfumes, fragrances, or essential oils that can irritate sensitive or inflamed skin. It should be used on a regular basis, ideally around three times a day (including after showers). Moisturizing creams (from a tube or a tub) may also be more effective than lotions (typically dispensed from a pump).

All moisturizers have their pros and cons. Depending on the condition of your skin, you may want to consider the following:

  • Moisturizers for scaly eczema are a good choice if you have a lot of flaking but no breaks in the skin as they can sting if there are any wounds or openings.
  • Emollient moisturizers are a good option if you are in the middle of a flare-up as they are non-irritating and readily available in most drug stores and pharmacies.
  • Ceramide moisturizers are excellent options as they both soothe and help the skin heal faster during a flare-up. On the downside, they're generally quite costly.

Sources:

Halvarsson, K, and Loden, M. "Increasing quality of life by improving the quality of skin in patients with atopic dermatitis." International Journal of Cosmetic Science. 2007;2:69-83.

Eichenfield, L.; Tom, W.; Chamlin, S.; et al. "Guidelines of Care for Atopic Dermatitis." Journal of the American Academy of Dermatology. 2014; 70(2):338-351.

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