Eczema: prevention and treatment
Eczema — also known as atopic dermatitis — is a type of chronic (ongoing or recurrent) skin inflammation. People with eczema have dry, irritable skin. The normal protective barrier of the skin is not effective in many people with eczema, and this allows substances to get in and irritate the skin. In addition, itching and scratching contribute to the damage and inflammation of the skin.
While there is no cure for eczema, there are treatments that can reduce symptoms and prevent flare-ups.
You can look after your eczema by protecting your skin barrier with moisturisers, avoiding irritants to the skin and triggers of your eczema, and lastly by treating flare-ups promptly with medicated ointments or creams.
Eczema often improves on its own with age - many children with eczema grow out of it.
Avoiding irritants and allergens
It’s important to try to avoid anything that tends to aggravate your eczema.
Common environmental irritants include:
- bubble baths;
- grass; and
Common allergens (substances that can aggravate eczema if you are allergic to them) include:
- house dust mites;
- animal dander (small scales from the skin and hair of animals); or even
- certain foods.
Overheating can also make your eczema worse, and 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.
Soap substitutes for people with eczema
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, 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.
Having shorter or less frequent baths/showers can also help treat dry skin. Having long, hot showers can cause eczema to flare up.
Moisturisers or emollients
Moisturising your skin is one of the easiest and most important measures in protecting your skin barrier, 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 skincare routine. Emollient is just another word for a moisturiser - normally a cream or ointment that softens the skin and may soothe it.
You should use moisturisers frequently throughout the day to keep your skin soft and supple. For very dry skin, moisturise at least twice a day all over the skin.
Avoid moisturisers that contain perfumes and preservatives (which can irritate the skin).
If you can, use ointments, which tend to be more effective than creams or lotions if you have very dry skin. Moisturisers should also be applied within 3 minutes of having your bath and shower to lock in the moisture.
Steroid creams and ointments
Creams or ointments containing corticosteroid are the most commonly used treatments for exacerbations (flare-ups, or flares) of eczema. Steroid preparations relieve itching by reducing inflammation in your skin, and are very effective and safe when used correctly.
During an eczema flare-up, corticosteroids should be applied to the entire area of skin that is inflamed. Daily applications are usually recommended until the inflammation has cleared up. The strength of the corticosteroid ointment or cream will depend on the area of skin that is affected (lower strengths are usually used for the face, armpits and groin).
Using high-strength steroid ointments or creams over long periods can be associated with local side effects (such as thinning skin, stretch marks and dilated blood vessels). However, short-term use of steroids to treat inflamed eczema is generally safe. The risk of having untreated eczema outweighs the risk of side effects from appropriate corticosteroid use.
As a guide, one fingertip-full of cream or ointment (from the end of the finger to the first crease) is enough to cover an area the size of 2 adult hands.
Immunomodulators (also called calcineurin inhibitors) such as pimecrolimus cream (brand name Elidel) can be used in the treatment of eczema. They control inflammation when applied to the skin and can be used to treat eczema symptoms and reduce exacerbations when a steroid cream cannot be used.
However, because of concerns about cancers of the lymphatic system and skin, pimecrolimus is not recommended for long-term continuous use and should not be used on skin that has pre-cancerous changes, is exposed to a lot of sun, or has previously had a skin cancer removed. Your doctor or specialist will be able to advise you if pimecrolimus is appropriate for you.
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.
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.
Anti-itch (anti-pruritic) preparations for eczema
Cold compresses, oatmeal bath additives and coal tar and pine tar preparations may help to relieve itchy skin.
Sedating antihistamines (antihistamines that make you drowsy) are occasionally recommended 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.
Wet dressings for eczema
Wet dressings – applying emollients or steroid cream to the skin, then covering with bandages or clothing (such as a t-shirt or pyjamas) that have been soaked in warm water – may help eczema symptoms, including itching, in some people.
Wet dressings are often used in severe flare-ups of eczema, generally for a period of a few days. They should be left on for approximately 15 minutes to one hour, and can be applied 3 to 4 times per day.
Your doctor may also recommend a technique known as the soak and smear technique to treat severe eczema. The soak and smear technique is done just before going to bed. You soak in a warm bath for 20 minutes and then apply corticosteroid to the affected skin straight after the bath (do not dry the skin with a towel). You then put on comfortable pyjamas with your skin still damp. The next morning you apply moisturiser to your skin.
Supplements such as evening primrose oil, fish oil and borage seed oil have been touted as possible treatments for eczema symptoms. However, there is a lack of good-quality evidence to show that they are effective in treating eczema. There is no evidence for the use of probiotics in the treatment of eczema.
Treatments for severe eczema
If you have severe eczema that is not responding to treatment, your doctor may refer you to a dermatologist (skin specialist).
Tablets that suppress your immune system, such as ciclosporin (brand name Neoral) 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 each week. This treatment is expensive and time-consuming, and possible long-term side effects include premature skin ageing and skin cancer.
Eczema support groups
There are support groups for people with eczema and parents or carers of children with eczema. Talking with other people who are dealing with similar challenges can help reduce feelings of stress.
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3. Mayo Clinic. Atopic dermatitis (eczema) (updated 26 Jul 2016). http://www.mayoclinic.org/diseases-conditions/eczema/basics/definition/con-20032073 (accessed Dec 2016).
4. BMJ Best Practice (Patient information from BMJ). Eczema (published 1 Dec 2016). http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532148.pdf (accessed Dec 2016).