Eczema can be quite stressful especially for adolescents and young adults. It may disturb your sleep and disrupt your daily routines. Long standing eczema may even cause depression in some patients. Family members of patients with eczema may also face various social, emotional and financial difficulties. Do not fight eczema alone. Seek emotional support from counsellors, support groups, family and friends.
How is eczema treated?
As per se, there is no cure for eczema however, it can be managed effectively so much that you may have no eczema symptoms. Eczema can go into total remission after a childhood in the majority of patients. But some may have time to time flare-ups even after control.
Eczema Treatment
After taking the history and examination of your skin, your doctor will diagnose eczema clinically. Lab tests are not usually needed for diagnosis. Sometimes your doctor will do a patch test to exclude other skin conditions such as contact dermatitis. Eczema is a chronic skin condition that may be persistent. You may have tried various home remedies and over the counter medications without any success.
Your doctor may have to try several treatments for months or even years until your eczema is properly controlled. However, even after successful control of your symptoms, you may get a sudden flare. Your doctor will advise you how to identify and avoid the triggers of eczemain order to prevent a flare.
You may already know that regular moisturizing helps to control your eczema. However, moisturizing per se is not adequate for successful control.
Your doctor will suggest a few of the following treatments to control your eczema.
- Your doctor will prescribe the best emollient which suits your skin. If your skin is very dry, he or she will prescribe an ointment. Ointments contain the most oil, therefore they are greasy. Ointments are very effective in keeping moisture of skin. A cream or a lotion is adequate for less dry skin. Moisturizing must be done twice a day. A cream is suitable to apply during day time. Since ointments are greasier apply them at night. Creams may sting more than ointments.
Your doctor will prescribe creams or ointments to treat your eczema. They will also control your itching while improving the rash by repairing the damaged skin.
Here are some of the prescribed creams or ointments.
- Corticosteroid creams or ointments – Once you moisturize your skin, apply a thin layer on the eczematous lesions as directed by your doctor. Corticosteroids reduce redness of your skin and swelling by controlling the inflammation.
Examples of topical corticosteroids are:
Hydrocortisone – for lesions in your face, neck and other sensitive areas
Betamethasone – more potent
Mometasone – effective with less side effects
Clobetasol – used for thick lesions and eczema on hands and feet
Note: Use a moisturizer first before applying the medicated creams, as it will help to penetrate your skin better. Once your initial lesions are controlled, use topical corticosteroids less frequently, to prevent a flare. Make sure not to overuse corticosteroids as they can cause thinning of your skin.
- Calcineurin inhibitors –
Calcineurin inhibitors act by affecting your immune response. It is safe to use them in anyone above 2 years of age. They are useful to treat eczema in sensitive areas and those lesions which do not respond to other treatments. After moisturizing your skin, apply as directed by your doctor. Avoid strong sun light when using calcineurin inhibitors.
Ex: Tacrolimus (protopic), Pimecrolimus (Elidel)
For severe eczema your doctor will use oral medications to fight inflammation and to control your symptoms.
- Oral corticosteroids – If your eczema is severe, your doctor will prescribe oral corticosteroids.
Ex: a short course of oral prednisone
They are effective, although they cannot be used for long periods because of the potential side effects that can be serious.
- Medications that fight infection – If your eczema is associated with a bacterial infection, an antibiotic cream will be prescribed. If your infection looks severe with oozing of pus and fever, a short course of oral antibiotics may be prescribed to treat the infection.
- Dupilumab (Dupixent) – a new option to treat severe Eczema.
This is an injectable biologic (monoclonal antibody) which is recently approved by the FDA. It is used for people with severe eczema that does not respond well to other medications. Dupilumab is an expensive drug. It is safe when used only as directed. More studies are needed to identify the benefits of this drug.
- Antihistamines – Ex: Fexofenadine (Allegra), Cetirizine (Zyrtec), diphenhydramine
Antihistamines will be prescribed to control itching. Anti-itch medications can cause drowsiness. Therefore, it is best to use them before you go to bed.
There are certain therapies that may be combined with the medications.
- Applying wet wraps – The affected region can be wrapped with emollients, corticosteroids, and wet bandages. It is shown to be effective in patients with severe eczema. However, wet wrapping may be too intensive to do at home. Therefore, for patients with widespread eczema lesions, wet dressings are done a hospital setting, because it requires good nursing care and expertise. If you are competent enough, you can do wet wrapping at home once you learn the proper technique from your doctor.
- Light therapy – Phototherapy with artificial UVA (Ultra violet Alight) or NB- UVB (narrow band ultra violet B) light can be used alone or in combination with other treatments. You can try exposing your skin to natural sun light in controlled amounts as light therapy.
Light therapy is found to be beneficial in patients who do not respond to topical treatments or in those who get frequent flares.
- Behavior modification and other relaxation techniques – This will help to keep your stress under control as well as help those who scratch their lesions habitually.
- Counselling – you may be tired of eczema, especially if you have been having it for a long time. Talk to a therapist or a counselor for emotional support.
- Dietary modifications – Your doctor may suggest certain dietary changes if your history suggests food triggers. Foods such as cow’s milk, eggs, soy may trigger symptoms or cause flares. If your doctor suspects a food allergy, he or she may refer you to a dietician to modify your diet.
How to manage your eczema?
Manage Stress
Manage your stress well by practicing relaxation techniques such as yoga and meditation
Sound Sleep
Always try to get quality sleep. Poor sleep can increase your stress and make you less functional during day time
Healthy Diet
Eat a balanced, healthy diet. Make sure you avoid triggering foods
Home Remedies for Eczema
You can try these home remedies to control and prevent getting eczema flares.
- Avoid scratching – scratching can worsen your eczema. Eczema is commonly known as “The itch that rashes”, as the rash appears after itching and worsen with continuous scratching. If you get an urge to scratch, just pat on your skin or distract yourself by thinking of something else.
Cover the itchy areas if you are unable to avoid scratching. For children with eczema, trimming of their nails help. Getting them to wear gloves or anti-scratch mittens can prevent unintentional scratching at night. Covering your rash with a bandage will not only prevent scratching, but also will protect your skin.
- Warm baths – you can sprinkle your bath water with colloidal oat meal or baking soda. Soak yourself for 15 minutes and pat dry.
- Use a mild, fragrance free soap to wash your skin. Pat dry with a soft towel. Avoid wiping hard or rubbing your skin.
- Avoid strong soaps and detergents as they can worsen your rash.
- Moisturize to keep your skin well hydrated – by using a good emollient regularly you can moisturize your skin well. Choose one that is alcohol and paraben free and with minimal fragrance. Ingredients in a good moisturizer include aqueous cream, glycerol, Dimethicone, Argon oil, Shea butter, cocoa butter and Lanolin oil. When selecting a moisturizer look for these ingredients. Choose the best emollient that is suitable for your skin type. You can get help from your doctor to select the most suitable emollient for you.
- Apply the moisturizer after a bath while the skin is still damp. Damp skin will absorb and lock in the moisture well.
- Identify and avoid the triggers that can worsen your eczema.
Ex: Certain food items, Pollen, dust, excessive sweating and heat, strong soaps and detergents. Identify them early and avoid them as much as possible. Quit smoking if you do.
Avoid wool or clothing which are too tight, rough, or scratchy. Wear smooth-textured, cooling clothes to minimize skin irritation. If you are going out in hot weather or during your workouts, wear appropriate clothing to prevent excessive sweating.
What are the OTC (over the counter) products you can use for Eczema?
You can try these home remedies to control and prevent getting eczema flares.
- Avoid scratching – scratching can worsen your eczema. Eczema is commonly known as “The itch that rashes”, as the rash appears after itching and worsen with continuous scratching. If you get an urge to scratch, just pat on your skin or distract yourself by thinking of something else.
Cover the itchy areas if you are unable to avoid scratching. For children with eczema, trimming of their nails help. Getting them to wear gloves or anti-scratch mittens can prevent unintentional scratching at night. Covering your rash with a bandage will not only prevent scratching, but also will protect your skin.
- Warm baths – you can sprinkle your bath water with colloidal oat meal or baking soda. Soak yourself for 15 minutes and pat dry.
- Use a mild, fragrance free soap to wash your skin. Pat dry with a soft towel. Avoid wiping hard or rubbing your skin.
- Avoid strong soaps and detergents as they can worsen your rash.
- Moisturize to keep your skin well hydrated – by using a good emollient regularly you can moisturize your skin well. Choose one that is alcohol and paraben free and with minimal fragrance. Ingredients in a good moisturizer include aqueous cream, glycerol, Dimethicone, Argon oil, Shea butter, cocoa butter and Lanolin oil. When selecting a moisturizer look for these ingredients. Choose the best emollient that is suitable for your skin type. You can get help from your doctor to select the most suitable emollient for you.
- Apply the moisturizer after a bath while the skin is still damp. Damp skin will absorb and lock in the moisture well.
- Identify and avoid the triggers that can worsen your eczema.
Ex: Certain food items, Pollen, dust, excessive sweating and heat, strong soaps and detergents. Identify them early and avoid them as much as possible. Quit smoking if you do.
Avoid wool or clothing which are too tight, rough, or scratchy. Wear smooth-textured, cooling clothes to minimize skin irritation. If you are going out in hot weather or during your workouts, wear appropriate clothing to prevent excessive sweating.
- Manage your stress well by practicing relaxation techniques such as yoga and meditation
- Always try to get quality sleep. Poor sleep can increase your stress and make you less functional during day time
- Eat a balanced, healthy diet. Make sure you avoid triggering foods