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The Combined Approach to Treat Eczema

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What Triggers Eczema?

Skin is the largest organ in humans constituting the outer most layer of the body. It forms a barrier between the internal body and the environment to carry out these two-key functions:

1) To retain moisture by preventing the loss of water

2) Preventing foreign particles such as pathogens, allergens, irritants etc from entering inside the body.

This is called as the skin barrier function and its maintenance is very crucial for the skin’s health and overall protection of the body. In some Individuals due to complex interaction between the genetic and environmental factor, this skin barrier disrupts, and immune response of the cells gets altered. This alteration gives rise Atopic Dermatitis also commonly known as Eczema.

Eczema is commonly recognized as a dry, red, itchy and inflamed skin condition. This skin condition is common among the babies that disappear as the baby grows. But in some individuals, it continues and becomes a lifelong condition. Many teens and adults too suffer from this chronic skin condition. Eczema in children is common. Eczema gets flared or the condition exacerbates due to its triggers which can be anything from your day to day life such as food, apparel, weather, perfume, detergent, etc.

Eczema doesn’t have a complete cure like diabetes; it needs proper management. So the best treatment for eczema is
essential. A properly managed eczema skin is as good as normal skin. It is very crucial to keep a check or track your various activities for effective eczema management.


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The Combined Approach to Atopic Eczema Treatment

Managing eczema is not only about drugs and lotions, but it is also a multi-step and multi-factor process that includes, avoiding triggers, applying creams, taking medicines, changing behavior, etc. In short, it is a combined approach bringing together the conventional dermatology treatments with a set of psychological interventions. The combination of these topical remedies and the elimination of self-damaging behavior such as scratching optimizes the effectiveness of healing and managing eczema.

This Combined Approach to treating eczema is one of the techniques from behavioral dermatology. It uses behavior modification to optimize the conventional treatment of atopic eczema. It was originally devised by Dr. Peter Norén, Dermatologist in Uppsala, Sweden.  eliminating the habitual behavior is key as it results in the chronic eczema condition not allowing it to heal.

Using the EczemaLess app you can inculcate the combined approach in your routine to treat and manage eczema effectively. Let us check out the fundamentals of treating eczema with a combined approach using eczemaLess app

3 Fundamentals of treating eczema

The 3 fundamentals for treating eczema using the combined approach are

  1. Manging Dryness
  2. Treating Eczema Inflammation
  3. Scratch control

Managing Skin Dryness

Managing Skin Dryness in Eczema

In Eczema due to the barrier dysfunction the skin losses its property to retain moisture. This results in water loss making the skin dry. Dry skin further exacerbates the eczema symptoms giving rise to itching, making the skin susceptible to damage due to scratching. Extreme Dry skin also leads to cracks, which opens the entrance to the pathogen, causing infection in Eczema.

This dry condition can be managed by keeping the skin moisturized. Effective moisturizing is one of the key elements in keeping Eczema flares down and avoiding flare-ups.

For effective moisturizing one should be doing it in a certain fashion, at proper intervals and by selecting appropriate moisturizers. The best treatment for eczema is important hence, check out the tips below to effectively moisturize your skin in Eczema

Step 1 – Select the right moisturizer

Moisturizers come in different forms such as creams, lotion, and ointment. Each one differs from others in terms of water level and medicinal contents. You must always go with the application that is easy to apply and suits your eczema condition or get a piece of advice from your physician

Step 2 – Time to Apply

Figure out the right time and frequency to get maximum benefit in the treatment. The best time to apply moisturizer is immediately after your shower or as soon as you are out of a bathtub.

Reapply the moisturizer frequently, at a regular time interval, or as soon as the previous application dries up to retain the skin moisture effectively. Skin area which is exposed requires more frequent application than those which are covered.

Step 3 – Method to apply

Apply a thin layer to provide insulation for the water inside the skin and not very thick, because thick layer will trap the heat inside which may worsen then condition. Do not rub hard as it may further damage the skin

Apply the moisturizer softly but effectively covering all the skin areas, especially the effected and exposed ones. apply quickly without consuming much time before the wet skin gets dried up.

Treating Eczema Skin Inflammation

Topical Creams to treat Eczema

Eczema cannot be cured completely, the treatment of eczema lies in managing its symptoms such as inflammation, itch, rash effectively and preventing the episodes of flare-ups. As a primary line of treatment to eczema flares, topical and non-topical steroids and creams are used. These creams quickly relieve the itching and reduce the inflammation. Along with the other techniques, this will prevent Eczema flare-ups.

It is very essential to get the right topical treatment from your care provider. It is also very important to use them exactly as it is prescribed.

It is recommended to use it exactly as prescribed by the physician and not to leave until the skin stops itching and the inflammation has gone away. But not too long more than prescribed duration which may lead to topical steroid addiction and other side-effects due to overuse.

Use the fingertip rule for the quantity required to cover the affected area effectively.

Scratch Control

Scratch Control tips

The above two fundamentals fall under the conventional remedy for eczema, whereas this falls under the Psychological treatment that is bringing a behavioral change or habit reversal technique.

Often “itch” and “scratch” are used interchangeably to describe the same thing but clinically both mean different things. Itch is a feeling, while scratching is an action or behavior towards that feeling.

The dry skin and red rash condition of the skin gives rise to an unbearable itch. This itch leads to scratch to get temporary relief. But when an individual scratches the skin it gets damaged. Damaged skin leads to more rash that means more itching and ultimately which causes more scratching. This is called the vicious itch-scratch cycle which causes exacerbation of Eczema and damage to the skin.

When this cycle continues, one tends to scratch again and again which becomes a habit. So now the person starts scratching due to habit without any itch.

Habitual Scratching is the main cause of Chronic Eczema which continuously damages the skin and doesn’t allow eczema to heal. Hence it is very crucial to control the scratching or reverse this habit of scratching. There are numerous habit reversal techniques which can be used to prevent scratching, along with the other treatment.

The scratching can be tracked by counting them and noting the situations, circumstances and what helped for scratching. One of the best ways to deal with itch without scratching psychologically is holding the fist tightly for 30 secs. If it still feels itchy than a pinch or poke a nail on the skin.

Treatment cycle Duration

Treatment with topical steroids occurs in two stages in 1st stage of healing, the normal appearance of the skin is restored i.e. the skin looks good this is called “The look Good Point” and the second one “feel-good point” on.  Hidden healing which further reduces the possibility of a flare-up.

So, it is very important to continue the application beyond the look good point. As per the recommended approach, it takes approximately 5 – 6 weeks while treating chronic eczema to reach the look good point and takes a couple of weeks more to accomplish hidden healing. In acute eczema the numbers approximately the same only the weeks change into days.

The Combined Approach was designed for adults and older children with proper stages and routine to be followed.  A modified version suitable for Younger Children is also released which is almost like the earlier involving the parents. The stages of treatment are outlined, with an emphasis on how the parents, and others, are required to be involved. Both the plans for adults and younger children is based on the three fundamentals of treatment with few pre-treatment assessments.

Other points to consider along with the combined approach

Managing Triggers – Different people have different triggers that cause their eczema to flare. It’s important to keep track to identify the triggers and avoid it. Keep a track of your triggers using the trigger section in the app. In case of food try elimination diet technique (inform your physician before trying)

Managing Stress – Stress aggravates the eczema symptoms causing flare-ups. It also induces scratching leading to the itch-scratch cycle. Try different meditation techniques, to reduce stress and achieve peace of mind

Maintain Attitude – For the people suffering from eczema, life can often be miserable. A psychological boost is important if you believe you can do. Don’t “accept and live with it, think like it’s just a small skin problem.  Don’t give up if previous attempts have failed, the combined approach is holistic and has been shown to provide positive results

Avoid infection: In eczema due to low immunity and skin barrier dysfunction, the patient is at high risk for the infection. The patient needs to be extra cautious about the eczema flares he gets if the treatment is not subsidizing the flare one should seek medical. It may be due to the infection. Look for symptoms for Infection in eczema especially in kids.

Conclusion:

As we can see that though Eczema does not have any cure, by using proper techniques one can overcome Eczema. The combined approach of using conventional treatment along with behavioral changes can be very effective in combating Eczema in the long run.

References:  

  • https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.15092
  • https://www.researchgate.net/publication/311935534_Habit_reversal_for_habitual_scratching_in_younger_children_with_atopic_eczema

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