Eczema (or dermatitis) is very common condition that affects millions of people of all ages. In mild cases of eczema, the skin is dry, scaly, red and itchy. In more severe cases there may be weeping, crusting and bleeding. Constant scratching causes the skin to split and bleed and also leaves it open to infection.
If you have eczema, your skin may not produce as much fats and oils as other people’s, and will be less able to retain water. The protective barrier is therefore not as good as it should be. Everyday substances like soap or hand sanitizer contribute to breaking down the skin. Skin with eczema is more liable to become red and inflamed on contact with substances that are known to irritate or cause an allergic reaction.
Eczema is a chronic condition; it typically improves and then flares (gets worse) periodically. Some people have no symptoms for several years. Eczema is not curable, although it is possible to control your symptoms with a variety of self-care measures and medications.
Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with eczema are thick creams (such as Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline), which contain little to no water. Emollients are most effective when applied immediately after bathing. Emollients can be applied twice a day or more often if needed. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.
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It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving itching from eczema. An unscented, mild soap or non-soap cleanser should be used sparingly. Apply an emollient immediately after bathing or showering to prevent your skin from drying out as a result of water evaporation. Emollient bath additives (products you add to the bath water) have not been found to help relieve symptoms.
In some cases, health care providers may recommend dilute bleach baths for people with eczema. These baths help to decrease the number of bacteria on the skin that can cause infections or worsen symptoms. To prepare a bleach bath, one-fourth to one-half cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for 5 to 10 minutes twice per week and should be followed by application of an emollient.
Eliminating factors that aggravate your eczema symptoms can help to control the symptoms. Possible triggers may include:
- Cold or dry environments
- Emotional stress of anxiety
- Rapid temperature changes
- Avoid exposure to certain chemicals and/or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke
- Topical steroids
Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize your skin. As the skin improves, you can switch to a non-medicated emollient. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin that can result from long-term use.
- Topical immunomodulaters
Topical immunomodulators are a fairly recent development in the treatment of atopic eczema. The term immunomodulator refers to a drug that is able to modulate or alter the immune system in some way. This helps to reduce inflammation and redness.
They are not steroids and therefore do not have the concerns about potential skin thinning associated with inappropriate use or overuse of topical corticosteroid treatments.
- Oral antihistamines
Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine (Benadryl) and prescription antihistamines, such as hydroxyzine (Vistaril, Atarax) and cyproheptadine, are most effective for itching caused by eczema, although these drugs can cause drowsiness.
The nonsedating antihistamines such as cetirizine (Zyrtec) and loratadine (Alavert, Claritin) may relieve itching; both are available without a prescription and cause less drowsiness.
- Oral steroids
Oral steroids (prednisone) or injected steroids (triamcinolone) occasionally are used for a short period of time to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis or for prolonged periods of time because of potential side effects.
- Oral antibiotics
Antibiotics are often used to treat bacterial infections, open sores, or cracking in the skin caused by frequent scratching. A skin care professional can prescribe antibiotics for a length of time based on the condition of your skin issue and your specific needs. Taking the required antibiotics for the recommended time will continue to prevent infections from reoccurring.
Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. However, treatment with these drugs can cause serious side effects, including an increased risk for infection. They are not recommended for use in infants or young children.
The injectable biologic medication dupilumab (Dupixent) may be beneficial for treating eczema. Due to its high cost and potential side effects, this drug is reserved for adults with moderate to severe eczema that has not responded to other treatments.
Ultraviolet light therapy (also called phototherapy) can effectively control eczema. However, this therapy is expensive and may increase your risk of skin cancer, and is therefore recommended only for people with severe eczema whose symptoms do not respond to other treatments.