Eczema is a chronic skin disorder that causes skin to become dry, cracked, and irritated on various parts of the body including on face, hands, feet, on scalp, and even around eyes and eyelids. The bad news is there is no cure for the disease. However, there are a number of treatment options you can use to obtain relief from eczema symptoms. Here’s a breakdown of what’s available and some self-care remedies that can prevent flare ups or minimize discomfort.
The severity of your condition will determine which treatment options work best for you. You should discuss the various remedies with your healthcare provider or dermatologist to figure out which ones will help you manage your eczema the best.
Emollients are typically thick, creamy moisturizers that form a barrier on the skin to help it retain moisture and protect it from environmental elements. These products contain oil, but the amount varies depending on the type. Ointments tend to have the most oil but can leave a greasy residue on skin, clothing, and bedding. Lotion tends to contain mostly water mixed with a little bit of oil, so they are not always effective at treating eczema because the water evaporates too fast. Cream moisturizers generally have a 50/50 mix of oil and water, but they may not be as useful for people with very dry skin.
Using emollients correctly is a critical part of obtaining the protection they provide. Apply the moisturizer at least twice a day, whenever your skin feels dry and itchy, and/or after taking a shower to lock in moisture. Avoid rubbing the emollient into the skin. Instead, gently smooth it on and work in the same direction the hair grows. During flare ups, use more than you normally would and on a more frequent basis.
Do not share your emollient with other people, and scoop the substance out of the jar using a spoon or use a pump dispenser to avoid spreading bacteria to the moisturizer and giving yourself an infection.
Barrier Repair Moisturizers
These are prescription-strength emollients prescribed to you by a doctor. They work by enhancing or replacing the skin’s natural barrier. Since skin affected by eczema doesn’t produce as many ceramides (fats that naturally occur in the skin), these creams contain lipids that form a barrier to keep moisture in and bacteria out. They are generally prescribed when regular emollients fail to provide relief.
A few popular ones are Atopiclair, Mimyx, Hylatopic Plus, and Epiceram.
This medication is made from steroids, which are hormones that naturally occur in the body. When applied topically to affected skin, corticosteroids can reduce inflammation, irritation, soreness, and itching. It can also reduce the urge to scratch, which will allow the skin to heal.
Topical corticosteroids come in three strength levels: mild, moderate, and high-dose. Your doctor will prescribe or recommend a medication based on the severity of your flare ups. Some of the more popular ones include hydrocortisone, clobetasone butyrate, and mometasone.
Unlike emollients, you usually only apply topical corticosteroids once per day, since there is no increased benefits associated with using it more frequently. In some cases, your doctor may recommend that you use this medication less often (e.g. weekends only) but over a longer period of time to help control symptoms and prevent flare ups.
The medication should be applied first and allowed to soak into the skin. This will take about 30 minutes, so wait to apply an emollient to the affected areas until that time has passed. However, you should continue applying moisturizer to unaffected skin right after taking a shower.
Only use the medication until two days after your flare up clears up. This will allow you to treat the inflammation that may continue under the skin after the visible symptoms have disappeared but minimize the side effects associated with the use of topical corticosteroids. These side effects include thinning of the skin, changes in skin color (lightening), acne, and increased hair growth. Any side effects that do develop while using the medication generally subside once you stop.
If topical corticosteroids are not effective at treating your eczema flare ups, you may be prescribed corticosteroid tablets. This is an oral medication designed to reduce inflammation inside the body and is typically only prescribed for 5 to 7 days to treat severe eczema flare ups.
Though this type of systemic treatment can be effective, it’s associated with a higher risk of side effects such as high blood pressure, changes in mood and behavior, and increased susceptibility to infections. You’ll need to work closely with your doctor to ensure use of this medication doesn’t threaten your health.
In some cases, the doctor may prescribe corticosteroid injections that are applied directly to the affected patches of skin. This is typically done in cases where the eczema outbreak and resulting inflammation is particularly severe.
Although eczema is not an allergic reaction, antihistamines can reduce or eliminate itching. This medication blocks histamine, a substance in the blood that stimulates the body’s immune response.
Use of antihistamines can reduce nighttime scratching and give your skin a chance to heal. However, some brands of antihistamines can cause daytime drowsiness, so you should discuss non-sedating options with your doctor if you’ll be participating in activities where you need to remain alert (e.g. driving, operating machinery).
Bandages and Wet Wraps
If your eczema is particularly bad, covering the area with a wet wrap has been shown to quickly alleviate symptoms, sometimes within hours. This treatment involves applying corticosteroid medication to the affected skin and then wrapping it in special medicated bandages that have been wetted in water. The wrap allows the medication to better penetrate the skin as well as help the skin retain moisture. It may also reduce itching.
It is a labor intensive treatment because you’ll need to rewet the wraps at regular intervals when they start to dry out. Many times, nursing expertise is required to apply the wraps correctly, especially if they will be applied to the face. This is why this treatment primarily done in doctor’s offices and hospitals. If you suffer from severe flare ups on a regular basis, though, your doctor may teach you how to do this treatment at home.
Topical Calcineurin Inhibitors
These are non-steroid medicines that have the same effect as corticosteroids. They are applied to the skin to reduce itching and treat the rash associated with eczema by suppressing immune system activities. However, topical calcineurin inhibitors do not cause the same side effects associated with steroids such as acne, discoloration, thinning skin, or stretch marks. Because they suppress the immune system, though, you may have an increased susceptibility to communicable diseases such as cold as well as infections.
Protopic (tacrolimus) and Elidel (pimecrolimus) are two commonly prescribed medications in this category.
This treatment uses narrowband ultraviolet light to alleviate the symptoms of eczema outbreaks such as itching and inflammation. It also improves the skin’s ability to fight off bacteria and increases vitamin D production, both of which can help the skin heal and resist future outbreaks. Other forms of UVA light such as broadband, PUVA, and UVA1 may be used in certain situations, and medication may be in conjunction with phototherapy to enhance the effect of the ultraviolet light.
Phototherapy is typically prescribed to treat widespread and localized flare ups that do not respond to other types of topical treatments. Though it takes about 1 to 2 months of continuous treatments (about 2 to 3 times per week) to see results, approximately 60 to 70 percent of people who undergo phototherapy experience improvements in their symptoms.
Like any treatment, there is a risk of side effects, which includes burns, faster skin aging, and increased risk of skin cancer. You can also damage your eyes if you don’t wear eye protection during the treatment.
The cause of eczema is still unknown, but it is theorized that immune system dysfunction may contribute to the onset of the disease. An autoimmune disorder is when the body views its own tissues and organs as foreign matter and begins to attack them, causing systemic inflammation. Immunosuppression therapy, which primarily consists of various medications, inhibits the action of the immune system to reduce inflammation and resultant symptoms.
Some commonly prescribed immune suppression drugs include cyclosporine, methotrexate, and mycophenolate mofetil. While effective, many doctors and patients view the use of these medications as a last resort because the side effects can be severe. While using immunosuppressants, you have in increased risk of bacterial and viral infections, cancer, kidney damage, liver damage, high blood pressure, and you may experience gastrointestinal distress such as vomiting.
In general, these drugs are only prescribed for a short period of time to help patients get their eczema under control, and then they are switched to other treatments when the disease becomes more manageable.
Because the skin barrier is thin or non-existent, you have a higher risk of getting bacterial infections, especially if your skin is cracked or develops open sores. These infections can trigger eczema flare ups and worsen symptoms. To combat these infections, your doctor may prescribe oral or topical antibiotics.
It’s important to use the medication for the length of time prescribed; otherwise, drug-resistant strains of bacteria may develop and it’ll be harder to get rid of them.
Also called liquor carbonis detergens (LCD) and liquor picis carbonis (LCP), coal tar is a byproduct of carbonized or gasified coal. It contains a number of medicinal compounds that are useful for alleviating symptoms related to eczema, psoriasis, dandruff and other similar skin disorders. You can find a number of medicated shampoos, soaps, and ointments that contain coal tar marketed under a variety of brand names such as Denorex, Tegrin, T/Gel, and Neutar.
In addition to reducing itching, coal tar contains an analgesic that alleviates pain. However, it has a strong smell, can stain fabric, and may irritate skin. You should only use it while under the care of a doctor who has experience treating patients with eczema to ensure you’re using it safely.
Psychodermatology is a fancy word for the management of skin disease by using various psychological methods. Since stress is a contributing factor to eczema flare ups, reducing stress in your life will be an important aspect of your treatment. Cognitive-behavior therapy techniques may also be used to help you stop participating in counterproductive behaviors such as scratching.
Common psychodermatology techniques include biofeedback, hypnosis, meditation, and methods that focus on relaxation such as deep breathing. They are safe to use and typically do not cause side effects. However, they can be time consuming, and it may take a while before you see results.
Bacteria on the skin are a constant concern when it comes to eczema. As mentioned previously, the lack of a barrier makes skin more prone to infections. Taking a bleach bath two to three times per week is an effective way to deal with this issue.
Pour 1/2 cup of bleach into a full bath of warm water (or a 1/4 cup for a half bath) and soak in the mixture for 10 minutes. Rinse off thoroughly, dry, and immediately apply moisturizer.
Bleach can irritate and even burn the skin, so it’s essential that you are careful with your measurements and rinse your skin completely. Also, avoid wiping your eyes with your wet hands; otherwise you may get bleach in them and cause damage.
If you’re leery about using bleach in your bath water, you can get the same effect by using vinegar instead. Simply add one cup to one pint of white or apple cider vinegar to a full bath of warm water. Soak for 10 minutes, rinse, dry, and moisturize.
Self Care Tips
While medication and other remedies are an important part of managing your eczema, self-care plays a vital role as well. Here are several things you should do on a consistent basis to help prevent flare ups and minimize symptoms when you do experience an outbreak:
- Shower or take a bath every day in warm water; the water should not be too hot or too cold as either extreme temperature can dry out skin
- Pat skin dry. Avoid rubbing as this can irritate skin and cause it to lose moisture.
- Apply moisturizer within three minutes of getting out of the bath to lock in the moisture your skin absorbed
- Moisturize multiple times a day or whenever your skin gets dry
- Only use mild soaps or soap-free cleansers that don’t contain perfumes or unnecessary preservatives and additives
- Avoid wearing clothing made from rough fabrics such as wool or synthetic fibers; stick to cotton and other soft fabrics
- Use a humidifier when the weather is cold and dry; the humidity in your home or office should be around 45 to 55 percent
- Avoid becoming too hot or too cold
- Take time to learn what your eczema triggers are and take steps to minimize their presence in your life