Eczema: prevention and treatment
Eczema — also known as atopic dermatitis — is a type of chronic (persistent or recurrent) skin inflammation. People with eczema have dry, irritable skin, and itching and scratching are the cause of most of the skin changes. Eczema is treated by avoiding irritants to the skin and by using applications of moisturising and healing ointments or creams.
Avoiding irritants and allergens
It’s important to try to avoid anything that tends to aggravate your eczema. Common environmental irritants include soaps, bubble baths, shampoos, solvents, wool and nylon. Pollens, house dust mites, animal dander (small scales from the skin and hair of animals) or even certain foods can also aggravate eczema if you are allergic to them.
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
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 can also be helpful, but you should be careful as they make the bath slippery. Having shorter or less frequent baths/showers can also help treat dry skin.
Moisturisers or emollients
Moisturising your skin is one of the easiest and most important measures in preventing itching and scratching, as well as reducing eczema flare-ups. Be careful to avoid moisturisers that contain perfumes and preservatives which can irritate the skin.
Moisturisers should be applied frequently — at least twice a day all over the skin. Ointments tend to be more effective than creams or lotions for very dry skin. It’s best to apply the moisturiser or emollient straight after a shower or bath to help seal in the moisture from bathing.
Wet dressings
Wet dressings (applying emollients or steroid cream to the skin then covering with bandages soaked in warm water and finally dry bandages) may help eczema symptoms in some people. However, more research is needed to show whether wet dressings are effective in relieving eczema symptoms.
Steroids
Creams or ointments containing corticosteroid are the most commonly used treatments for exacerbations of eczema. Steroid preparations relieve itching by reducing inflammation in your skin, and are very effective and safe when used correctly.
Using high-strength steroid creams over long periods is associated with local side effects (such as thinning skin, stretch marks and dilated blood vessels). So in general, you should use the lowest strength and smallest amount that works adequately. Facial skin is particularly susceptible to steroid side effects.
Occasionally, corticosteroid tablets are needed to control symptoms in people with severe eczema. They are usually only given for a short period of time due to potential side effects.
Topical immunomodulators
Immunomodulators such as pimecrolimus cream (brand name Elidel) are the newest form of treatment for 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 become infected. If this occurs, your doctor may prescribe antibiotic cream or tablets to treat the infection. Tablets are usually prescribed because they are more effective than creams. 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-pruritic (anti-itch) preparations
Sedating antihistamines (antihistamines that make you drowsy) may be used 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. Oatmeal bath additives and pine tar preparations may also help to relieve itchy skin.
Nutritional supplements
Supplements such as evening primrose oil and flaxseed oil may also help treat eczema symptoms. However, there is a lack of good-quality evidence from patient studies that proves they are effective. There is also no scientific proof that fish oil, borage oil, or vitamin or mineral supplements are effective treatments for eczema.
Treatments for severe eczema
Tablets that suppress your immune system, such as cyclosporin (e.g. Neoral, Sandimmun) 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.
Last Reviewed: 26 March 2007
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