How to treat eczema?

Written by: Ayesha Khan, MBBS

In a Nutshell

• Eczema is a chronic inflammatory skin condition that is characterized by dry, itchy, and flaky skin
• Lifestyle modification and treatment modalities can be employed to keep eczema flares in check
• Treatment regimen varies and is a combination of oral, injectable, and topical medications, and phototherapy

What is Eczema?

Eczema is a chronic inflammatory condition of skin that is non-contagious. It is characterized by appearance of red, scaly, cracked, and itchy patches on skin. In severe cases, blistering may also occur. According to latest estimates, eczema affects about 30% of the US population.

Eczema is an uncomfortable condition that has no cure so far. However, you can manage the symptoms with appropriate treatment (i.e. topical agents to control the symptoms), avoiding irritants, and basic self-care.

Simple Treatment Regimen

Symptoms of eczema are often unpredictable. Some people develop flares around a specific time of the year, while others experience symptoms all year long.

The goal eczema treatment is to moisturize the skin, reduce itchiness, redness and flaring of skin and minimize the risk of infection. Eczema symptoms are different for different people so, the remedy that is beneficial for one person may not be as effective for another individual. Treatment plan varies according to the severity and type of eczema and includes a combination of:

- Lifestyle changes

- Prescription and over the counter medications (oral, injectable, and topical drugs)

- Biologic drugs

- Phototherapy

Lifestyle Modifications

- Take cool or lukewarm baths over hot baths to minimize dryness of skin that further aggravates the irritation.

- Moisturize your skin after every bath while your skin is still damp. Use a small quantity (about the size of a lima bean) to apply a thin film on your face.

- Some people add different products that ease their symptoms such as vinegar, oatmeal, salt, baking soda in their baths.

- Use mild or gentle soaps and cleansers as harsh soaps further irritates your skin and worsen your symptoms.

Topical and over-the-counter medications: Topical anti-eczema medications can ease itching, inflammation, redness, and dryness of skin such as:

- Corticosteroids

- Phosphodiesterase inhibitors

- Skin barrier creams

- Calcineurin inhibitors

These topical agents can be used twice a day, or as suggested by your healthcare professional.

1. Phototherapy: Ultraviolet rays help in easing eczema symptoms. Phototherapy is suitable for people with moderate to severe eczema that is refractory to topical medications and home remedies. Phototherapy can be done at home by exposing skin to moderate amounts of natural sunlight or you can use artificial ultraviolet via UV lamps. Phototherapy not only eases discomfort but also increases the production of vitamin D and improves overall immunity. Phototherapy sessions may range from 15 minutes to an hour and it is recommended to give a 2-day break between sessions. It generally takes 1-2 months of regular phototherapy to see fruitful results.
2. Immunosuppressant: Some researchers believe that eczema is linked to hyperactive immune system that causes swelling and inflammation in response to allergens. Severe cases of eczema that are refractory to traditional treatments can be managed with immunosuppressants.
   Immunosuppressants are drugs that aid in suppressing the immune system and results in improving severity of eczema. The dosage and frequency vary according to patient factors and severity of condition.
3. Biologics: Another way to treat severe eczema or atopic dermatitis is using by using biologic drugs (a class of drugs that has a localized action that are administered intravenously to target specific areas of immune system that are triggering the inflammation. The dosage and frequency vary according to patient factors and severity of condition.

Self-Care to Prevent Flares

To reduce the frequency and intensity of flares, you should identify:

- The triggers or irritants that may cause a flare

- Avoid wearing clothes that further irritate your skin such as wool.

- Adopt good hygiene and moisturizing practices.

- Comply with your treatment regimen as suggested by your healthcare provider.

- Keep an eye on the signs of infection such as any secretion or pus-filled blisters, extreme pain, or redness on skin.

Nuances/ Safety:

- Eczema makes you more vulnerable to develop fungal, bacterial, and viral skin infections

- Family history of eczema or other allergy conditions can make you more susceptible to develop eczema

- According to estimates, about 30% of all children who have eczema also have food allergies and other respiratory allergies like asthma

Strength of Evidence: C
Treatment regimen varies according to severity of symptoms. Treatment regimen presented in this article is based of best practices as suggested by the National Health Services and American Dermatology Association.

Our Ruling:

Eczema is a chronic condition of skin that causes itchy, scaly, irritable skin. Symptomatic relief can be achieved by adopting strategies to control and manage the itch and discomfort. Eczema management varies according to age, severity of symptoms and medical history of the patient. Dry weather, low humidity, excess bathing, and using harsh soaps can aggravate eczema symptoms as people with eczema have usually very dry skin. Therefore, it is recommended to to moisturize skin at periodic intervals especially after bathing. For more severe symptoms, speak a to a healthcare professional for prescription medications.

Our Sources:

1. National Eczema Assn - Treating eczema
2. NHS - Eczema
3. NIAID - Managing eczema at home