Eczema is a skin condition seen in allergic people which causes the skin to be dry, sensitive and feel rough and scaley. Sometimes, this process can progress to a generalized rash which is scaly, red, itchy and sometimes even broken open or weeping. Eczema tends to occur in people with a family history of allergy (asthma, hayfever, eczema, and/or itchy, watery eyes). The treatment of eczema is primarily directed at keeping the skin well hydrated and oiled up. Oil on the skin provides a barrier to infection and is essential to healthy skin. To keep the skin well hydrated and protected with oil, we recommend using the mildest and the least amount of soap as is possible. Soap washes away the normal oils of the skin and makes eczema worse. So use as little as possible and use the least amount possible. In addition, people with eczema are often allergic to the fragrance used in soaps, so use fragrance free cleansers.
As eczema progresses, infections with Staph Aureus and viruses (such as molluscum contagiosum) become more common. Skin infections are a problem for people with eczema because the condition has damaged the skin barrier. Infections can become quite serious if they are not treated promptly, so it is important to recognize the signs of infection:
- Increased redness
- Pus-filled bumps or oozing fluid
- Honey-colored crusts or scabs
- Cold sores or fever blisters
If you see any of these signs, contact us immediately for treatment options.
Treatment of Eczema
The treatment of eczema varies on how severe the eczema is. Mild eczema is treated with the use of gentle cleansers and the application of emollients. Severe eczema may require all the treatment modalities outlined below.
1. Soaps and Emollients
A skin cleanser or soap is a bar or liquid used to cleanse the skin. You should try products labeled for use with “sensitive skin” that are fragrance free. Examples of gentle soaps and cleansers include:
In addition to this, we recommend applying an emollient to the affected skin to further seal the skin from continued water loss. A moisturizer is a skin care product that adds moisture to the skin by sealing the skin to continued excessive water loss. Ointments and creams are recommended instead of lotions for people with very dry skin. Products that can help add moisture include:
These are available without a prescription. There are more expensive and effective prescription versions of moisturizers and emollients such as:
Consult us regarding these treatments.
Sometimes exposures to certain things in the environment and/or diet can make eczema worse. This is particularly true of cow’s milk, soy, peanuts and strawberries. Please refer to the section on this website on allergy for more information. Avoiding certain foods and or environmental triggers can have dramatic effects in helping to improve eczema.
3. Allergy medications
Because eczema is an allergic condition, certain allergy medications such as anti-histamines and leukotriene modifiers can help eczema. Consult us regarding specific recommendations for your child.
4. Steroid Ointments, Eurissa and Topical Clacineurin Inhibitors
Over the counter strength 1% hydrocortisone ointment may be used to treat this condition. It is safe to be used daily in the treatment of eczema. Make sure to use the ointment version of 1% hydrocortisone. It helps to seal the skin and improves eczema.
If your child’s dry, sensitive skin continues to be a problem despite the above measures, you should bring your child into the office for a routine office visit. There are other effective treatment options available. Some of these treatments options include:
- Medium potency cortico-steroid formulations such as Mometasone, Desonide and Triamcinolone. These are safe, but should not be used every day unless we instruct you to do this for severe cases.
- Eucrissa is a prescription ointment used on the skin (topical) to treat mild-to-moderate eczema in adults and children 2 years of age and older. It is steroid free. It’s safe, but quite expensive.
- Topical Clacineurin Inhibitors (TCIs) are also medicines that are applied to the skin to treat severe cases of eczema. TCIs include Protopic® ointment (tacrolimus) and Elidel® cream (pimecrolimus). They control skin inflammation, but are not steroids. Thus, TCIs don’t cause steroid side effects such as thinning skin. A common side effect of TCIs is skin burning. This is usually not a long-lasting problem. These medications do contain a black box warning that they might extremely rarely cause certain tumors and or cancer. Thus, their use should be limited to severe cases of eczema.
5. Wet wrap therapy.
Wet wrap therapy such as recommended by National Jewish Hospital in Denver, Colorado.