MOISTURIZING THE SKIN
Frequent moisturization of the skin (2 to 3 times daily) can be necessary in patients with eczema.
The natural skin barrier, which would normally trap moisture in the skin, doesn’t work well for patients with eczema. This leaves the skin dry, rough and sensitive to irritants. It is a common myth that drinking an adequate amount of water during the day will hydrate the skin—however, it is in fact applying a moisturizer frequently that hydrates the skin.
HOW TO BATHE AND MOISTURIZE
After bathing, gently pat the skin dry. Then follow your doctor’s recommendations for moisturizing and medication use (such as immediately applying your prescription treatments to skin with eczema patches, and applying a moisturizer to areas of the skin that don’t have active eczema).
Daily baths or showers are reasonable for people with eczema, however the duration of the bath or shower should be brief (5 to 10 minutes) and the bath or shower should be done with clear warm water (not hot water). Moisturizer should be applied to the skin after every water exposure, including showering, bathing, and hand washing.
Here are some general guidelines to follow when selecting skincare products for bathing and moisturizing.
- Products that have few ingredients and that are formulated for sensitive skin and eczema. Look for thick moisturizers that will both moisturize the skin, and provide a thicker barrier.
- Products that fit your budget. More expensive is not necessarily better.
- Products that the eczema sufferer will tolerate and will actually use. If you or your child dislikes the feeling of petrolatum, then find a moisturizer that works for you!
- Refer to our list of products that have earned our Seal of Acceptance.
Medical treatment is an important part of controlling eczema and medications (including topical creams and ointments) should be used as prescribed by your physician.
Topical Corticosteroids are prescribed to reduce inflammation and itching. Strengths range from mild to very strong. When used under the direction of a physician, topical corticosteroids are very effective and safe. In fearing side effects eczema sufferers, or their caregivers, often use the treatment too sparingly, or too infrequently. Possible side effects include thinning of the skin if preparations are used excessively or for extended periods. Follow your physician’s recommendations exactly, and address any questions or concerns you have with your physician.
TOPICAL CALCINEURIN INHIBITORS
Topical Calcineurin Inhibitors (e.g. Elidel®, Protopic®) are prescribed for inflammation and itching, and can be used for short, intermittent periods of time unless otherwise directed by your physician. A possible side effect is a mild to moderate burning sensation.
TOPICAL PDE4 INHIBITORS
Topical PDE4 Inhibitors (e.g. Eucrisa™) work to block an enzyme called phosphodiesterase 4 (called PDE4 for short) from allowing too much inflammation to occur in the skin. Cells in our immune system produce PDE4 which helps the body control cytokines (proteins that contribute to inflammation). Sometimes, such as with people with eczema, cytokines are mistakenly triggered in the body and this inflammation results in eczema flares. Eucrisa™ comes in a 2% topical ointment and is approved for use in patients over the age of 2 years.
Topical Antibiotics are prescribed for secondary infection, which can worsen the eczema and may make it more difficult for the eczema to respond to treatment until the bacterial infection has been cleared. Topical antibiotic creams and ointments may treat localized patches of infected or resistant eczema.
Oral Antibiotics are prescribed for more significant skin infections. There is often secondary infection on eczema patches, even when there may be no other obvious signs of infection. Oral antibiotics are preferred over topical antibiotics when the infection is extensive.
Antihistamines are sometimes used to aid in sleep, but they are not recommended for routine use and not for children. As you regularly moisturize the skin, and use topical treatments as needed you will decrease the need for antihistamines, as itching decreases when the skin is moist and healthy. Use of antihistamines for children 6 years of age and under should be discussed with his/her physician.
WHAT TO DO WHEN ECZEMA DOESN’T GET BETTER
While many can often manage their eczema through a moisturizing regimen and topical medications, some individuals with a severe form of the disease don’t have an adequate response and may benefit from more aggressive therapies. If you are struggling to manage your eczema, talk to your health care provider about your options.
Phototherapy, specifically broad and narrow-band UVB light can be helpful for their local immunomodulatory effect. There are specific phototherapy units that are used to treat the hands and the body. Speak to your doctor about the possibility of Phototherapy as a treatment option.
Oral Corticosteroids (e.g. Prednisone) are rarely used and reserved for the most severe cases. There are long-term side effects with prolonged use, and because eczema is a chronic condition, this is not a permanent solution for severe chronic eczema.
Cyclosporine, methotrexate, azathioprine and mycophenolate mofetil are systemic therapies commonly used off-label for severe eczema by dermatologists. It is important to note that all of these medications can cause side effects and require regular monitoring. They should be used with caution and after discussion of their risks and benefits with your physician.
Biologic Drugs (e.g. dupilumab / Dupixent™) for atopic dermatitis (AD) are for patients with AD (the most common form of eczema) that is moderate or severe and does not improve enough with topical medications. Biologics for AD are taken with a needle injection under the skin. The medication works to stop the process of inflammation that occurs with AD. Speak with your doctor to learn more about biologics for AD. The first biologic approved in Canada for treating AD is called dupilumab (brand name Dupixent™).
It is important to understand that eczema is a chronic condition, for which there is no cure. Therefore it is equally important to understand how to manage the condition.
The goal of eczema management is to reduce the inflammation during acute flares. During periods of clear skin, the goal is to maintain that skin through moisturizer use.
Some eczema triggers may be avoidable (harsh soaps) but some triggers may be unavoidable (sweating for a young athlete). Sometimes an eczema flare can occur with what seems like no trigger. Eczema flares should be treated with medical treatments. You can discuss your eczema and suitable medications with your or your child’s physician.