Eczema is a term that actually describes a group of medical conditions. It causes the skin to become inflamed and irritated, and affects approximately 10-20% of infants and 3% of adults. Symptoms include itching and a rash, and are mostly commonly found on the face, backs of the knees, hands, wrists, and feet. Affected areas are usually very dry, with the skin appearing thickened or scaly. The exact cause is unknown, but it’s generally thought to be an overreaction of the immune system. Some people have flare-ups under certain circumstances, such as contact with certain chemicals or textures. There are a variety of treatments for eczema.
1. Steroids
Topical steroids are typically used as a short-term treatment for eczema, usually in conjunction with emollients (moisturizers, discussed below). Topical steroids are applied to the skin, and are different than the steroids you may think of when you think of birth control pills or bodybuilding. Topical steroids are usually used to treat flares, and once the flare subsides, the treatment is stopped or stepped back, depending on the severity of your eczema overall. Typically, it’s applied 1-2 times per day, either before or after emollient application, with a period of about a half hour between the two treatments.
2. Antihistamine
Antihistamines are used to treat allergic reactions, when the body releases histamine because it perceives pollen or dust or other things as a threat. Eczema is not a histamine issue, but the antihistamine can have a sedating effect. This effect allows the person to stop scratching, which makes the condition worse. It can be particularly useful if the person is having trouble sleeping due to extreme itchiness. It’s important to note, however, that only certain antihistamines work. Topical applications generally do not seem to work, while first-generation oral applications do. Second-generation oral antihistamines, such as Claritin, also do not have the same sedating effect, and therefore also don’t seem to have the same effect.
3. Topical Antiseptic
Topical antiseptics are typically used when the area afflicted has gotten infected. Infection usually occurs when the person has scratched the itchy skin and broken the surface, allowing bacteria to enter the wound. There are a variety of antiseptic solutions available, including simple household bleach. However, it is important that a doctor looks at the infected area and works with the patient to determine the best topical antiseptic for their particular situation.
4. Coal Tar Extract
In its natural form, coal tar is thick, black, viscous and has a characteristic smell. For treatment of eczema and other skin conditions, it is usually mixed with Sulphur or other ingredients to make creams, gels, lotions, and shampoos. It can be used to treat the scaling, inflammation and itchiness of eczema. The use of coal tar is declining, but it is still low-cost and less toxic to the system than some other treatments. Traditionally, coal tar extract is applied at bedtime (to avoid staining and smell during the day) and left on for at least two hours. The area can be wrapped in bandages to keep the coal tar in place and avoid staining. It should not be used on raw, oozing, blistered, or infected areas.
5. Ultraviolet light therapy
Ultraviolet light therapy, also known as phototherapy, is the use of a special machine to emit UVB light. UVB light is found in natural sunshine, and is a very good treatment for widespread eczema or localized areas that haven’t improved with other topical treatments. It can reduce itching, increase vitamin D production, increase bacteria-fighting systems in the body, and calm inflammation. Effective phototherapy requires at least 2-3 treatments per week in a doctor’s office, and does come with a few risks: burns, increased aging and an increased risk for skin cancer are all significant risks.
For ultraviolet light therapy, you’ll apply a hydrating oil to the skin and stand in a cabinet with protective goggles over your eyes and your underwear on. The treatment is activated for several seconds to minutes, and your response is recorded. The light is gradually increased over time. Results are not immediate, but gradual over time. If successful, treatments can be scaled back and sometimes stopped altogether, though they can be restarted if symptoms return.
6. Moisturizer
Proper moisturizing is key to treating eczema. Emollients maintain skin hydration and barrier function. Two of the best are petroleum jelly and mineral oil with no additives, but there is a plethora of over-the-counter options available for eczema that are highly effective. Patients should check ingredient labels before buying and do a patch test to ensure there are no reactions before starting to use a new product. There are three basic moisturizing options: ointments, creams and lotions. Ointments are thicker greases and are very good at retaining moisture.
Creams are not as thick or greasy, though they do contain the same grease mixed in water or other liquid. They also tend to contain stabilizers that may irritate sensitive skin. Lotions tend to be the thinnest applications, made of oil and water, but they also tend to not work very well for retaining moisture in extremely dry skin as the water evaporates too quickly. Ointments, creams or lotions are typically applied after a lukewarm bath or shower, while skin is still slightly damp to help lock in the hydration. It’s applied daily, and depending on the dryness level of the skin, may be applied more than once per day.
7. Barrier Cream
Skin barrier creams are another form of emollient. They differ from the ones mentioned above in a few ways. One is that they are infused with lipids and ceramides, two naturally occurring substances which are found in healthy skin barriers. This helps to improve the skin barrier and therefore reduce the symptoms of eczema. They also differ from the other moisturizers because where other moisturizers are applied to the entire body, skin barrier creams are only applied to the areas affected.
They also require the supervision of a doctor – you’ll need a prescription, rather than getting them over the counter. Skin barrier creams form a protective layer on the skin, keeping out impurities that could cause itching or infection, while also locking in hydration. This allows the afflicted skin to heal and also to become more resistant to the symptoms, such as burning, dryness, and itching.
