Eczema

eczemaThe goals of eczema treatment are to heal the skin, prevent new flare-ups, and reduce the urge to scratch, which can further irritate and prolong symptoms.

Eczema treatment may last for many months, and treatments often need to be repeated.

There are several treatment options available for eczema or atopic dermatitis. Your doctor will recommend a treatment plan based on several variables, including:

  • Your age
  • Location (face vs. knee)
  • Severity
  • Acute vs. chronic (long-lasting symptoms may require more potent medications)
  • Results of past eczema treatments
  • Your personal preferences

Treatment mainstays include trigger avoidance and frequent moisturizing.

Additional treatment options include:


Moisturizers and Eczema

One of the most important steps for treating and managing atopic dermatitis is to use a moisturizer. Moisturizers provide a layer of protection from irritants, trap moisture in the skin, help restore the skin barrier, and improve the skin’s appearance.

Regular use of a moisturizer for eczema may reduce the need for other medicines.

Moisturizers are best applied at least twice a day within 3 minutes after a bath, shower, or swim.

When choosing a moisturizer, look for a hypoallergenic and ointment-based product. Thicker moisturizers will protect the skin longer than lighter lotions. Avoid moisturizers containing alcohol, fragrances, or other chemicals that can irritate the skin. Even seemingly harmless substances like glycerin can dry the skin of people with atopic dermatitis. Brand names of frequently recommended moisturizers include:

  • CeraVe
  • Cetaphil
  • Eucerin
  • Aquaphor
  • Vaseline Petroleum Jelly—-though thick, it is quickly absorbed by very dry skin

Before applying the moisturizer, use tepid water and a gentle cleanser to remove dead skin cells. Do not scrub or rub excessively. Apply the moisturizer immediately afterward while the skin is still damp.

Remember to use plenty of moisturizer to keep atopic dermatitis at bay, especially in children. Keeping a child’s skin sufficiently moisturized could require as much as 1-2 bottles of moisturizer per week. Adults will need even more.


Topical Corticosteroids

Topical corticosteroids are commonly used to calm the irritation from an eczema, or atopic dermatitis flare. These anti-inflammatory medications are available in various strengths, with “super potent” being the strongest. The more potent, the greater the risk of side effects.

Mild or acute cases of atopic dermatitis usually respond well to mild corticsteroids. Severe or chronic atopic dermatitis, with skin thickening, or on the palms or soles, may require more potent corticosteroids.

If topical corticosteroids are used for too long or inappropriately, they can cause side effects such as thinning of the skin, or become absorbed into the blood.

Use only mild corticosteroids on delicate areas like the face, groin, underarms, and genitals. Potent formulations should only be used for a few weeks at a time and never on wounds or skin that is thinned from overuse. Potent corticosteroids should be used with special care in children.

In general, moderate-to-potent corticosteroids are recommended for use on thick lesions for a limited time.


Topical Immunomodulators

Topical immunomodulators (TIMS), or calcineurin inhibitors, are a type of medication applied to the skin that can help control the symptoms of atopic dermatitis and reduce the need for topical steroids. They are a useful alternative for sensitive locations, such as the face and skin folds. They are generally effective and well tolerated.

There are currently two FDA-approved topical immunomodulators for treating atopic dermatitis: Elidel (pimecrolimus) and Protopic (tacrolimus). Both work by reducing inflammation and other symptoms of atopic dermatitis.�These medicines have fewer side effects than topical corticosteroids, but it has been theorized that they may lead to an increase risk of skin cancer.


Oral Antihistamines

Oral antihistamines help reduce the itching and scratching that can further damage the skin. They are often recommended for use at night to help prevent scratching during sleep, and some people find them too sedating for use during the day.


Antibiotics

Bacteria, such as staph, can live on the surface of skin without causing any problems. However, at times, these bacteria can trigger atopic dermatitis flare-ups or prevent inflamed skin from healing.

Topical antibiotics are useful because they can be applied directly to an inflamed area. However, an oral antibiotic, such as cephalexin or erythromycin, may be recommended if larger areas are inflamed or appear infected.


Oral Corticosteroids

Short courses of oral corticosteroids, such as prednisone, may help control a severe case quickly. Risks of this treatment include a rebound of symptoms and side effects such as dizziness or fatigue. The medication is usually limited to a few weeks and the dosage is often tapered off.


Immunosuppressive Drugs

When atopic dermatitis fails to respond to any other therapies, immunosuppressive drugs may be recommended to calm the immune system. These include cyclosporine, methotrexate, azathioprine, and mycophenolate.

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