Moisturizing

Dermatitis severely dries out the skin,and keeping the affected area moistened can promote healing and retain natural moisture. This is the most important self-care treatment that one can use in atopic eczema.

The use of anything that may dry out the skin should be discontinued and this includes both normal soaps and bubble baths that remove the natural oils from the skin.

The moistening agents are called 'emollients'. The rule to use is: match the thicker ointments to the driest, flakiest skin. Light emollients like Aqueous Cream may dry the skin if it is very flaky and whilst it is the moisturiser traditionally prescribed by doctors in the UK, it is in fact only licensed for use as a soap substitute on washing

Emollient bath oils should be added to bath water and then suitable agents applied after patting the skin dry. Generally twice daily applications of emollients work best and whilst creams are easy to apply, they are quickly absorbed into the skin and so need frequent re-application. Ointments, with their lesser water content, stay on the skin for longer and so need fewer applications but they must be applied sparingly if to avoid a sticky mess.

Typical emollients in the U.K. are: Oilatum or Balneum bath oils, Aqueous cream for washing with, Diprobase or Doublebase pump-action creams also used for washing and may be later applied directly to the skin. The preferred moisturiser of dermatologists is a mix of liquid and white-soft paraffins. Sebexol, Epaderm ointment and Eucerin lotion or cream may be helpful with itching. Moisturizing gloves can be worn while sleeping.

Some report improvement of symptoms after treatment of the skin with porridge oats, either directly or with an extract.

Itch Relief

Antihistamine medication may reduce the itch during a flare up of ezcema, and the reduced scratching in turn reduces damage & irritation to the skin (the Itch cycle).

Capsaicin applied to the skin acts as a counter irritant (see Gate Control Theory of nerve signal transmission). Other agents that act on nerve transmissions, like menthol, also have been found to mitigate the body's itch signals, providing some relief. Whilst research has suggested Naloxone hydrochloride and dibucaine suppress the itch cycle in atopic-dermatitis model mice.

Corticosteroids

Dermatitis is often treated by doctors with prescribed Glucocorticoid (a corticosteroid steriod) ointments or creams. For mild-moderate eczema a weak steroid may be used (e.g. Hydrocortisone or Desonide), whilst more severe cases require a higher-potency steroid (e.g. Clobetasol propionate). They are highly effective in most cases, but must be used sparingly to avoid possible side effects, the most significant of which is that their prolonged use can cause the skin to thin and become fragile (atrophy). High strength steroids used over large areas may be significantly absorbed into the body causing bone demineralisation (osteoporosis). Finally by their immunosuppression action they can, if used alone, exacerbate some skin infections (fungal or viral). If using on the face, only a low strength steroid should be used and care must be taken to avoid the eyes.

Hence a steroid of an appropriate strength to promptly settle an episode of eczema should be sparingly applied. Once the desired response has been achieved, it should be discontinued and not used for long-term prevention.

Immunomodulators

Topical immunomodulators like pimecrolimus (Elidel® and Douglan®) and tacrolimus (Protopic®) were developed after corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. The US Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings:

• The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's disease).
• Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use.

Eczema Resources Online

Types of Eczema

• Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is thought to be hereditary, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on face and scalp, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are in actuality irritant contact dermatitis. It is very common in developed countries, and rising. (L20)

• Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to, say, a solvent). Some substances act both as allergen and irritant (e.g. wet cement). And some substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three fourths of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from one’s environment. (L23; L24; L56.1; L56.0)

• Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles dry cracked river bed. This disorder is very common among the older population. Ichthyosis is a related disorder. (L85.3; L85.0)

• Seborrheic dermatitis (aka cradle cap in infants, dandruff) causes dry or greasy scaling of the scalp and eyebrows. Scaly pimples and red patches sometimes appear in various adjacent places. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin, and is often curable. (L21; L21.0)

Treatments vary: Creams, Powders, Ointments, and Medications exist. Eczema is also affected by stress, lifestyle choices, diet, and other factors. Remember that your overall mental health and attitude will always affect the quality of life of those suffering from chronic conditions.This website exists to provide information
for sufferers of different forms of eczema and atopic dermatitis.

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