The main treatment for eczema is to keep the skin moisturized using creams, ointments, and shower and bath oils that replenish the skin's natural protective oils. However, doctors, allergists and dermatologists recommend a number of treatment options. Treatments for eczema aim to:
If eczema develops, follow the primary health provider’s treatment recommendations and avoid known irritants. The area where the eczema originated may easily become irritated again, so it needs special care. Continue to follow the tips listed here, even after your skin has healed.
Non-conventional approaches exist for treating eczema, including traditional Chinese medicine and Western herbalism. There are a wide variety of treatments, with effectiveness varying from individual to individual. Other remedies lacking scientific evidence include chiropractic spinal manipulation. People can also use clothing designed specifically to manage itching, scratching and peeling associated with eczema. Inform your doctor, allergist or dermatologist if they are utilizing one of these treatments. Alleged remedies include:
Oatmeal – Oatmeal has long been a remedy to relieve itching, and can be applied topically as a cream or, as a colloid, in the bath. It is part of many commercial products for eczema treatment and other skin conditions. Some recent studies say that oat can provoke flare-ups in some patients.
Seawater - Salt-water baths have shown to help some children diagnosed with atopic eczema. The reason may be the antiseptic properties seawater has. The Dead Sea has long been popular for alleviating skin problems including eczema.
Sulfur – Sulfur has been used as a topical treatment in the alleviation or suppression of eczema for years. It became fashionable in the Victorian and Edwardian eras. Today, sulfur has regained popularity as a homeopathic alternative to steroids and coal tar, although there is no current scientific evidence that sulfur treatment relieves eczema.
Probiotics – Probiotics are live microorganisms taken by mouth, such as the Lactobacillus bacteria found in yogurt. More commonly used for digestive problems, they are not especially effective for treating eczema, and could cause infection.
Traditional Chinese Medicine (TCM) - Certain blends of Chinese herbal medicines have been proven effective in controlling eczema, but have also been toxic in some, with severe consequences. In Chinese Medicine diagnosis, eczema is considered a manifestation of underlying ill health. Treatment concentrates on the overall health of the individual, not just resolving the eczema but improving quality of life (energy level, digestion, disease resistance, etc.). A recent study published in the British Journal of Dermatology describes these improvements in quality of life and the reduced need for topical corticosteroid applications. The ten different plants traditionally used in Chinese medicine for eczema treatment suggest herbal remedy benefits, but reviewers noted that the blinding of the test was not maintained, leaving the results invalid.
It is difficult to avoid all the triggers, or irritants, that cause or worsen eczema flare-ups. In fact, eliminating allergens rarely clears up the condition. Items that trap dust such as feather pillows, down comforters, mattresses, carpeting and drapes can actually worsen the condition. Allergy shots are rarely successful in treating atopic dermatitis and could make the condition worse. However, some self-care measures can reduce itching and soothe inflamed skin:
Apply cream – Applying an anti-itch cream or calamine lotion to the affected area can help soothe symptoms of eczema. A non-prescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can provide temporary relief. A non-prescription oral antihistamine, such as diphenhydramine, can help in cases of severe itching.
Avoid scratching - Cover the irritated area if you can't keep from scratching it. Trim the fingernails and wear gloves at night.
Apply cool, wet compresses - Covering the irritation with bandages or dressings can protect the skin and prohibit scratching.
Choose mild soaps – Be sure to only use soaps without dyes or perfumes and to rinse any soap completely off the body.
Identify triggers - Try to identify and avoid triggers that worsen inflammation. Rapid temperature changes, sweating and stress can worsen eczema. Avoid contact with wool in rugs, bedding and clothes. Avoid harsh soaps and detergents.
Moisturize the skin - Use an oil or cream to seal in moisture while skin is still damp from a bath or shower. Pay special attention to legs, arms, back and the sides of the body. If the skin is already dry, consider using a lubricating cream.
Use a humidifier - Hot, dry indoor air can cause itching and flaking of sensitive skin. A portable home humidifier or furnace humidifier adds moisture to the air inside the home. Portable humidifiers come in many varieties. Be sure to keep the humidifier clean to prevent bacteria and fungi growth.
Take a warm bath - Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub. Or, add 1/2 cup (118 ml) of bleach to a 40-gallon (151 l ) bathtub filled with warm water. The diluted bleach may kill bacteria that grow on the skin.
Wear cotton clothes - Avoid clothing that's rough, tight, and scratchy or made from wool that can cause irritation. Wear appropriate clothing in hot weather or during exercise to ward off excessive sweating
Over-the-counter (non-prescription) anti-itch creams and other self-care measures can help control mild atopic dermatitis. Additionally, your doctor may prescribe pills, creams or ointments to help treat symptoms of eczema, underlying allergy problems or complications caused by eczema. The following medications may be used for eczema treatment:
Antibiotics - Antibiotics may be necessary for a bacterial skin infection or an open sore or fissure caused by scratching. A physician may recommend taking antibiotics for a short time to treat the infection or for longer periods of time to reduce skin bacteria and to prevent recurring infection.
Corticosteroid creams or ointments - Prescription corticosteroid creams or ointments can ease scaling and relieve itching. Some low-potency corticosteroid creams are available without a prescription, but the primary health provider should be consulted before using any topical corticosteroid. Long-term or repeated use can have side effects such as skin irritation or discoloration, thinning of the skin, infections, and stretch marks. In worst cases, long-term and repeated use of corticosteroid creams and ointments may cause hypocorticism.
Immunomodulators - A class of medications called immunomodulators, such as tacrolimus and pimecrolimus, affect the immune system. They can help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children over 2 years of age and for adults. The Food and Drug Administration recommends that immunomodulators be used only when other treatments have failed, or if someone can't tolerate other treatments, due to possible concerns about the long-term effects of these medications on the immune system.
Oral antihistamines - Oral antihistamines may help severe itching. Diphenhydramine can produce drowsiness and may be helpful at bedtime. If skin is cracked, a doctor may prescribe mildly astringent wet dressings to prevent infection.
Oral corticosteroids - For severe cases, a short-course of oral corticosteroids, such as prednisone, may be needed to reduce inflammation and control symptoms. These medications are effective but aren’t for long term use due to potential serious side effects, such as cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
Phototherapy (light therapy)
As the name suggests, during this type of treatment modality natural or artificial light is used to treat the eczema. The most basic and easiest form of phototherapy involves exposing the skin to controlled amounts of natural sunlight. Other forms of phototherapy use artificial ultraviolet A (UVA) or ultraviolet B (UVB) light alone or in combination with medications. Though effective, long-term light therapy can age skin prematurely and increase the risk of skin cancer. Therefore, it's important to consult a health professional before using light exposure to treat atopic dermatitis. They can give advice on the possible advantages and disadvantages of light exposure for a patient’s specific situation.
Treating infantile eczema
Treating infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and using bath oils, lotions, creams or ointments to lubricate the baby's skin. See a pediatrician if these measures don't improve the rash or if the rash is infected. Your baby may need a prescription medication to control the symptoms or treat the infection. An oral antihistamine may be recommended to lessen the itch and to cause drowsiness, which can be helpful with night time itching and discomfort.