It’s always best to consult a doctor with a special interest in the condition. Treatment would usually entail the following steps:
1. Identify those factors causing or worsening the condition and then avoid these factors.
2. Reduce or stop itching.
3. Keep the skin moist.
4. Manage the affected skin.
Where stress might be a precipitating factor, various methods of stress management can be implemented – discuss these with your doctor.
The most important treatment for the eczema is to moisturise the skin and to relieve the itch. Moisturising creams and ointments are the mainstay of eczema treatment. They are completely safe and should be applied liberally at least twice daily to hydrate and protect the skin. Some people may find that certain of these preparations irritate their skin.
If this occurs, another product should be tried. This is in true even for aqueous cream. Different emollients include Emulsifying Ointment (HEB), Cetomacrogol, Ultrabase and Oilatum cream. Sometimes coal-tar is applied to treat thickened skin.
Emollients are safe when you adhere to the following guidelines:
- Use frequently, especially when the skin feels dry and itchy.
- Apply after a bath, when water has penetrated and hydrated the skin (see “bathing” below).
- Apply with clean hands. It is very easy for children with eczema to develop infected skin.
- Gently apply a thin, even layer. Do not rub the skin too hard, as this can stimulate itching.
- For thick preparations, use the dot method. Apply by dabbing small amounts (“dots”) where required, and rub in gently.
- Each child with eczema should have a separate supply of emollient, to avoid cross-infection.
- Do not put your fingers into the tub of emollient; rather use a spoon or spatula.
- Your health practitioner may suggest either a “thin” or “viscous” product, depending on the condition of the eczema.
These produce rapid relief and are used in higher strengths for short periods to settle eczema flare-ups. Following improvement, a long term steroid may still be required to control the affected skin.
There are various strengths and your doctor will select the appropriate one.
Steroid cream should be applied frequently and regularly and is usually applied after bath time, when the skin is hydrated and moisturised.
Generally speaking, once the eczema is controlled, milder, diluted steroid creams or emollient only may then be used. If they are used for longer periods they may be diluted in an emollient.
There has been a fear that long-term use may lead to thinning of the skin. However, the newer preparations are much safer.
Carefully follow directions for use to avoid side effects, and never use creams meant for the body on the face.
Cortisone tablets or injections are not often used in eczema, but in particular situations they may be used for a short term to bring the eczema under control. Uncommonly, some individuals become allergic to the skin treatment. Discuss this with your doctor. New treatments that are effective in some individuals may also result in less of the steroids being required.
Eczema sufferers are more prone to skin infections (bacterial, fungal and viral, including the common wart). Oral antibiotics are usually prescribed to treat infected eczema, which may present as sudden development of crusting, oozing and redness of the skin.
Itching is the most common, but often least tolerated symptom of eczema. A substance called histamine, released from the damaged skin cells, plays a minor role in causing the itch.
Stimuli cause the release of histamine from cells. Antihistamines block the effect of histamine release and thereby reduce the itch. Itching results in scratching that releases further chemicals, resulting in a vicious cycle.
It is very important to get the itching and scratching under control, so speak to your doctor if itching persists.
Some children may require a larger dose than the normal prescribed dose, or even the use of a second medication.
The older sedating type antihistamine tablets or syrups such as Aterax will reduce itching, but their main role is to sedate the child. They should therefore they should be used at night. Avoid antihistamine creams as they may sensitise the skin.
Evening primrose oil (or gamma linolenic acid) has been tried and may work in some individuals, but research has not shown it to be a very successful treatment. Researchers are evaluating extracts of Chinese herbal tea.
Other recommendations to manage eczema
The more severe the eczema, the more stringently you should take the following management strategies:
- Bathing: Sit in a lukewarm bath for 20 minutes at least once a day in order to hydrate the skin.
- Use 100% cotton soft towels and never rub the skin, rather pat it dry.
- If non-perfumed soaps such as Pears, Dove or Neutragena irritate the skin, then opt for products such as aqueous cream mixed with liquid paraffin, Aquabar or Cetaphil lotion.
- Apply moisturising emollients to the skin within three minutes of patting the skin dry. You may find it helpful to use a kitchen timer to get used to a period of 3 minutes.
- If using a new cream, ointment or soap, test some on a small patch of skin before applying it to the entire body to be sure it will not cause a reaction. Avoid the eyes.
- Consult your doctor about whether a particular product may be suitable for your skin or not.
Washing of clothes
Use non-biological washing powders such as Sunlight and Skip instead of enzyme-enriched Punch, Biotex, Surf or Omo.
Cover as much skin as possible with non-allergenic lightweight cotton clothing, taking care not to overdress or become overheated. Cotton night gloves, as well as neatly clipped finger nails will reduce scratching. Sometimes elbow splints need to be applied to stop intractable scratching at night. If your child’s sleep is being affected by itching, this clearly indicates the itch is not adequately controlled.
Cotton underwear, clothing and bed linen are recommended.
Wash all new clothes and bed sheets before using them to remove the chemicals introduced in the manufacturing process. Wash all bedding at temperatures above 55 degrees Celsius to eradicate mites and remove their faeces.
Reviewed by Professor Sharon Kling, Clinical Unit Head, General Paediatrics, Intensivist at Tygerberg Hospital and Associate Professor, Department of Paediatrics and Child Health at Stellenbosch University. February 2015.
Original article by Dr Harris Steinman, May 2007.