Treatment
Your skin is dry, not because it lacks grease or oil, but because
it fails to retain water. Therefore, to correct dryness, water is
added to the skin, followed by a grease or oil-containing substance to
hold the water in.
This can be done by soaking the affected area, in a basin, bath, or
shower, for 15-20 minutes using lukewarm water. Hot water dries out
the skin. Then, remove excess water by patting with a soft towel.
Avoid vigorous use of a washcloth in cleansing. When toweling dry, do
not rub the skin. Blot or pat dry so there is still some moisture left
on the skin, and immediately apply an oil (eg Hermal Bath Oil or
RoBathol are best, also Neutrogena light sesame oil, Alpha-Keri,
Lubriderm oil or plain Vaseline or Crisco). Use these only after the
bath, as they do not not contain water as the lotions do. Then apply a
moisturizer (examples: Shepard's Cream Lotion [Dermik], Complex 15
LOTION [Schering-Plough], Cetaphil cream, Vaseline Dermatology Lotion,
and Moisturel).
Use of moisturizers without first trapping in water is much less
effective. Still, most patients find that two or three additional
applications of moisturizers helps and clothes should be laundered
with SOAP (e.g. grated Ivory, as Ivory Flakes has been reformulated to
a detergent, or other soap product free of dyes, fragrance,
antibacterial agents, etc.). Avoid drier softening sheets.
Tar Preparations
Tars and extracts of crude coal tar are often used to reduce the
amount of topical steroids needed in chronic maintenance of eczema. A
pharmacist can make up One to five percent LCD (Liquor carbonis
detergens) in a cream. Tar gel products (Estar Gel and Psorigel) are
available, but they contain alcohol and may cause burning and
irritation on already red and inflamed skin.
Steroids
Topical steroids are particularly useful to treat flare ups of
eczema. They help keep down the inflammation and itching. Apply them
just on the rash (instead of the oil recommended above) especially
after a soak or bath. Do not use topical steroids more than twice a
day. Your pharmacist can provide topical steroids in large jars to
reduce the cost.
Hydrocortisone ointment or cream can be used for eczema in infants
and young children, or in skin folds in adults. More potent topical
steroids should not be used on thin-skinned areas of the face, neck,
axilla, and groin. Short, supervised courses of medium potency topical
steroids creams--such as Cutivate, Elocon or Derematop -- are safe and
effective for flares of eczema on other parts of the body. Adverse
effects of topical steroids include thinning of the skin (atrophy), a
change in the color of some skin (depigmentation), and acne-like
eruptions.
Ultraviolet Light
Ultraviolet light (UVB or PUVA) therapy may be of some help in
chronic eczema that does not respond well to other therapy. UVB and
PUVA require three per week and must be used under professional
supervision. However, avoid sunburn and hot or humid conditions that
might make your skin even itchier.
The risks of UVB or PUVA are sunburn and increased the risk of skin
cancers if used for too long. Do not use ultraviolet light therapy if
you always burn and your skin doesn't tan at all, or if light
aggravates your condition.
Antibiotics-See eczema-Infections
Antipruritics
Itching, is often the most aggravating of all your eczema symptoms.
Antihistamines may provide some relief. The antihistamines reduce
scratching mainly through tranquilizing and sedative effects. It takes
several weeks of use on a regular basis to help. This is because
scratching aggravates the eczema, keeping it from healing. Cutting
nails, and using cotton gloves at night can minimize scratching. For
children, knee-high socks are better than gloves, because they are
harder to accidentally pull off during sleep. Zyrtec is particularly
helpful. The topical use of antihistamines such as benadryl should be
avoided, because it is ineffective and may produce allergic reactions.
Menthol or Pramoxine containing products such as Aveeno cream or Prax
lotion may offer additional help.
Evolving treatments
Recently treatment with drugs that work on a
system that related to the one Aspirin work on have been used for
asthma. These medications have few side effect-an occasional headache
mostly-and show good result in a little under half the people treated. Adults
are usually given Accolate (zafirlukast) 20mg twice daily, children
over 6 years get Singulair (montelukast) 5mg chewable
daily. and younger get 1/2 of 5mg chewable tab per day. About a third
of the most severe eczema patients will improve with the drug
Plaquenil. All will clear completely within weeks if given Neoral,
but long term damage to the kidneys prevents it's use except for short
periods.
Corticosteroids
Oral steroids should be avoided because of the seriousness of their
side effects and the potential for severe flares of eczema when they
are discontinued. Intensified skin care will help to suppress the
flaring of the eczema during a taper from oral steroids.
Therapy of Acute Flares
The doctor may suggest hospitalization simply because it may be
necessary to break the cycle of chronic inflammation, or other
problems that are exacerbating the illness. Frequently, five or six
days of vigorous in-hospital treatment care can result in a dramatic
clearing of the eczema. Food tests, allergy skin testing, and the
development of an outpatient therapy plan can all be done during the
hospitalization. Unfortunately, getting approval from insurers is
often difficult. During an acute flare the number of 15-20 minute
baths must be increased to three or four per day. Besides hydrating
the skin, baths also increase the penetration of topical medication up
to ten-fold if the medicine is applied immediately after the bath. Wet
wraps after baths may also help hydration and medicinal penetration.
Bedtime wet wraps are most practical, and can be done with elasticized
gauze followed by ace bandages or double pajamas. (The first pair of
pajamas are worn damp but not soaking wet, and a second pair of dry
pajamas are worn over them. For a tighter fit, sometimes a plastic
sauna suit is used instead of the dry pajamas.) For feet and hands,
socks can be used. Additional blankets or increased room heat may be
necessary during this three to seven days to prevent chilling.
