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Updated April 11, 2014

Updated April 11, 2014

Prevention and Treatment of Eczema

Eliminating the triggers. Avoiding the triggers of itching should be the first priority for patients with atopic dermatitis. Environmental triggers can be decreased by avoiding wool, nylon, stiff or irritating clothing which may irritate the skin and promote sweating. Instead, wear cotton clothing that has been washed with a mild detergent such as Drift® or Snow®, or use a double-rinse cycle. Use caution with fabric softeners, which may irritate the skin.

In the summer months, use of an air conditioner prevents sweating and removes excessive humidity. In the winter months, use a humidifier to prevent excessive drying of the skin.

Avoid getting sun-burned, and use sunscreens. Be aware that many of the prescription medications, such as topical steroids, may make your skin more sensitive to the sunlight and therefore worsen eczema. Avoid traumatizing the skin by keeping fingernails short and hands clean to avoid scratching and infecting the skin.

Patients with significant atopic dermatitis should be evaluated for allergy testing to common aeroallergens and common food allergies. Avoiding allergens such as animal dander, dust mites and cockroaches can improve atopic dermatitis. Eliminating foods to which a person is allergic will also result in the improvement of the eczema.

Maintain good skin care. Good skin care starts with adequate moisturizing and hydration, which decreases itching and formation of eczema. Hydration of the skin is maintained by the twice daily application of skin moisturizing creams (examples include Keri®, Lubriderm®, Nivea®, Nutraderm®, and Eucerin®). Less expensive moisturizers include generic forms of Johnson and Johnson’s Baby Lotion® (which is actually more of a cream) available at discount retailers. Vegetable shortening (such as Crisco®) is another good, inexpensive moisturizer.

Avoid lotions if possible, which contain too much water – this results in drying of the skin. The difference between a lotion and cream is that a cream has a slightly greasy feel to it even after it has been applied to the skin. Avoid pure petroleum jelly (such as Vaseline®), which does not moisturize the skin, unless placed on top of a moisturizer or moist skin.

Bathing can be helpful if done in the correct manner; and harmful if done incorrectly. Avoid extremely hot or cold water showers or baths. Try to bathe daily, and soak in the water until the fingertips start to wrinkle. Blot dry with a towel (rather than rubbing), and apply a moisturizing cream from head to toe (focusing on problem areas) within 3 minutes of getting out of the bath or shower, while the skin is still moist. If the skin is allowed to air-dry before the moisturizer is applied, the eczema could get worse.

Itching may be at least partially controlled with the use of low-sedating antihistamines during the day, such as cetirizine (Zyrtec®), fexofenadine (Allegra®), loratadine (Claritin®), or with sedating antihistamines such as diphenhydramine (Benadryl®) or hydroxyzine (Atarax®) at night. It is controversial whether antihistamines are helpful in the treatment of atopic dermatitis.

Treatment of Atopic Dermatitis

Once eczema has worsened as a result of uncontrolled itching and scratching, medications are needed to control the problem. Topical medications are used for all but the worst eczema flares, and include topical steroids and a new class of medications called topical calcineurin inhibitors, such as Elidel® and Protopic®.

Topical steroids. These medications are the first line therapy for atopic dermatitis, and are available in lotions, creams, ointments and solutions (for the scalp), and most are by prescription only. Low concentration forms are available over-the-counter. In general, medications in ointment forms are stronger than cream forms, which are stronger than lotion forms. Topical steroids should be used in the lowest strength possible, for the shortest time possible, as side effects such as thinning of the skin, pigment changes of the skin, and absorption into the body are possible.

Topical calcineurin inhibitors. These relatively new medications, Elidel® and Protopic®, are approved for short-term use in children older than 2 years of age for atopic dermatitis. They do not cause thinning of or pigment changes in the skin, can be used safely on the face, and can help reduce the amount of topical steroids needed when used for mild symptoms. The FDA recently raised some safety concerns regarding these medications.

Oral steroids. Rarely, short courses of oral steroids are required to achieve control of a severe flare of atopic dermatitis. Extreme caution should be used, as while the eczema typically gets better on the oral steroids, a “rebound effect” can occur with worsening of the skin soon after the steroids are stopped. If oral steroids are required, the dose should be tapered slowly to minimize this risk.

Oral and topical antibiotics. In some cases, worsening atopic dermatitis can be a result of a skin infection or colonization with a common bacterium, Staphylococcus aureus, and a course of antibiotics against this type of bacteria is required. It is usually safe to continue the use of topical steroids even if the eczema is infected. Topical antibiotics are typically enough for localized infections of eczema, while oral antibiotics may be needed for infections involving larger areas of skin.

Learn more about the basics of atopic dermatitis, including symptoms, how it is diagnosed, and common triggers.

Source: Atopic Dermatitis Practice Parameters. Ann Allergy Asthma Immunol. 2004;93:S1-21.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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