By Dr Ananya Mandal, MD
There are several types of eczema. The commonest form encountered is atopic or allergic eczema. The first step to treatment is to diagnose the cause of the condition and the possible triggers. Avoidance of the triggers may help in prevention of relapses.
There is no simple cure for atopic eczema but there are several measures that can provide relief from symptoms and prevent relapses. Children with atopic eczema in general may improve with age.
Pharmacotherapy or medicines used in eczema
Medications used to treat atopic eczema include moisturizers or emollients to be used at all times for preventing dry skin and topical corticosteroids that prevent local inflammation.
Emollients or moisturizers
Emollients or moisturizers help soften and smooth the skin and keep it moist. They are the most important treatment for dry skin associated with atopic eczema. Emollients stop water being lost from the outer layer of the skin and prevent drying up of the skin. They act as a protective barrier to keep the moisture in and the irritants out.
Several different emollients are available. Some of these include ointments for very dry skin, cream or lotion for less severe conditions, thinner emollients for face and hands, emollients to be used instead of soap and emollients to be added to bath water or use in the shower.
Ointments contain the most oil so can be quite greasy and lotions contain the least oil so are not greasy but can be less effective. Emollients should be used at all time especially in between flare up of the lesions. Creams and lotions tend to be more suitable for red, inflamed areas whereas ointments are more suitable for areas of dry skin that are not inflamed.
Topical corticosteroids are measured in a standard unit called the fingertip unit (FTU). Normally 1 FTU is the amount of topical corticosteroid squeezed along an adult's fingertip and is enough to treat an area of skin twice the size of an adult's hand.
Corticosteroids work by quickly reducing inflammation. Topical corticosteroids can be prescribed in different strengths, depending on the severity of the eczema. They can be very mild, such as hydrocortisone, moderate, such as clobetasone butyrate or strong.
Severe cases of atopic eczema may require oral corticosteroids as well. Topical corticosteroids are associated with side effects like stinging or burning on application. If used for too long they may cause thinning of the skin, visible blood vessels, acne and increased hair growth.
There are several other medications as well. These include antihistamines that are basically anti-allergy medications used for severe itching. These are taken as pills. Antihistamines stop the effects of a substance in the blood called histamine. Antihistamines may be prescribed during flare-ups. Antihistamines can be sedating, which cause drowsiness, or non-sedating.
Some patients with severe eczema may also require oral corticosteroid pills to relieve symptoms. This however should be as prescribed by the physician. Self administered and abruptly stopped corticosteroids may do more harm than good.
In patients with infected eczema antibiotics are prescribed. Oral antibiotics are prescribed in severe infections. The antibiotic most commonly prescribed is flucloxacillin, which is usually taken four times a day for seven days.
Other alternatives are erythromycin (four times a day for seven days) or clarithromycin (twice a day for seven days).
Topical or local antibiotics
For small infections topical or local antibiotics may be used. Topical antibiotics should not be used for longer than two weeks because the bacteria may become resistant to the medication.
Commonly prescribed topical antiseptics include chlorhexidine and triclosan.
Newer medications for allergic or atopic eczema include immunosuppressants like topical calcineurin inhibitors, such as pimecrolimus and tacrolimus. Alitretinoin, is a medication for severe, long-term hand eczema that has not responded to other treatments, such as topical corticosteroids. This should be used only under the prescription and supervision of a dermatologist.
Deep penetrating light therapy uses ultraviolet light to control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Overexposure to ultraviolet light carries its own risks.
Light therapy may be used with the application (or ingestion) of a substance called psoralen. This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light
Self care measures
There are several self-care treatments at home that may alleviate the eczema symptoms.
The commonest symptom is extreme itchiness. The primary self measure is to reduce scratching. Scratching a lesion will aggravate the skin more and will eventually cause it to thicken, and form crusts. In addition scratching also causes tiny abrasions over the skin and increases the risk of infections.
To prevent scratching nails should be kept short. Anti-scratch mittens may be used in babies to prevent scratching. Other techniques for avoiding skin damage from scratching include tapping or pinching the skin until the itch has gone.
Every type of allergic eczema has some common allergens or triggering factors. Avoiding these triggers helps in prevention of exacerbations. For example, if wool or a particular fabric is irritating the skin it should be avoided and cotton and natural materials should be worn. If certain soaps or detergents are aggravating the lesions, they should be avoided.
Winters and dry weathers often aggravate eczema. The individual is advised to use humidifiers and room heaters to keep it at conformable temperatures.
Many children with atopic asthma have several food allergies. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. A dietician may advise diets to incorporate the essential nutrients while avoiding triggers. This is especially important in children with atopic eczema.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)