Many lifestyle changes may have to be made to best deal with eczema. Not only will the patient have to follow much of these instructions – the patient’s family may have to abide by these changes at home as well.
Eczematous skin is not as tolerant to random environmental changes as normal skin. To reduce the itchiness and dryness of the skin, we must work harder to maintain the skin’s moisture. Doing so will allow the skin to protect itself from infection and will allow the skin to heal. With the dryness, fine cracking often allows many minor infections to occur, causing further discomfort. Following these instructions can make all the difference between skin that can function normally and skin that gets more itchy and bothersome.
Getting moisture into skin, and helping it stay there is our goal. When bathing, soaps tend to remove protective oils. This allows the skin to absorb water faster, but we must remember to re-seal the skin with a moisturizer immediately afterward. The trick is to keep water from evaporating away minutes later. So, just after bathing and toweling off is the time to work to maintain that moisture. [ Years ago, the recommendation was to bathe less often to maintain the natural oil barrier; superior results are now achieved by bathing followed by moisturizing. ]
If you’ve been given a prescription for topical medication, apply the medication just after toweling off.
Whether or not you’ve applied medication, follow up with moisturizer. Moisturizers should be applied over the whole body, even if medication is applied in only one area.
Do not scratch or rub the skin which will worsen the itch and rash. The itch must be controlled to stop the itch-scratch-itch cycle.
- A mainstay of treatment is corticosteroids, given as topical preparation – either cream or ointment based – or systemic. Corticosteroids usually provide some relief for pruritus (itchiness). These preparations are usually used sparingly and for short periods of time to avoid side effects, especially thinning of the skin. Steroid ointments are less irritating than steroid creams, but are sometimes less desirable due to their greasiness.
- Other commonly used topical preparations avoid steroids by using calcineurin inhibitor products such as tacrolimus ointment and pimecrolimus creams. There are a myriad of other topical agents that can be applied to calm the skin and decrease the inflammation which leads to scratching and flare of eczema.
- Oral antihistamines are commonly recommended to decrease itching. Scratching causes breaks in the skin which can lead to infection. To prevent scratching, the antihistamines may be taken daily; such steps may be necessary to give the skin a chance to heal.
- If infected, skin can be cultured to determine the offending organism, and oral or topical antibiotics can be tailored to treat the offending organism(s).
Three Types of Moisturizers
- Ointments are semi-solid greases that help to hydrate the skin by trapping in the moisture and preventing water loss. Ointments are very good at helping the skin retain moisture but some dislike the greasy feeling on their skin.
- Creams are mixtures that contain more oil than water. They are less greasy than ointments and should always be applied to skin within three minutes after bathing. However, irritation of the skin sometimes develops in reaction to preservatives in the products.
- Lotions are mixtures with more water than oil; they do not function as well as other moisturizers because the water in the lotion evaporates quickly.
- Use gentle, soap-free, fragrance-free cleansers for bathing. Soaps have a high pH (pH of 9 to 10.5), while skin is more acidic (pH of 4.5 to 5). Typical soaps would aggravate eczema.
- Bathe with warm water, not hot water. Hot water can exacerbate eczema, making skin more red and “itchier”. Bathe daily, and 10 minutes per bath is enough for moisturization: don’t sit and soak for an hour.
- Bleach baths have been found to decrease the rate of infection among the atopic eczema population. Chemically this is the same as swimming in a chlorinated pool. Bleach baths decrease the bacteria on the skin and thus, decrease skin infections. To make the bath, pour ¼ cup bleach into a half tub of water or ½ cup of household bleach in a full bathtub. The water must be mixed well prior to entering. Of course, small children should bathe in much less water than adults and should be monitored at all times while in the bath.
- Oatmeal baths can be used to relieve itching. This can be a homemade preparation or bought in a store, and mixed in with the bath water. Some patients find this soothing.
- Oil baths are not recommended because the tub and surrounding areas become more slippery, possibly dangerously so.
- One should avoid scrubbing with a washcloth or towel or “loofah” and should pat dry, not rub the skin.
- Avoid allergic substances. See our section on ‘triggers’.
- Foods do not directly cause eczema but they can worsen eczema.
- Wash all new clothes before wearing them. When washing (old or new clothes) use a second rinse cycle to ensure removal of soap and detergent left over from the wash cycle.
- Wool clothing can be “scratchy” and should be avoided; cotton clothes are preferable. For cold weather, layer your clothing so you can easily adjust for a comfortable temperature with adjustments to the layers (e.g., take off or unzip an appropriate layer). Overdressing in winter can lead to overheating, making the eczema worse.
- Dust mites can collect in bedroom carpets and bedding. Simple control measures include use of pillow coverings, mattress covers, removing bedroom carpets and frequent washing of bed-coverings.
- A cool ice pack applied to the skin for a short period – even only seconds – may help relieve itch.
- Work and sleep in comfortable surroundings. This may mean using a humidifier in the winter and an air conditioner in the summer. Family members may have to adjust to patient’s comfort levels.
- Avoid strenuous exercise which can cause a flare-up of eczema with resultant itching.
- A recent article correlated lower vitamin D levels with patients with more severe forms of atopic dermatitis. This suggests that, if a blood test checking Vitamin D levels shows low levels, supplementing with vitamin D may help clear eczema from your skin.
You can read more at our page on Dry Skin.