Eczema may be persistent and difficult to treat
Eczema may be persistent and difficult to treat

Eczema may be persistent and difficult to treat. A combination of various treatment modalities may be required to treat eczema and control flare-ups. Despite successful treatment, flare-ups may still occur. Treatment of eczema also involves identifying and avoiding skin irritants or food allergies, avoiding extreme temperatures, and frequently lubricating the skin. 

Treatment options for eczema include the following:

Topical medications

  • Topical medications are medications that are applied externally, over the skin. This includes medicated creams, ointments, and lotions. They are used to reduce swelling, dryness, and itching and help heal the skin. Topical medications that are commonly prescribed for eczema contain corticosteroids. Steroids reduce inflammations and itching, but overuse can cause thinning of the skin. Other creams containing drugs such as Protopic (tacrolimus) that suppress the white blood cells and hence control skin reactions. Direct strong sunlight should be avoided when these products are being used. Topical antibiotics may be prescribed to treat secondary (superimposed) infection. Regularly applying moisturizers that are free of chemicals, artificial colors, or fragrances will help soothe the skin, hydrate, repair, and soften it as well.

Oral medication

  • Medication to treat infection: Antibiotics may be prescribed to treat secondary infections. Antibiotic creams may also be used. An antibacterial cream may be used if your skin has a bacterial infection, an open sore, or cracks. The doctor may recommend you to take oral antibiotics for a short time to treat the infection.
  • Medication to reduce inflammation: Oral corticosteroids such as prednisone may be prescribed in severe cases and cases in which there is no improvement with only topical medication. Steroids suppress the immune system and hence suppress inflammation and skin reactions.
  • Newer medications to treat severe eczema: Injectable medicines such as Dupixent (dupilumab) may be used in severe cases of eczema. These medications modify the immune system. They reduce inflammation and the signs and symptoms associated with eczema. 

Other therapies

  • Wet dressings: Wrapping the affected area with topical medications and wet bandages can help in severe and widespread eczema. This may be done by a healthcare professional or at home after learning the instructions.
  • Phototherapy (Light therapy): Light therapy can be used in cases when topical treatments don’t help and those who have frequent flares-ups. Light therapy involves exposing the skin to controlled amounts of natural sunlight or artificial ultraviolet A (UVA) and ultraviolet B (UVB).
  • Psychological therapy: A professional therapist or counselor can help you deal with frustration and depression due to their skin condition. Stress can induce flare-ups. Hence, a therapist can help manage stress. Relaxation techniques can help those who have a habit of constantly scratching. 

What is eczema?

Eczema is an inflammatory condition characterized by patches on the skin with severe itching, redness, and dryness anywhere on the body. It can occur in children, teenagers, or adults. Eczema is not contagious. It is a lifelong condition with multiple flare-ups and periods of remission (symptom free periods). 

There are five different types of eczema:

  • Atopic dermatitis: It is the most common type of eczema. Hence, eczema is often called atopic dermatitis. The skin is extremely sensitive to certain substances.
  • Contact dermatitis: This is caused by skin contact with irritants. It takes prolonged contact with the irritants for the rash to develop.
  • Dyshidrotic dermatitis: It affects the fingers, palms, and soles. There are deep-seated blisters that cause pain. Causative agent may be stress, metal jewelry, or sweat.
  • Nummular dermatitis: It usually occurs during the winter. Coin-shaped areas of itching and scaling are seen.
  • Seborrheic dermatitis: More commonly called as dandruff, it is caused by a yeast and is characterized by yellowish flakes over scalp. It occurs on the scalp and hair borne areas such as the eyebrows or eyelids.

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What causes eczema?

The exact cause of eczema is unknown.

  • It is caused due to an overactive immune system that responds aggressively when exposed to triggers. 
  • Some people have a genetic tendency for eczema. 
  • People with asthma are more prone to develop eczema. 

There are different types of eczema, and they tend to have different triggers. Common triggers of eczema flare-ups include the following:

  • Skin contact to chemical irritants, for example, soaps, detergents, etc.
  • Certain fabrics such as rough fabrics
  • Synthetic fabrics
  • Increased body temperature
  • Sweating
  • Temperature changes
  • Stress
  • Food allergies
  • Animal fur
  • Upper respiratory infections and other systemic infections 
  • Asthma 

What are the signs and symptoms of eczema?

Common symptoms include the following:

  • Red, itchy, dry, rough, and irritated skin
  • Red or brownish-gray patches
  • Multiple small, raised bumps that may ooze fluid when scratched 
  • Crusting due to dried-up fluid 
  • Pus discharge due to secondary infection
  • Lichenification: Thickening of the skin due to irritation and constant scratching
  • Dry, scaly, cracked skin
  • Worsening of eczema following scratching 

How is eczema diagnosed?

The diagnosis can be made by a complete physical assessment by the physician. Blood test, skin prick test, or patch testing and other specialized tests may performed to identify skin allergens and to eliminate other skin conditions 

How to prevent flare-ups and complications of eczema?

Complications and flare-ups can be prevented by the following ways:

  • Moisturizing the skin frequently with moisturizers without chemicals, artificial colors, and fragrances
  • Avoiding sudden changes in temperature or humidity
  • Avoiding sweating
  • Physical and emotional stress management
  • Avoiding wearing rough fabric materials such as wool
  • Avoiding direct skin contact with harsh soaps, detergents, and chemicals
  • Avoiding food triggers
  • Using a humidifier in the house and bedroom

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Medically Reviewed on 8/25/2020
References
https://emedicine.medscape.com/article/1049085-overview

https://www.webmd.com/skin-problems-and-treatments/eczema/types-of-eczema#1

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