Management & Treatment of Eczema
This page provides you with an introduction to the basics of successful eczema management. You can find more information in our Articles and Fact Sheet sections.
Whatever the type of eczema you have, the main treatment is the same. Your Doctor or Nurse will prescribe you an emollient to moisturise the skin and, if the skin is inflamed, a topical corticosteroid to reduce the inflammation. Additional information about further treatments for the different types of eczema are at the end of this section.
Emollients
Emollients are non-cosmetic moisturisers which come in the form of creams, ointments, lotions and gels. Emollients help skin to feel more comfortable and less itchy. They keep the skin moist and flexible, helping to prevent cracks.
Creams contain a mixture of fat and water and feel light and cool to the skin. For this reason many people with eczema prefer creams for day time use. All creams contain preservatives and people can become sensitive to them, although this is not common.
Ointments do not contain preservatives. Ointments can be very greasy and some people find them cosmetically unacceptable. However, because they are very effective at holding water in the skin, they are useful for very dry and thickened skin. Ointments should not be used on weeping eczema – use a cream or lotion instead.
Lotions contain more water and less fat than creams, but are not very effective at moisturising the skin. However, they are useful for hairy areas of the body.
Used every day, emollients may be all you need to keep mild to moderate eczema under control.
Soap Substitutes
Soap is very drying to the skin and is best avoided by people with eczema. The hands are particularly at risk, as they are washed more frequently. Liquid soaps/cleansers and perfumed products should also be avoided as they tend to irritate skin with eczema.
Emollient soap substitutes do not foam but are just as effective at cleaning the skin as soap. Soap substitutes can either be applied before bathing, showering or washing, or while in the water.
Bath Oils
Bubble baths are extremely drying and potentially irritating to people with eczema. A daily bath removes dirt and skin debris which could cause infection. There is a range of emollient bath oils available, which can also be used in the shower, either on a sponge, or applied all over the body before showering off.
Emollient shower gels are also obtainable and your GP/Nurse/Pharmacist will be able to advise you about the range of bathing products available.
How are emollients applied and when?
- Apply emollients after bathing, while water is still trapped in the skin for extra hydration.
- Use liberally and frequently – at least three times a day.
- Apply gently in the direction of the hair growth. Never rub up and down vigourously as this could trigger itching, block hair follicles or create more heat in the skin
- Continue to use the emollient, even when the eczema has improved as this will help prevent flare ups.
Which emollient should I use?
Finding the right emollient is a matter of trial and error, so the best emollient is the one you or your child prefers to use. Your GP, nurse or pharmacist should be able to advise you on the different products available and you find more information about emollients in our fact sheet section.
Topical corticosteroids
‘Topical’ means something that is applied to the skin and topical steroids are a valuable tool in the management of eczema and contact dermatitis.
Steroids are a group of natural hormones produced in the body by a variety of different glands. Topical steroids used in the treatment of eczema are mainly synthetic.
The main value of topical steroids is that they reduce inflammation and speed up the healing of the skin. They also help to make the skin less red, hot, itchy and sore.
Are topical steroids safe to use?
Topical steroids, used appropriately and under supervision, are a safe and effective treatment for eczema. The likelihood of side effects occurring is directly related to the potency of the preparation, where it is being used, the condition of the skin on which it is used and the age of the person concerned. All these factors will be taken into consideration when a prescription is given to treat eczema.
Allergy to the steroid itself or to the base ingredients of the preparation can sometimes occur. If the eczema gets worse after using a particular topical steroid let your doctor know.
Fear of side effects can make people under-treat their eczema by stopping treatment too soon or not using the steroid they have been given. This can affect the overall management of the condition and may mean that a stronger preparation has to be used to bring the eczema under control again.
If potent topical steroids are used for a long period of time, particularly to the face and flexures, without adequate supervision skin thinning can occur. Using potent topical steroids for a short period will not cause skin thinning. You should always use your topical steroids as prescribed by your doctor or nurse.
How are topical steroids applied?
You will be instructed to apply a steroid twice a day although in some cases a doctor may recommend three times. Some steroid preparations have now been developed that only need to be applied once a day to control eczema.
There are no standard rules regarding whether to apply a steroid preparation after or before using an emollient. However, whichever order of care you choose it is important to leave as long a period as practical, at least 15 minutes, between the two treatments.
You may be given more than one topical steroid to treat your eczema. Make sure that you are clear which preparation to use on which part of the body. If in doubt talk to your pharmacist /nurse or contact your doctor.
You will find more information about topical steroids and how to use them in our fact sheet section.
Additional Information
- For additional information on Atopic Eczema Click Here
- For additional information on Contact Dermatitis Click Here
- For additional information on Seborrhoeic Eczema Click Here
- For additional information on Gravitational Eczema Click Here
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