Additional information for treating and managing atopic eczema
In addition to using emollients and topical steroids you may need to draw on other forms of treatment when managing atopic eczema:
Infected eczema
Damaged skin is vulnerable to infection. There are a number of different causes of infection, depending on the type of eczema, but it can be treated effectively, especially if caught at an early stage. You can help keep skin clean by taking a regular bath or shower and by using emollients before and after.
Atopic eczema is most often infected by a bacterium called Staphylococcus aureus, which makes the eczema worse and slower to heal. Infected skin looks red and inflamed; it is usually weepy, with small yellow or red spots. Scratching causes more damage and allows bacteria to spread.
Paste bandages and Wet wraps
Special bandages can be used on part or all of the body to help moisturise the skin and also to protect it from the damage caused by scratching. Bandages should NEVER be used on infected skin.
Paste bandages contain emollient and other helpful things such as coal tar and calamine while wet wrapping combines a dry outer bandage and a wet inner bandage over a layer of emollient and some times a topical steroid.
Bandaging helps the skin absorb the emollient better, reduces itchiness and makes the skin more comfortable. You should ask a dermatologist or dermatology nurse to show you how to wet wrap properly and safely. The National Eczema Society has an fact sheet about wet wrapping : go to the fact sheet section for more information
Complementary Therapies
Although complementary therapies are not a cure for eczema, some people find them very helpful, especially when used in combination with conventional medicine. You should always let your doctor/nurse know if you are thinking of trying any kind of complementary therapy and must not suddenly stop using the treatment that has previously been prescribed for you. If you want to try a complementary therapy make sure you go to a properly trained and registered practitioner (you can find these through a therapy’s governing body). Ask in advance how much the treatment is going to cost. Complementary medicine can be very expensive
Safety is also a consideration. People often think because a cream or product is labelled ‘natural’ it is safe to use. Herbal remedies can have powerful, and even dangerous, side effects. In addition some pots of Chinese and African herbal creams have been found to contain potent topical steroids and even life threatening ingredients (e.g. arsenic). Make sure that any cream you intend to use has an ingredients list on the pot or tube. Ask in advance how much the treatment is going to cost. Complementary medicine can be very expensive.
Diet
We still do not know enough about the role of diet in eczema. Many carers believe that their child’s eczema is caused by something in their diet but only a small number of children , generally under age 3, with eczema are helped by changes in diet and, even in those who are, they will still need to use a good skin-care routine to protect against other triggers. In other words, it is rarely diet alone that triggers eczema.
Keeping an accurate diary of what your child eats and of the condition of the eczema can be useful. Signs that food may be playing a role in a child’s eczema include worsening of the eczema, itching or abdominal pain, swelling and redness. Always consult a doctor or dietician before you make any changes, especially long term, to a child’s diet.
There is no specific diet for the treatment of eczema as the type and number of food triggers can differ a lot between children. The most common food triggers are cow’s milk and eggs, but many other foods including Soya, wheat, fish and nuts are common.
There is no 100% reliable test for identifying which foods trigger eczema. An exclusion diet is therefore the only way of finding out whether a food is a trigger or not. It involves:
- Removing all sources of the suspected food or foods for two to six weeks to bring about an improvement in the eczema.
- Giving the child the suspected food to bring about a return (or worsening) of the eczema.
- Removing the suspected food trigger to bring about the improvement in the symptoms for the second time.
Exclusion Diets should be supervised by a healthcare professional . Parents and carers should never attempt an exclusion diet on their own and it is important that the diet chosen is the right one and nutritionally correct.
Topical Immunomodulators
Topical immunomodulators are a fairly recent development in the treatment of atopic eczema. The term immunomodulator refers to a drug that is able to modulate or alter the immune system in some way. This helps to reduce inflammation and redness. They are not steroids and therefore do not have the concerns about potential skin thinning associated with inappropriate use or overuse of topical corticosteroid treatments. Protopic ointment™ and Elidel cream™ are both topical immunomodulators. They are however relatively new treatments and so their long term effects are less well known and trials are ongoing to assess the long-term side effects of this new treatment.
The National Eczema Society has fact sheets about both Protopic ointment™ and Elidel cream™ : go to the fact sheet section for more information.
Treatments for more severe eczema
Other treatments for very severe eczema include Cyclosporin, Azapriathine, oral steroids and ultraviolet light treatment. The latter should not be confused with using a sun lamp which is not advisable if you have eczema. These treatments are generally prescribed by dermatologists and in cases where the eczema does not respond to the treatments. They are usually prescribed for adults. The National Eczema Society has fact sheets about Cyclosporin and Azapriathine : go to the fact sheet section for more information.
Trigger factors
You and your doctor or nurse may need to look at environmental and other circumstances that may be triggering or aggravating the eczema. The presence of pets, the nature of your work, or aspects of your home environment, for example, can all affect eczema.
You may also find the extra information below useful :
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