While there is no "cure" for eczema, several types of treatments relieve the rash and the itching. This section has information on:
- "Soak and seal" skin care
- Tar-based shampoos
- Topical steroids
- Topical calcineurin inhibitors
- Antihistamines
- Treatment for skin infections
- Wet wrap therapy
- Phototherapy
- Psychological counseling
- Day hospitalization
"Soak and seal" skin care
The best way to put moisture back into dry, itchy skin is to follow a regimen called "soak and seal." It involves four steps:
- Take a warm bath or shower (at least one per day) lasting approximately 10 minutes.
- Use a gentle cleansing bar or body wash (these are not the same as soap!). Good brands include Dove, Aveeno, Eucerin, Basis, Cetaphil, Oilatum, and Oil of Olay. In general, choose “sensitive skin” preparations. During a severe flare-up, however, you may want to bathe or shower without using cleansers.
- Gently pat away excess water with a towel. Do not rub.
- Immediately apply skin medication or moisturizer (good brands of moisturizers include Vanicream, Eucerin Crème Original or Calming, Aquaphor ointment, CeraVe cream, or Cetaphil cream) to damp skin. This seals in moisture. Do not apply moisturizers over skin medications.
Nonsteroidal prescription creams include Atopiclair and Mimyx. They do not have age or length-of-use restrictions.
Tar-based soaps and shampoos
Skin and scalp products that contain coal-tar extracts have long been used to reduce itching and rash. They are not as strong as some other medicines, but they have long-lasting action against inflammation and have few side effects. Tar-based shampoos are helpful if the scalp is red and itchy. One popular brand is T-Gel.
Topical steroids
Steroid medications applied directly to the skin are called topical steroids. They fight inflammation and so reduce itching and help keep the rash under control. Topical steroids come in many forms, including ointments, creams, lotions, gels, and tape. Because they come in different strengths, you should not substitute one for another without consulting with your healthcare provider.
They are generally safe drugs when used properly, although they can have side effects. For instance, they may cause thinning of skin, particularly on the face, which can make the blood vessels underneath appear more prominent. Topical steroids also can cause acne.
A commonly prescribed medium-strength topical steroid for atopic dermatitis is triamcinolone cream or ointment. A commonly used over-the-counter steroid cream or ointment is hydrocortisone.
Systemic steroid pills, liquids or injections, like prednisone, generally aren't used to treat atopic dermatitis because of their side effects and because the rash often comes back quickly after they are stopped (“rebound flare”).
Topical calcineurin inhibitors
Like topical steroids, these drugs are applied directly to the skin as ointments or creams, and they work to reduce immune system overactivity, thus diminishing the rash and itching.
These medicines can be particularly useful for patients who do not respond to conventional therapy. Since they don’t cause thinning of the skin, topical calcineurin inhibitors are especially useful for treating eczema of the face, underarms, around the breasts and groin areas. The most commonly seen side effect is a burning sensation on the skin, but this usually does not last long.
Currently, approved topical calcineurin inhibitors include Protopic (tacrolimus) ointment, 0.03 percent for children 2 years and older with moderate to severe eczema and 0.1 percent for ages 16 and older, and Elidel (pimecrolimus) cream, 1 percent for patients 2 years or older with mild to moderate eczema. Both drugs should not be used continuously and not as first-line therapy.
Antihistamines
Some oral antihistamines that cause drowsiness, such as Atarax (hydroxyzine) and Benadryl (diphenhydramine), can be helpful at bedtime. In addition to reducing itching, these medications can help patients fall asleep. Oral antihistamines that aren't sedating, such as Claritin (loratadine), generally aren't useful for itch but may be helpful for allergic symptoms.
Topical antihistamine creams, or creams that contain anesthetics, should be avoided. They can further irritate the skin.
Treating skin infections
Infections with bacteria and viruses are common among atopic dermatitis patients. For instance, over 90 percent of patients have the bacteria Staphylococcus aureus on their skin, and the breaks in the skin barrier caused by the rash and by scratching can lead to infection. Proper skin care measures directed at maintaining a healthy skin barrier are a key part of reducing bacterial colonization or infection. In addition, topical anti-inflammatory medications including steroids and calcineurin inhibitors reduce the ability of bacteria to bind to the skin.
For small, localized bacterial infections, a prescription topical antibiotic called mupirocin is often used. This is an ointment usually applied to the affected area three times per day for one to two weeks. The brand name of this drug is Bactroban. Oral antibiotics are used for more extensive or more severe skin infections. A skin culture done with a cotton swab may be helpful to determine if bacteria are sensitive or resistant to different antibiotics. Methicillin-resistant staphylococcus aureus (MRSA) is becoming a more common problem for patients with atopic dermatitis.
Viral infection is another complication of atopic dermatitis. Herpes simplex is a common viral culprit. Anti-infective drugs such as oral acyclovir or valcyclovir may be prescribed for localized outbreaks but intravenous acyclovir may be needed for more wide-spread infection. If there is any possibility of ocular involvement, then evaluation by an eye specialist as soon as possible is necessary.
Good skin hydration is also important in restoring the skin barrier to protect against infectious agents. Cleansers can also decrease skin colonization by bacteria. Some dermatologists have been prescribing dilute bleach baths, especially for patients with recurrent MRSA. However, these may be very irritating for some patients and since the nose is a main reservoir of staph bacteria, patients often get quickly re-colonized.
Wet wrap therapy
When symptoms are severe, your healthcare provider may suggest wet wrap therapy. These are dressings—often made from articles of clothing—that have been soaked in warm water with a dry layer applied on top. Face wraps are done by nurses trained in the procedure using gauze and surgical netting.
Apply wet wraps to skin after soaking and sealing and after applying topical steroid medicine. The wraps help keep skin moist and improve effectiveness of topical medicine. They also have a cooling anti-itch effect. Rewet or take the wraps off when they start to dry out. This should be done under medical supervision for short periods of time and only to the more severe eczema, and the patient should be observed for signs of skin infection.
Phototherapy
Exposure to natural sunlight or ultraviolet light often helps people with atopic dermatitis. However, it can be counterproductive if at the same time patients are exposed to heat and humidity, which causes them to perspire and itch or get sunburned.
Phototherapy with many different types of ultraviolet light may be prescribed, such as broad-band ultraviolet B, broad-band ultraviolet A, narrow-band UVB, or combined UVAB light. Tanning beds are not appropriate therapy. This treatment should be used in conjunction with other therapies. It also should be reserved for patients with especially severe atopic dermatitis because of potential long-term adverse effects, including premature aging of the skin and skin cancer.
Psychological counseling
People with atopic dermatitis often struggle with a poor self-image and low self-esteem. In severe cases, the appearance of their skin can invite teasing and, especially with children, interfere with peer relationships. The sleep disturbances that may accompany atopic dermatitis put added stress on individuals and those closest to them.
Atopic dermatitis patients who are experiencing a lot of stress may benefit from psychological counseling or even from taking antianxiety drugs. Relaxation therapy and biofeedback also can be helpful for people who are finding it hard to control their scratching.
Day hospitalization
Day hospitalization at centers specializing in treatment of skin disorders, including National Jewish Health in Denver, can be helpful for patients whose rashes are not controlled by medications and by avoiding irritants. Patients spend their days in a hospital and go home or to a local hotel at night. This can help get treatment back on track in several ways:
It removes the patient from allergens in the home. It also allows the patient to be seen concurrently by a team of specialists: allergist-immunologists, psychosocial staff, nurse-educators, and nutritionists. Team members assist in a patient's self-care regimen so they can teach the patient proper techniques. This hospital time may be used for evaluating response to different medications, testing for specific triggers of atopic dermatitis, under controlled conditions and doing food challenges. Sleep disturbance and behavioral aspects of the disease can be addressed. Most people's atopic dermatitis improves significantly during hospitalization, so they are able to avoid more aggressive treatments.
Day hospitalization programs usually last one to two weeks.
Last reviewed on 10/21/09
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