Eczema treatment is an important health topic due to its high prevalence among both children and adults. Statistics show that about 10-20% of children and 1-3% of adults around the world suffer from eczema at varying levels of severity. Knowing the different treatment modalities, both topical and systemic, enables patients and doctors to control symptoms, reduce inflammation and itching, and improve quality of life.
What is eczema?
Atopic dermatitis (eczema) is a common chronic inflammatory skin disease that makes the skin dry, itchy, and inflamed. It’s most common in young children, but can occur at any age. Atopic dermatitis is long-lasting (chronic) and can sometimes become more severe. It can be irritating but is not contagious, and people with atopic dermatitis are at risk of developing food allergies, hay feve,r and asthma. There are several types of atopic dermatitis (eczema). Each type has unique triggers that can affect your skin barrier function, including:
- Atopic dermatitis
- Contact dermatitis
- Sweaty eczema
- Nervous itching
- Nummular eczema
- Seborrheic dermatitis
It is possible to have more than one type of atopic dermatitis (eczema) at the same time.
Causes of eczema
The exact cause of eczema has yet to be determined, but there are several factors that are thought to play a role in its onset:
- Genetic factors: The risk is increased if one parent has allergic diseases such as asthma or allergic rhinitis. Gene mutations associated with skin barrier weakness have also been identified.
- Skin microbiome: The composition of microorganisms on the skin in eczema patients differs from that of healthy people, which may impair skin barrier function.
- Environmental factors: Exposure to pollutants such as smoke, soot, sulfur dioxide, and carbon monoxide may increase the likelihood of infection.
- Immune response: An overactive immune system leads to inflammation of the skin when encountering minor irritants.
Eczema triggers
Triggers vary from person to person, and include:
- Coarse fabrics such as wool
- Stress and tension
- Dust, mold, pollen, and animals
- Chemicals such as perfumes and dyes
- Cold and dry air or heat and humidity
- Certain foods in people with food allergies
Eczema treatment
There are many ways to treat eczema and many moisturizers used in this treatment.
Best creams and moisturizers for eczema
Medicated moisturizers are medical preparations used in eczema treatment and dry skin. They differ from cosmetic moisturizers in that they are unscented and do not contain anti-aging ingredients. Moisturizers soothe, moisturize, and protect the skin, thereby reducing the number of eczema attacks. There are several types of eczema, there are several options of moisturizers available to treat eczema, and moisturizers should have the following qualities:
- Gentle or for sensitive skin
- Contains Vaseline or mineral oil
- No preservatives or stabilizers
- Hypoallergenic and free of fragrances and dyes
- Contains lipids and ceramides to improve the skin barrier
Types of moisturizers used in eczema treatment
Moisturizers that are left on the skin:
- It protects the skin and prevents water loss
- Pharmaceutical forms:
- Lotion: Light, suitable for hairy areas or moist eczema, quickly absorbed, but weak in intense moisturizing.
- Cream: A mixture of water and fat, easy to spread and light, requires repeated application.
- Gel: Light, non-greasy, retains moisture for a good period of time.
- Spray: Suitable for hard-to-reach areas, contains oil-based components dissolved in silicone.
- Ointment: Thick and creamy, excellent for very dry or thick skin, usually used before bedtime.
2. Auxiliary components
Some additional ingredients include:
- Moisture-attracting moisturizers: Like glycerin and urea, they attract water to the skin and increase the duration of moisturization.
- Antipruritics: Such as lauromicrogol, help relieve itching and soothe skin irritation.
- Ceramides: Restores the natural lipid balance necessary to maintain the integrity of the skin barrier.
- Oatmeal: Contains natural antioxidants, soothes the skin and reduces inflammation.
- Antimicrobial agents: Used to reduce the growth of germs on the skin, but may cause irritation with prolonged use.
Showering with moisturizers
The patient should apply the eczema treatment by showering using moisturizers where:
- It is advisable to use moisturizing bath products or replace soap with moisturizers
- Water should be lukewarm to avoid worsening eczema
- Be careful not to slip: Use a mat and handrail when showering
Choosing the right moisturizer
There are several rules to keep in mind when choosing the right moisturizer
- The best is what works well for you and that you enjoy using, to ensure repeated application.
- You may need to use different types for different parts of the body or depending on the season.
- Test the product on a small area first to avoid irritation.
How to apply moisturizers
How to apply moisturizers for eczema includes the following rules:
- At least twice a day, and more often during eczema flare-ups or severe dryness
- After showering, gently pat the skin dry and immediately apply the moisturizer
- Apply the moisturizer in the direction of hair growth, refrain from rubbing up and down
- Continue using moisturizers even after the condition improves to minimize future flare ups
- Use a spoon to avoid contamination of the ointment, except for hand pumps
- Follow intervals when using topical steroids or calcineurin inhibitors
- Steroids: Moisturize 30 minutes after steroid application.
- Tacrolimus: It is preferable to use a moisturizer two hours after applying the medication.
- Pimecrolimus: No time interval is needed before using the moisturizer.
- Beware of explosion: Clothing and linens contaminated with dry moisturizers are flammable.
Moisturizers and some people’s allergies (ASD or sensory issues)
There are several rules for avoiding sensory sensitivities:
- You can try different types of moisturizers: Sprays, gels, light creams, or bath oils to minimize direct skin contact.
- Removing clothing labels, using natural fabrics, and rewarding children for applying moisturizers can help with treatment adherence.
Moisturizers that are no longer recommended:
- Water-based cream: No longer recommended as a moisturizer or soap substitute, it contains sodium lauryl sulfate, which irritates the skin and exacerbates eczema.
Complementary Eczema Treatment
Complementary therapies include a range of practices and products that are not typical of conventional medicine and are used in conjunction with conventional therapies to improve quality of life and manage symptoms, not as a substitute for conventional medicine. It is always important to consult a doctor before starting any complementary therapy to avoid interactions or side effects.
The most common types of complementary therapies:
- Western Herbalism
- Used to stimulate immunity or support normal body functions.
- Ensure the product has a THR license and follows safety instructions.
- It is recommended to test the cream on a small area before daily use.
- Chinese Herbs
- Used according to individual diagnosis by a specialist.
- Some creams may contain steroids or cause liver and kidney damage.
- It is important to consult a doctor and have blood tests done regularly.
- Homeopathy
- It relies on giving very diluted substances to treat the symptoms.
- There is no strong evidence of its effectiveness, and it is no longer supported by the NHS.
- Aromatherapy
- Essential oils are used to reduce inflammation and soothe itching.
- The oil should be tested on the skin first, and avoid oils on broken skin.
- Reflexology
- Focuses on points on the feet or hands to calm the body and stimulate relaxation.
- Avoid touching inflamed or broken areas.
- Nutrition and Supplements
- Supplements such as vitamin E, B6, selenium, zinc, and evening primrose oil have not been shown to be effective.
- Vitamin D may help protect the skin and reduce inflammation, especially in children and infants.
- Probiotics may help prevent eczema in children who are prone to it, but they do not improve current symptoms.
- Hypnotherapy
- It aims to control the itching and psychological stress associated with eczema.
- It should be done by a professional and trained specialist.
- Other relaxation techniques
- Helps reduce stress that increases itching and aggravation.
- Includes: meditation, mindfulness, deep breathing exercises, autogenic exercises, yoga.
Diet and its role in treating eczema
Diet plays an important role in controlling the severity of eczema symptoms. Although foods are not the direct cause of the disease, some foods may increase skin irritation, while others can calm inflammation and support healthy skin.
Foods that trigger eczema?
There are some foods that may trigger allergies or increase the severity of eczema flare-ups, most notably:
- Eggs
- soy
- Nuts
- Peanuts
- Wheat (gluten)
- Milk and dairy products
- Foods high in sugars and saturated fats
This group is known as the “no-no” foods for atopic dermatitis patients, and it is recommended to avoid or minimize them if you notice worsening symptoms after consuming them.
Foods that help treat eczema
On the other hand, there are foods that are rich in anti-inflammatory elements that help improve skin health and reduce the severity of flare-ups:
- Fatty fish such as salmon and sardines (source of omega-3)
- Antioxidant-rich fruits such as berries and oranges
- Leafy vegetables such as spinach and broccoli
- Legumes and whole grains
- Olive oil and avocado
Eating a balanced diet that includes these foods is part of dietary eczema treatment, but it’s not a substitute for prescription medical treatment.
Cognitive Behavioral Therapy (CBT)
It is a technique based on talking with a specialized therapist and is commonly used to help people cope with anxiety and depression. It can also be useful for people with chronic conditions such as atopic dermatitis, where stress and tension can affect the severity of symptoms. This type of therapy focuses on the relationship between thoughts, feelings, and behaviors, and helps the individual change unhelpful thinking and behaviors, contributing to a better quality of life and better symptom control.
How does cognitive behavioral therapy help with eczema?
Cognitive behavioral therapy helps treat eczema by:
- It teaches the patient to recognize and challenge their negative thoughts
- Helps to accept reality and cope with sudden attacks of eczema
- Teaches strategies to minimize scratching and maintain a skin care routine
- Includes regular sessions with a therapist and homework assignments to apply skills to daily life
Habit Reversal Technique and Common Approach in Eczema Treatment
Constant scratching
- Eczema causes constant itching that leads to frequent scratching
- Constant scratching turns eczema into a chronic condition and hinders skin healing
How does habit reversal technology work?
Habit reversal technology works by:
- It aims to reduce automatic behaviors such as scratching or rubbing.
- The person learns scratching awareness and replaces it with alternative behaviors such as holding the hand for 30 seconds until the urge to scratch goes away.
- Helps heal chronic skin when combined with optimal topical therapy (moisturizers and steroid creams).
Common approach
- Sessions of 4-6 meetings over approximately two months
- Includes scratch tracking using a diary counter
- Adjusting medications to be more effective during the program
- Monitor progress and gradually reduce itching, increasing confidence and self-control in the condition
Effectiveness of the method
The effectiveness of the curriculum lies in:
- Studies have shown that the combination of habit reversal + topical therapy is better than topical therapy alone
- Enhances a person’s sense of control and reduces the need for long-term use of strong medications
For dough dressings and wet packaging
Purpose of use
- Prevent itching and minimize scratching
- Improved absorption of moisturizers
- These methods should only be used under medical supervision.
- Helps control the itch-scratch cycle and eczema attacks
How to use them
For children
The whole body can be covered with bandages or wet wrapping.
Adults
Usually used only on specific patches of eczema.
Wet packaging
- Apply a generous layer of moisturizer, and sometimes a mild or medium-strength topical steroid (only under medical supervision).
- Cover the area with a warm, moist tube bandage.
- Place a dry layer on top of the wet layer.
- Especially useful at night as it cools the skin and reduces itching.
Dough dressings
These pads contain ingredients that soothe itching and relieve inflammation and are a common type:
- Ichthopast: Includes ichthamol and zinc oxide to moisturize and soothe itching.
- Viscobast and Zipzok: Both include zinc oxide, and Zipzoc is characterized by its sock-like shape rather than a bandage.
It can be used on entire limbs or on specific patches after applying a moisturizer or topical steroid, but only under medical supervision.
Due to the mess created by the paste, a secondary dressing is used to stabilize the paste dressing.
Light therapy, or phototherapy
Phototherapy: This treatment is used for people who do not improve with topical treatments or whose symptoms quickly reappear after treatment. The simplest form of phototherapy involves exposing the affected area to specific amounts of natural sunlight. Other forms use artificial ultraviolet A and narrowband ultraviolet B light alone or in combination with other medications.
Types of light therapy
Types of light therapy include
- Broadband UV: Older and less effective.
- Narrow UV
- Wavelengths between 311–313 nm
- More effective and helps reduce itching and inflammation.
- Can achieve longer skin clarity period
- UV light with photosensitive drug
- Requires taking a light-sensitive medication or adding it to the bath.
- Used for severe eczema or on specific areas of the skin.
- Not suitable for pregnancy or breastfeeding
Using light therapy
- For moderate to severe atopic dermatitis (eczema) that has not responded to moisturizers and steroids.
- Not suitable for those with light sensitivity or radiation-sensitive skin conditions.
- Narrowband and Broadband UVB are safe during pregnancy and breastfeeding, PUVA should be avoided.
Cycle time and dosing
- UVB: 2-3 times weekly, PUVA: Twice weekly.
- Duration: Usually 12-16 weeks.
- The dosage is determined by skin type and initial sensitivity testing.
- There is a lifetime maximum dose limit to minimize the risk of cancer.
Side effects
Side effects of light therapy for eczema
- Activating cold sores
- PUVA may cause nausea
- Skin redness, dryness, mild sunburn
- Prolonged use may lead to skin aging or increased risk of cancer
- Use sunscreen (SPF50+) and protective clothing while in the sun
Continue with moisturizers and topical treatments
- Continue to moisturize regularly, especially after treatment
- Topical steroids may be continued depending on the condition of the eczema
- Do not use topical calcineurin inhibitors, such as Elidel and Protopic, on treatment days because they increase the skin’s sensitivity to light
What to avoid during treatment
There are a number of things to avoid during treatment
- Medications that increase skin’s sensitivity to light
- Additional sun exposure or tanning beds
- Perfumes, cosmetics before treatment
- Haircutting or unusual hair removal on treated skin
- Certain foods such as carrots, celery and citrus fruits that increase skin sensitivity
How is childhood eczema treated?
If your child has skin conditions such as eczema, you can:
- Use moisturizers several times a day. For infants with atopic dermatitis(eczema), regular moisturizing, such as with every diaper change, is very helpful
- Keep the room temperature as constant as possible. Changing room temperature and humidity can dry out your baby’s skin
- Give your child a short warm bath rather than a long hot bath, as a long bath can dry out your child’s skin
- Keep baby in cotton clothes. Wool, silk and synthetic fabrics such as polyester can irritate his skin
- Use laundry detergent for sensitive skin or unscented laundry detergent
- Helping your child avoid rubbing or scratching their skin
Pediatric light therapy
This treatment is used for severe cases only, after other conventional treatments have failed, starting with very small doses and then gradually increasing them according to the child’s response. In some clinics, parents are allowed to stay by the child’s side during the sessions to reduce stress and fear, the child needs to wear goggles during the treatment, and all scheduled sessions must be adhered to to ensure the best possible effectiveness.
How long after treatment will I feel better?
After treatment, it may take several weeks before eczema disappears completely. Topical or oral medications prescribed by your healthcare provider can help make your symptoms go away faster. If your symptoms worsen after treatment, or don’t go away after several weeks, contact your healthcare provider.
How to prevent eczema
Establishing a basic skin care routine may help prevent eczema flare-ups. The following tips may help minimize dryness from showering:
- Avoid irritants and allergens
- Taking a bath or shower with warm, not hot, water
- Use a humidifier if dry air is drying out your skin
- Stay hydrated and drink at least eight glasses of water a day. Water helps keep your skin hydrated
- Moisturize your skin regularly or when it’s dry. Retain moisture after showering by applying moisturizer right away
- Wear loose-fitting clothes made of cotton and other natural materials. Wash new clothes before wearing them. Avoid wool or synthetic fibers
- Managing stress and emotional factors. See a psychiatrist for pharmacotherapy and a psychotherapist for talk therapy if you are experiencing issues with your mental/emotional health
In conclusion, eczema treatment play a key role in controlling symptoms and reducing inflammation and itching, whether through moisturizers, topical steroids, immunosuppressants, or modern biological therapies. It is important to consult your doctor before starting any treatment to determine the most appropriate according to the type of atopic dermatits (eczema) and the severity of the condition. Adherence to the treatment plan and regular follow-up can help improve quality of life and effectively control the disease.
Sources
- National Center for Biotechnology Information. (2023). Atopic Dermatitis (Eczema). In StatPearls. Retrieved from
- National Institute of Allergy and Infectious Diseases (NIAID). (2023). Eczema: Causes and Triggers. Retrieved from
- Li, Y., & others. (2022). Advances in understanding the pathophysiology of atopic dermatitis. Frontiers in Immunology, 13, 9788967.