Treatment - Eczema - beta

Treatments for eczema (atopic eczema) can help to ease the symptoms.

There's no cure, but many children find their symptoms improve as they get older.

The main treatments for eczema are:

• emollients (moisturisers) - used every day to stop the skin becoming dry
• topical corticosteroids - creams and ointments used to reduce swelling and redness during flare-ups

Other treatments include:

• topical pimecrolimus or tacrolimus for eczema - these are used in sensitive sites that are not responding to simpler treatment
• antihistamines for severe itching
• bandages or special body suits to allow the body to heal underneath
• more powerful treatments offered by a dermatologist (skin specialist)

Emollients

Emollients are moisturising treatments. You apply them to your skin. They then help to reduce water loss by covering your skin with a protective film.

They're often used to help manage dry or scaly skin conditions, such as eczema.

They make the skin feel less dry and may also help protect against inflammation.

Emollients also help to reduce the number of flare-ups you have.

If you have mild eczema, talk to a pharmacist for advice on emollients. If you have moderate or severe eczema, talk to your GP.

Choosing an emollient

Several different emollients are available. Talk to a pharmacist for advice on which emollient to use. You may need to try a few to find one that works for you.

Your GP may tell you to use a mix of emollients, such as:

• an ointment for very dry skin
• a cream or lotion for less dry skin
• an emollient to use instead of soap
• an emollient to add to bath water or use in the shower
• one emollient to use on your face and hands, and a different one to use on your body

The difference between lotions, creams and ointments is the amount of oil they contain.

Ointments contain the most oil so they can be quite greasy. But they are the most effective at keeping moisture in the skin.

Lotions contain the least amount of oil. They are not greasy, but can be less effective. Creams are somewhere in between.

If you have been using a particular emollient for some time, it may become less effective or start to irritate your skin.

If this is the case, you may find another product suits you better. You can speak to a pharmacist about other options.

The best emollient is the one you feel happy using every day.

How to use emollients

Use your emollient all the time, even if you do not have symptoms.

Many people find it helpful to keep separate supplies of emollients. You might keep a supply at work or school, or a tub in the bathroom and another in the living area.

To apply the emollient:

• use a large amount
• do not rub it in – smooth it into the skin in the same direction the hair grows
• after a bath or shower, pat the skin dry and apply the emollient while the skin is still moist to keep the moisture in

You should use an emollient at least twice a day, or more often if you have very dry skin.

During a flare-up, apply generous amounts of emollient more often. But remember to treat inflamed skin with a topical corticosteroid. Emollients used on their own are not enough to control it.

Do not put your fingers into an emollient pot. Use a spoon or pump dispenser instead, as this reduces the risk of infection. And never share your emollient with other people.

Topical corticosteroids

If your skin is sore and inflamed, your GP may prescribe a topical corticosteroid (applied to your skin). This can reduce the inflammation within a few days.

Topical corticosteroids can be prescribed in different strengths. This depends on the severity of your eczema and the areas of skin affected.

They can be:

• very mild (such as hydrocortisone)
• moderate (such as clobetasone butyrate)
• even stronger (such as mometasone)

If you need to use corticosteroids often, talk to your GP. They can check the treatment is working and you're using the right amount.

How to use topical corticosteroids

Do not be afraid to apply the treatment to affected areas to control your eczema.

Follow the directions on the patient information leaflet that comes with your medicine. This will give details of how much to apply.

Most people only have to apply it once a day as there's no evidence of any benefit to applying it more often.

When using a topical corticosteroid:

• apply your emollient first and wait 30 minutes until the emollient has soaked into your skin - you might also prefer to apply the corticosteroid at a different time of day (such as at night)
• apply the recommended amount of the topical corticosteroid to the affected area
• continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated

Your doctor may suggest using a topical corticosteroid less often, but over a longer period of time. This will help to prevent flare-ups.

Side effects

Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them.

In rare cases, they may also cause:

• thinning of the skin – if the strong steroids are used in the wrong places, such as the face, for several weeks
• changes in skin colour – for example, skin can lighten after many months of using very strong steroids
• acne (spots) – especially when used on the face in teenagers
• increased hair growth

Most of these side effects will improve once treatment stops.

Your risk of side effects may be increased if you use a strong topical corticosteroid:

• for many months
• in sensitive areas such as the face, armpits or groin
• in large amounts

Your GP should prescribe the weakest effective treatment to control your symptoms.

Antihistamines

Antihistamines are a type of medicine that block the effects of a substance in the blood called histamine.

They can help relieve the itching associated with eczema.

They can either be sedating, which cause drowsiness, or non-sedating.

If you have severe itching, your GP may suggest trying a non-sedating antihistamine.

If itching during a flare-up affects your sleep, your GP may suggest taking a sedating antihistamine.

Sedating antihistamines can cause drowsiness into the next day. It may be helpful to let your child's school know they may not be as alert as normal.

Bandages and wet wraps

In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema.

These can be used either over emollients or with topical corticosteroids to prevent scratching. They allow the skin underneath to heal, and stop the skin drying out.

Corticosteroid tablets

Corticosteroid tablets are rarely used to treat eczema. They may be prescribed for short periods of 5 to 7 days to help bring severe flare-ups under control.

Longer courses of treatment are generally avoided. This is because of the risk of serious side effects.

Your GP may refer you to a specialist if you need repeated or prolonged treatment with corticosteroid tablets.

Seeing a specialist

In some cases, your GP may refer you to a specialist in treating skin conditions (dermatologist).

You may be referred if:

• your GP is not sure what type of eczema you have
• normal treatment is not controlling your eczema
• your eczema is affecting your daily life
• it's not clear what's causing it

A dermatologist may be able to offer the following:

• allergy testing
• a thorough review of your existing treatment - this is to make sure you're using enough of the right things at the right times
• topical calcineurin inhibitors - these are creams and ointments that suppress your immune system.
• very strong topical corticosteroids
• bandages or wet wraps
• phototherapy – ultraviolet (UV) light that reduces inflammation
• immunosuppressant tablets to suppress your immune system, such as azathioprine, ciclosporin and methotrexate
• alitretinoin – medicine to treat severe eczema affecting the hands in adults
• dupilumab – a medicine for adults with moderate to severe eczema

A dermatologist may also offer support to help you use your treatments the right way. They may be able to refer you for psychological support if you feel you need it.

Complementary therapies

Some people may find complementary therapies such as herbal remedies helpful in treating their eczema. But there's little evidence to show these remedies work.

If you're thinking about using a complementary therapy, speak to your GP first. This is to make sure the therapy is safe for you to use.

Make sure you continue to use the other treatments your GP has prescribed.