Eczema is a chronic skin disorder characterized by scaly and itchy rashes. Atopic dermatitis is the most common type.
Atopic dermatitis is due to a skin reaction pattern, similar to an allergy, that causes long-term inflammation of the skin. Most people with atopic dermatitis also are missing certain proteins from the surface of the skin. These proteins are important in maintaining the skin barrier function. As a result, their skin is more easily irritated by minor irritants.
Taking care of your skin at home may reduce the need for medicines.
Eczema - self-care
Try not to scratch the rash or your skin in the inflamed area.
- Relieve the itch by using moisturizers, topical steroids, or other prescribed creams.
- Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.
Antihistamines taken by mouth may help with itching if you have allergies. Often you can buy them over-the-counter. Some antihistamines can cause sleepiness. But they may help with scratching while you sleep. Newer antihistamines cause little or no sleepiness. However, they may not be as effective in controlling the itch. These include:
- Fexofenadine (Allegra)
- Loratadine (Claritin, Alavert)
- Cetirizine (Zyrtec)
Benadryl or hydroxyzine may be taken at night time to relieve itching and allow for sleep.
Day-to-day Skin Care
Keep the skin lubricated or moisturized. Use ointment (such as petroleum jelly), cream, or lotion 2 to 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or chemicals you know you are allergic to. Having a humidifier in the home may also help.
Moisturizers and emollients work best when they are applied to skin that is wet or damp. These products soften the skin and help it retain moisture. After washing or bathing, pat the skin dry and then apply the moisturizer right away.
Different types of emollients or moisturizers may be used at different times of the day. For the most part, you can apply these substances as often as you need to keep your skin soft.
Avoid anything that you observe makes your symptoms worse. These may include:
- Foods, such as eggs in a very young child. Always discuss with your health care provider first.
- Wool, and other scratchy fabrics. Use smooth, textured clothing and bedding, such as cotton.
- Sweating. Be careful not to over dress during warmer weather.
- Strong soaps or detergents, as well as chemicals and solvents.
- Sudden changes in body temperature and stress, which may cause sweating and worsen your condition.
- Triggers that cause allergy symptoms.
When washing or bathing:
- Bathe less often and keep water contact as brief as possible. Short, cooler baths are better than long, hot baths.
- Use gentle skin care cleansers rather than traditional soaps. Use these products only on your face, underarms, genital areas, hands, and feet, or to remove visible dirt.
- DO NOT scrub or dry the skin too hard or for too long.
- After bathing, it is important to apply lubricating cream, lotion, or ointment on the skin while it is damp. This will help trap moisture in the skin.
The rash itself, as well as the scratching, often causes breaks in the skin and may lead to infection. Keep an eye out for redness, warmth, swelling, or other signs of infection.
Medicines From Your Doctor
Topical corticosteroids are medicines used to treat conditions where your skin becomes red, sore, or inflamed. "Topical" means you place it on the skin. Topical corticosteroids may also be called topical steroids or topical cortisones. These medicines help "calm" your skin when it is irritated.. Your provider will tell you how much of this medicine to use and how often. DO NOT use more medicine or use it more often than you are told.
You may need other prescription medicines such as barrier repair creams. These help to replenish the normal surface of the skin and rebuild the broken barrier.
Your provider may give you other medicines to use on your skin or take by mouth. Be sure to follow the directions carefully.
When to Call the Doctor
Call your provider if:
- Eczema does not respond to moisturizers or avoiding allergens.
- Symptoms worsen or treatment is ineffective.
- You have signs of infection (such as fever, redness, or pain).
Eichenfield LF, Boguniewicz M, Simpson EL, et al. Translating atopic dermatitis management guidelines into practice for primary care providers. Pediatrics. 2015;136(3):554-565. PMID: 26240216 www.ncbi.nlm.nih.gov/pubmed/26240216.
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James WD, Berger TG, Elston DM. Atopic dermatitis, eczema, and noninfectious immunodeficiency disorders. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 5.
Ong PY. Atopic dermatitis. In: Kellerman RD, Rakel DP, eds. Conn' s Current Therapy 2019. Philadelphia, PA: Elsevier; 2019:940-944.