Treatment of Eczema (contact dermatitis)

Health encyclopaedia - Alphabetical Topic List

| A |

| B |

| C |

| D |

| E |

| F |

| G |

| H |

| I |

| J |

| K |

| L |

| M |

| N |

| O |

| P |

| Q |

| R |

| S |

| T |

| U |

| V |

| W |

| X |

| Y |

The three main goals of controlling and treating contact eczema are, the identification and avoidance of the cause, and healing the skin and keeping it healthy.

Whether your eczema is due to an irritant, such as detergent, or due to an allergen, such as nickel, care and treatment of your skin is the same. Treatment is based on the use of, emollients (moisturisers) including soap substitutes, bath oils, and topical corticosteroids (steroids) for flare-ups.

There may also be a need for antimicrobial treatment (to treat skin infection), and antihistamine tablets (to help sleep disturbance caused by itching).

In more severe cases which are difficult to treat there may be a need for, other immunosuppressant medicines such as ciclosporin and azathioprine, and phototherapy and photochemotherapy. (light treatment, or light treatment plus medication).

The way you use and apply the treatments is a key factor in how successful you will be in keeping the eczema under control. Failure of treatment can often be due to incorrect use. There are many preparations of each type of treatment. It is often a matter of practicality and personal preference that determines which preparation is best. It may take time to find the best one(s).

Emollients (moisturisers)

Emollients reduce water loss from the outer layer of your skin by covering it with a protective film. This keeps the water in the skin where it is needed and also helps to keep infections and other harsh substances out. Emollient creams and ointments are essential in the prevention and treatment of eczema. Emollients are very safe and you cannot overuse them. They are not active drugs and do not get absorbed through the skin into the body.

Topical corticosteroid (steroid) preparations

A topical corticosteroid cream or ointment can quickly bring the eczema under control. It is not a cure but is effective in reducing the inflammation associated with a flare up of eczema.

For most people with mild to moderate eczema, treatment with a mild steroid (hydrocortisone 1% cream or ointment) for one to two weeks is enough to treat a flare up. You may need to step up to a stronger steroid if there is no response, but in general, you should use the lowest strength that works. Your doctor or pharmacist can explain the differences between the preparations available. Topical steroids must only be used to treat eczema when the eczema has flared. Start treatment at the first sign of a flare up. You should already be using emollients regularly throughout the day .

Used correctly, topical steroids are safe and effective whereas untreated eczema can have serious consequences.

You could be sensitive to one of the ingredients in the cream or ointment, apart from the steroid. If you notice that the eczema gets worse, it is important that you talk to your pharmacist or doctor to discuss alternatives.

Anti-infective agents

You can help to prevent eczema becoming infected by, keeping hands clean and nails clean and short, and avoiding scratching.

If there is any suspicion that the eczema has become infected (such as redness, weeping or blisters) see your doctor as soon as possible because the infection can spread quickly and the use of steroid creams can mask or further spread the infection.

Your GP will give you a course of oral antibiotics and/or an antibiotic cream or ointment. The oral antibiotic is usually a penicillin such as flucloxacillin (or erythromycin if the patient is allergic to penicillin). Antibiotic creams or ointments used are fusidic acid or mupiricin or a combined steroid and antibiotic cream or ointment

Antihistamines

Sedative antihistamines, such as alimemazine (previously known as trimeprazine) and hydroxyzine may sometimes help to reduce the itch of eczema at night and give a good nightâ€™s sleep. They are only suitable for short periods of treatment (e.g. to break a pattern of sleepless nights). They can make you feel drowsy the next day so may not be suitable if you drive.

Give the dose about one hour before bedtime so that it has time to take effect. A bath about an hour before bed followed by plenty of moisturisers can help cool the skin and may be more effective than the antihistamine. Give the antihistamine after bathing not before. Antihistamine creams are not effective in eczema treatment and should be avoided as sometimes the ingredients in them can make the eczema worse.

Over-the-counter medicines for eczema

A range of shampoos, emollient products and some topical steroid preparations can be bought from pharmacies. Some of them are cheaper to buy this way, than on a prescription.
Ask your pharmacist for advice on the different products and how to use them.

After asking you a few questions to find out about you, your condition and any medicines you may take or use (including any treatments applied directly to the skin), they may decide it would be better for you to see your GP to review your condition and its treatment.

Tell your pharmacist if you, or the person who needs the treatment, is allergic to peanuts because some products contain peanut (arachis) oil.

If your eczema does not improve after one week of using an over-the-counter preparation, particularly a moderately potent corticosteroid e.g. clobetasone butyrate, you should see your GP.

Hospital treatments

People with severe eczema or eczema resistant to treatment may require referral to a skin specialist (dermatologist).

Treatments used may include: 'wet wraps', tar and/or steroid occlusion bandages, light therapy, and medicines which suppress the immune system such as ciclosporin.