Health encyclopaedia - Alphabetical Topic List
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Treatment of Eczema (discoid)
There is no simple cure for discoid eczema but you can do a lot to prevent and treat it.
Treatment is based on the use of: emollients (moisturisers) including soap substitutes, bath oils and general moisturizers, and topical corticosteroids (often shortened to steroids ).
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, oral corticosteroids, 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 for you or your child. It may take time to find the best one(s). Do not try several new treatments at once - for example, a mixture of creams, new diet and herbal medicine, because if things improve, you will not know which treatment has worked.
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.
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
Rarely, the infection may have been caused by the cold sore virus (herpes simplex). This is treated with an anti-viral medicine such as aciclovir and hospital admission may be necessary in severe cases.
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 night’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.
Topical immunomodulators
Tacrolimus ointment and pimecrolimus cream have recently been introduced. There is evidence that they reduce inflammation, but it is not completely understood how they work. As these are new treatments, further research is still needed to fully assess their role in treatment and their long term safety.
Only dermatologist can start tacrolimus treatment. Local arrangements may be in place to allow your GP to continue to prescribe tacrolimus under supervision of the dermatologist.
Pimecrolimus is used to treat mild to moderate eczema and to prevent acute flare ups. It is sometimes considered as a second choice treatment in some eczema patients where topical steroids are considered unsuitable or are not working.
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.
Complementary treatments
Evening primrose oil supplements, borage oil, homeopathy (graphites, nat.mur) and Chinese herbal medicine (Chinese gentian, Chinese wormwood, peony root, rehmannia) have all been used to treat atopic eczema.
There is little evidence to prove how these alternative medicines work or how safe or effective many of them are. Certain herbs and preparations contain ingredients that can be harmful if not used with care or if not obtained from reputable sources.
Before using any complementary medicine for eczema, you should talk to your GP or pharmacist (chemist). You can also phone NHS Direct on 0845 4647.
