ECZEMA (How to reduce flares)

Eczema, also known as Atopic Dermatitis is an inflammatory condition that is characterized by dry, itchy skin. There are several types of dermatitis but “Atopic Dermatitis” will be discussed here. Eczema is usually genetic and normally occurs in persons who have an atopic tendency, which is a person who may develop eczema and/or asthma and allergic rhinitis.
 
The exact cause of eczema is still unknown. Persons typically present with skin that is dry and itchy, sometimes with redness, scaling and blisters. It may occur on any part of the body, but is very common in the skin creases. By far the most defining symptom of eczema is the itch, which can be so unbearable that it leads to loss of sleep, frustration, anger and depression. Persistent scratching can lead to cuts in the skin, which can become infected. Eczema affects persons differently, but there are a number of common triggers including soaps, detergents, perfumes, rough clothing, heat, animal dander, food and stress. The treatment for eczema includes avoidance of the triggers and the use of emollients and topical steroids. Anti-histamines can be used to control the itch. Below are some of my tips to better prevent and manage eczema flares.
 
 
MOISTURIZE! MOISTURIZE! Moisturize!
 
Emollients are medical moisturizers used to treat eczema. They are safe and effective and can soothe, moisturize, and protect the skin, helping to reduce the number of eczema flares. They come in the form of creams, ointments, lotions and gels. Emollients help to keep the skin moist and flexible, which helps to prevent cracks, and make skin feel more comfortable and less itchy. Evidence show that the more emollients are used, the less topical steroids are needed.

Tip#1:
Do not shower in very hot water, which can strip the skin of natural oils and cause more dryness, use warm water instead.

Tip#2:
Ordinary foaming soaps and shower gels contain harsh detergents and fragrances that can dry and irritate the skin. If you get frequent flares, try using soap substitutes. (These are alternative cleansers that contain emollient oils to protect and moisturize the skin. They are used in the same way as you would a normal soap, but because they contain no harsh detergents, they do not create bubbles or foam).

Tip#3:
Do gently pat the skin with a soft towel after washing. Rubbing the skin forcefully can cause more skin damage. (Then apply emollient immediately).

Tip#4:
The right type of emollient is based on trial and error, but it should be used frequently. Twice a day is Ideal, and up to four times a day during a flare. Aveeno cream and E45 cream are good examples for mild flares.

Tip#5:
Rub the emollient gently into the skin until it completely disappears. Apply it to all parts of the skin, not just the areas where the eczema flares.

Tip#6:
Moisturizers should be applied downward or in the direction of the hair growth to lessen the risk of folliculitis.

Tip#7:
Emollients may sting for the first couple of days before they begin soothing the skin.

Tip#8:
Do not place your hands into the container; instead use a utensil to scoop out the moisturizer. This will prevent it from becoming infected with bacteria from the skin.

Tip#9:
Apply more emollient than usual if going for a swim to prevent the skin from over drying. Shower afterward and re-apply your usual amount.

Tip#10:
If using a topical steroid, apply the emollient first, then wait 20 minutes before applying the topical steroid.
 
TOPICAL STEROIDS

Topical steroids are valuable in the treatment of eczema flares by reducing inflammation. They come in various forms including ointments, creams, lotions and scalp preparations. They also come in various strengths; mild potency steroids are used for milder flares whereas more potent steroids are used for more severe flares.  When used appropriately, topical steroids are safe and effective treatments for eczema.  However they are not without side effects. The likelihood of side effects occurring is directly related to the potency, the part of the body it is being applied, the condition of the skin, and the age of the person. If used inappropriately or over long periods of time, topical steroids can lead to thin and loose skin, prominent blood vessels, ‘stretch marks’, and hypo-pigmentation (lightening) especially in dark skin.

Tip#11:
Avoid frequent use of topical steroids on the face. Although adverse reactions are greater with more potent steroids, limiting their use on the face can reduce side effects.

Tip#12:
If possible try not to use topical steroids more than twice daily. Also, avoid using high potency steroids for more than 3 weeks continuously. If longer duration is needed, the steroid should be gradually tapered and resumed after a steroid free period of at least 1 week.

Tip#13:
Apply the topical steroid only on the areas of the skin with the eczema flare.

Tip#14:
Avoid using topical steroids frequently around the eyes, as there is a risk of developing glaucoma.

Tip#15:
Older persons should avoid frequently using steroids on their lower legs as there is a risk of developing leg ulcers.

Tip#16:
Hydrocortisone 1% is a low potency topical steroid that is extremely unlikely to cause adverse effects. If necessary it can be used on the face and in young children.

Tip#17:
If using a potent topical steroid, follow your doctor’s step down doses carefully to avoid unwanted side effects.

Tip#18:
Topical calcineurin inhibitors (TCI) are another class of anti-inflammatory therapy, which can be used to treat eczema. They are a good second line option for persons who do not respond to steroids, or who experience significant side effects of steroids. Consult a doctor to see if (TCIs) such as topical tacrolimus ointment or pimecrolimus cream could be considered to treat your eczema.


I hope these tips on ECZEMA were helpful; REMEMBER, YOUR HEALTH IS INVALUABLE.

Dr. Lawarna Matthew