Eczema is a is a common and chronic skin condition in which the skin appears inflamed, red, itchy and dry. There is no cure for eczema but there are recommendations to help manage symptoms. Managing eczema comes down to these basics: avoiding triggers, implementing a regular bathing and moisturizing routine, and using prescription medications as directed.
People with eczema tend to have an immune system that overreacts when triggered, producing red, itchy skin symptoms. Some children have specific things that trigger episodes of itchiness and rashes, while others may have none that can be identified. While allergenic triggers for eczema are not common, there are specific situations where your pediatrician may recommend allergy testing, such as difficult to treat eczema under 1 year of age.
Common triggers include:
Excessive bathing without moisturization
Friction and overheating of the skin
The best way to keep eczema under control is to establish a daily skincare routine and stick with it. The following are skincare techniques for managing eczema.
SOAK AND SEAL
Clean: Take at least one bath or shower daily, using lukewarm (not hot) water for 5-10 minutes. Use a gentle cleanser (not soap) recommended for sensitive skin with no added fragrances or dyes. Avoid rubbing or scrubbing the affected skin.
Treat: After bathing, pat the skin lightly with a towel leaving it slightly damp. Water softens the skin and enables it to better absorb medication and moisturizer. Apply a thin coat of the medication prescribed by your doctor to affected areas of the skin only.
Moisturize: Within 3 minutes, liberally apply a moisturizer all over the body (not just the eczema areas) to lock in moisture. Ointments and creams are more beneficial than lotions for people with dry skin conditions. Vaseline and mineral oil are particularly good for treating eczema. Wait a few minutes to let the moisturizer absorb into the skin before dressing. Use moisturizer throughout the day whenever the skin starts to itch or feel dry.
WET WRAP THERAPY
During more intense eczema flare-ups, wet wrap therapy can rehydrate and calm the skin. Wet wraps are best done after bathing, applying medication, and moisturizing.
Slightly dampen a piece of clean, white cotton clothing or gauze from a roll with warm water.
Wrap the wet dressing around the affected area.
Wrap a dry dressing over the wet one. You may use pajamas or a sweatsuit as the dry layer.
Carefully put on clothing to not disturb the dressing.
Leave the dressing on for several hours or overnight, taking care not to let it dry out.
In times when the eczema worsens or “flares up” a standard treatment regimen is to perform the following:
Twice daily apply a topical steroid to the area of worsening, followed by vaseline over the top of the cream.
Continue skin care as mentioned above.
Treat the eczema as per step 1, until the skin feels normal for a total of 3 days before discontinuing therapy and returning to your normal skin care.
Your doctor may add to or modify this regimen depending on complicating factors relating to your child’s specific eczema flare. For example, you doctor may add wet wrap therapy to the regimen listed above.
Medications & Itch Treatment
One of the most commonly prescribed medications for eczema is topical steroids. These medicines reduce redness, inflammation and itching so that your skin can begin to heal.
There are a number of different topical steroids that vary in strength. Here is a list of commonly used steroids in order of potency:
Triamcinolone 0.025% Lotion / Cream
Triamcinolone 0.1% Cream
Desonide 0.05% Ointment
Triamcinolone 0.1% Ointment
Only apply the steroid to eczema areas
Steroids are most effective when applied within 3 minutes after bathing
Only use as prescribed by your doctor – more often increases the risk of side effects
Certain areas of the skin including the face, genitals, and skin folds absorb more medication. Only use medications as directed on these areas.
There are other stronger steroids that may be used, but we recommend doing these under the care of a dermatologist.
Common medications used for itch, such as benadryl, do not work on the itch associated with eczema.
Tips to decrease itching:
Apply a cold compress
Wear soft, breathable clothing
Avoid harsh cleansers or soaps
Antihistamines, such as benadryl, will not stop the itching but may help with sleep
Because the skin barrier is compromised, people with eczema are more prone to skin infections. Signs of infection include eczema that is suddenly worse or doesn’t respond to treatment, honey colored crusts, fluid oozing from the skin, pus-filled bumps, pain, and severe itchiness.
Tips to prevent an infection:
Try not to scratch and rub the affected skin. Keeping nails short may protect from nighttime itching.
Establish a good skincare routine to protect the skin.
Bathe as often as directed to keep the skin clean.
Moisturize as often as necessary to avoid dryness and cracking. Avoid dipping your fingers into the moisturizer which can introduce bacteria.