The usual treatment consists of three parts:
- Avoiding irritants to the skin and other causes (triggers) wherever possible.
- Moisturizers (emollients) - used every day to help prevent inflammation developing.
- Steroid creams and ointments (topical steroids) - mainly used when inflammation flares up.
People with atopic eczema have a tendency for their skin to become dry. Dry skin tends to flare up and become inflamed into patches of eczema. Emollients are lotions, creams, ointments and bath/shower additives which prevent the skin from becoming dry. They oil the skin, keep it supple and moist and help to protect the skin from irritants. This helps to prevent itch and helps to prevent or to reduce the number of eczema flare-ups.
The regular use of emollients is the most important part of the day-to-day treatment for atopic eczema. Your doctor, nurse or pharmacist can advise on the various types and brands available and the ones which may suit you best.
You should apply emollients as often as needed. This may be twice a day, or several times a day if your skin becomes very dry. Some points about emollients include:
- As a rule, thicker, greasy ointments work better and for longer than thinner creams but they are messier to use. Some people don't mind using thick ointments; however, some people prefer creams (but apply them more often).
- Apply liberally to all areas of skin. You cannot overdose or overuse emollients. They are not active medicines and do not get absorbed through the skin.
- Apply emollients in the general direction of hair growth. If applied in the opposite direction the base of the hair shafts can get blocked, leading to possible infection.
- Use emollients every day. A common mistake is to stop using emollients when the skin appears good. Patches of inflammation, which may have been prevented, may then quickly flare up again.
- Various emollient preparations come as bath additives and shower gels. These may be considered in people with extensive areas of dry skin. However, there is some debate as to how well these work. If you do use them, they should be used in addition to, not instead of, creams, ointments or lotions that you rub on to the skin.
- Pump dispensers are better than pots because they are less likely to harbor germs. If you need to use a pot, use a clean spoon or spatula to get the contents out, rather than your fingers.
- When you have a bath or shower, consider adding an emollient oil to the bath water or as you shower. This will give your skin a general background oiling.
- Use a thick emollient ointment as a soap substitute for cleaning. You can also rub this into particularly dry areas of skin.
- After a bath or shower it is best to dry by patting with a towel rather than by rubbing. Then apply an emollient cream or ointment to any remaining dry areas of skin.
- Between baths or showers, use an emollient cream, ointment or lotion as often as necessary.
- A dry dressing may be helpful if your eczema is more severe, as this helps to keep the emollient from being rubbed off the skin and stops scratching. However, you should not use a dressing if infection is present.
- Use an emollient ointment at bedtime.
Warning: bath additive emollients will coat the bath and make it greasy and slippery. It is best to use a mat and/or grab rails to reduce the risk of slipping. Warn anybody else who may use the bath that it will be slippery.