Treatment Eczema

This section is about what over the counter treatments are available (not all treatments may be available in that country) and how they help.

Please check all ingredients if one are allergic or sensitive to them.
Treatments are not allowed on mouth, lips, eyes/ears, genitals and/or anus
For external use only
All treatment takes time to work, so please be compliant.
Emollient products/creams/oils can be highly flammable, keep away from naked flames.
Do not share products with others
Products can be mixed and matched (not steroids)

Aim:

The aim is to restore the right amount of water in the skin and prevent eczema flare ups and restore the skin to its original state.

There are a wide range of treatments available for eczema/dry skin. The main aim is to soothe the skin and re-hydrate the skin. If one develops an allergic reaction (rash) to any products, stop using that product and try something else as there are plenty of versions and alternatives available.
The products below can be used as a combination (for best results) or individually. Compliance and correct use is very important for effective treatment.

If one does not find one suitable or is allergic to one try another alternative in the range but please note the oilier the product is, the more it will retain water in the skin and the more effective it is, however it is harder to apply on the skin.

Order of forms which are the oiliest (oiliest at top):

Ointments
Emollient and oils
Cream
Lotion

Emollients and oils

Emollients are first line treatments to improve eczema. It keeps the skin hydrated, making it more flexible and less itchy.
It should be used (add in bath) 10-20 minutes once or twice daily in Luke warm water (spending more than 20 minutes in the bath can irritate and worsen the dry skin).
It provides an oily layer over the surface of the skin and keeps the skin hydrated.
It traps water under the oily layer and prevents water being evaporated.
It also decreases the penetration of allergens and irritants (hence used in allergies).
It decreases itchiness and soothes irritated skin and has anti-cleaning properties so soaps are not needed.
One should use emollients in the same direction as the hair grows, do not rub in a circular motion onto skin (it will block pores and make eczema worse).
Be aware emollients can make the skin, bath and showers very slippery and extra care is needed especially with children and elderly, a bath mat may help.
Always once finished clean the bath or shower thoroughly after use.
Always ‘pat dry’ with a clean dry towel, do not rub the skin.
A big advantage with emollients is that it can be used to cover large areas and should be used regularly even if one has no flare-ups.
They also seem to make other treatments more effective for example when using a steroid cream (use the emollient first and then 10-15 minutes after apply other necessary treatment).

These products can be left in the fridge , so when applied it gives an instant cooling effect (not anti-histamine)

Soap Substitutes/Skin Cleansers

Soaps, bubble baths, moisturising soaps can dry out your skin and leave the skin very irritated. An alternative to soaps are soap substitutes. They leave your skin moist and less irritated; one should wash with those instead.
Most soap substitutes come in a dispenser to prevent bacterial contamination. However, we do advise if more than one member uses a product, they should have their own.
If one does not have a dispenser one should scoop cream on a clean pate, instead of dipping their hands into a pot.
Soap substitutes do not lather like soap but they do cleanse the skin.
Refrain from use of inappropriate solvents (eg, gasoline) or abrasives (eg, pumice stone) to cleanse hands.

Creams

Creams hydrate the skin like emollients and prevent water evaporating from the skin.
Some creams are also used as ‘soap substitutes’.
They should be used liberally and regularly (four to six times daily). It is not unusual to use 250g-600g of cream each week. Most people believe that is too much, but it is not.
One should take a tub to school/work and it can be used all the body if required and not just on patches. Again it should be used even if one has no flare-ups.
A good tip is to warm cream with hands to make it easier to apply.
It should be used especially after one has had a bath or shower to lock water in the skin, since it is then one loses a lot of water from ones skin when drying oneself (ideally within three minutes of bathing and showering to ‘trap’ moisture).
Rub the cream softly in a downward fashion in direction of hairline.
Do not rub vigorously.
If itching is a particular problem, creams can be kept cooled in a fridge before applying them.
Ideal for summer use.

Lotions

They are like creams but are less oily and are easier to apply (less messy) .
They have an advantage to cover large areas and/or damaged skin and/or hairy areas.
They are ideal if skin not too dry.
Again they need to be used liberally and regularly even if one has no flare-ups.
It should be applied in the same direction as the hair grows and not a circular motion as it can block hair follicles and pores making eczema worse.
If itching is a particular concern It can be kept cooled in a fridge before applying them.

Ointments

Are like creams and lock in even more moisture, but are harder to apply, it can take up to an hour to soak in and can stain clothing.
Have less additives hence good for very sensitive skin.
Thick and greasy, hence good for very dry and thickened skin.
Ideal for night time (sleeping hours ) use.
It is ideal to use at night or if one has extremely dry skin. If itching is a problem, they can be cooled in the fridge before applying them.
It is best not to use on hairy areas as they can block hair follicles which can lead to further swelling and infection.
Ideal for cold weather and/or winter use.

Shower Gels

They work like emollients, but in a shorter time. It can be used under running water and in wash basins and are ideal for people on the go.
Again they should be used regularly and liberally.
Be aware it can make shower slippery,a shower mat may help (tell others!).
Again always pat dry and use even when one has no flare ups.

Sprays

Work like emollients and creams, the big advantage is one does not have to touch the skin.
It is ideal for very hairy skin and large areas and no bacterial contamination.

Skin Thickening Cream

These are used to hydrate the skin, replace natural moisturisers in the skin and soften the thick skin.
They cannot be used on broken skin or if have any kidney problems.

Antihistamines

These drugs work by blocking the chemical histamine which is released during an allergic reaction and itching. It helps to calm down the inflammation (hot, red and swelling) of the skin.

Older anti-histamines(can make one drowsy)	Time to Work	Duration of Action
Chlorpheniramine	15 20 mins	4-6 hrs
New anti-histamines (can rarely make one drowsy)	Time to Work	Duration of Action
Cetirizine	1 hr	24 hrs
Loratadine	1 hr	24 hrs
Acrivistine	15 – 20 minutes	8 hrs

Please note never to exceed the stated dose and are available in liquids and/or tablets and side effects of anti-histamines are more noticeable in older patients.

Steroidal Cream/ointment

These creams are only used sparingly when one has a flare-up on unbroken skin.
It can only be used up to seven days and restrictions do apply.
If one wants to use it outside the restricted rules then one must see a medical doctor for a prescription, because the medical doctor must asses if it is suitable to use.
They help to reduce redness and inflammation and it should be used 10-15 minutes after an emollient to get the optimum results.
Do not use creams/lotions at the same time with steroidal products as this makes the steroid less effective.
Ointments tend to be used at night or in more severe ‘flare ups’.
Creams are generally used in mild ‘flare ups’ and are easier to apply.
Side effects include:
- Transient burning or stinging
- Worsening and spreading of misdiagnosed fungal infection
- Reversible thinning of the skin
- Stretch marks
- Allergic contact dermatitis
- Acne vulgaris
- Skin develops clusters of itchy and painful blisters, often on the face and neck, or is unwell with a fever and swollen local lymph nodes (signs of eczema herpeticum), this requires a same-day appointment.
- Reversible, mild hypopigmentation (change of skin colour – becomes lighter skin)
- Excessive hair growth at the site of application
- Skin thinning

The risks of skin thinning with topical corticotosteroids are increased with:

- Using potent or very potent topical corticosteroids
- Inappropriate long-term continuous use
- Treating sensitive sites where the skin is thinner, e.g. face or genital areas
- Using topical corticosteroids under occlusion, e.g. a nappy, dressing, or when applying in skin folds
- Treating large areas.

The Pharmaceutical Journal, August 2021;Online:DOI:10.1211/PJ.2021.1.98990

Witch Hazel (used only when skin should is inflamed and not too dry)

It contains tannins which has:

Antioxidant properties
Anti-inflammatory activity
non anti-inflammatory activity that fights against bacteria
Can act as an astringent by drying out the skin
Always use a high quality forms (many cosmetics contain perfumed products and other additives which may not agree with your skin)- preferably non alcohol and/or contain aloe vera (has antiseptic properties and good for sunburns as well as moisturising properties) and/or hyaluronic acid (act as a good moisturiser)
It does not help to get rid of itchiness
It is not be advisable for certain skin conditions, such as rosacea and/or extreme dryness as it can be very drying, which could cause your skin to overproduce oil and worsen blemishes.
If one have any open skin areas, the product also cause the skin to burn when applied and/or one may want to use with caution if you have sensitive skin. If one finds condition is getting worst after using witch hazel then stop using it.
If you’re trying out witch hazel for the first time, it’s a good idea to test it out in a small area of skin away from your face, such as the inside of your arm. If you don’t see any redness, rash, or dryness after a couple of days, then you can try it out on your face.
Do not apply under the skin directly to help bags under the eye (mix with other creams and/or lotions).
If using this product and have signs of an allergic/anaphylaxis reaction, such as problems breathing, hives, facial swelling, or swelling of your lips, tongue, or throat, call for an ambulance and seek emergency medical attention.

Vitamins

Multivitamins are not intended to prevent long term conditions, reduce infection and is not proven (or data is weak) to help with cancer.

These are essential nutrients that the body requires in small amounts to function properly.

Herbal

Vitamins - If depressed