Eczema
How is eczema treated?
Rules of Thumb
- Prevention of itching is key to control
- You can’t moisturize enough!!!
- Most children with eczema do NOT have significant food allergies, and the ones who do often show little or no improvement when that food is avoided. Therefore, most patients do NOT need extensive evaluations for food allergies.
- When medications begin to clear your eczema DON’T STOP. You must continue to use all medications given to you to “control” your eczema and “prevent” new lesions.
Step #1: Do Less!
Dr. Contestable recommends that patients limit use of soap. YES! Trust me I get odd stares from patients all the time when I bring this up. So, if you are thinking – man this guy is a quack – you aren’t alone. I ask patients to think about a stick of butter in the shower with them. If the water is too hot it will melt the butter. If you use a ton of soap it will wash the butter away. That “butter” is your skins natural oils. So do less! Keep your skins natural oils and you may need less of the next few steps.
--- One side note, my son also has eczema. When he was about 5 years old, he turned to me and said “Dad, that soap makes me itchy”. I had been telling him for years to not use soap but one day he tried it on his own. It’s amazing, even kids know to avoid soap. To this day, I think he has only had soap on his body a few times. When he hits puberty it will be a different story.
Step #2: Moisturize!
For many people with mild eczema. The simple act of moisturizing the skin may be enough to repair the skin barrier. The best time to moisturize is right after the shower while your skin is still slightly damp. Towel off gently and then apply your moisturizer.
Step #3: See a Dermatologist!
While eczema is mostly related to skin barrier dysfunction there is also overactivation of the immune system which only creates more skin barrier dysfuntion. Studies show that even when skin with eczema appears “normal” there is still a higher concentration of immune cells in the skin “ready” to make the eczema flare.
Because of this, many patients will need topical medications to calm the skin and balance the immune systems presence. Common treatments include topical steroids (fluocinonide, triamcinolone, clobetasol, etc.), topical calcineurin inhibitors (Elidel or Tacrolimus), and other topical immunomodulators. For the most part, Dr. Contestable recommends only using topical steroids 5 days a week maximum. However, he also recommends at least using them 1-2 times weekly over hot
spots. This is due to the “over active” immune cells in normal appearing skin. We want to PREVENT a flare!
Topical steroids can have side effects of thinning of the skin, lightening of the skin, and atrophy of the skin. However, in Dr. Contestable’s experience, more harm is done by using too little steroid than using too much. It is important to work with your dermatologist to have an exact plan of using each particular steroid in the directed location for the correct number of times and follow up frequently if eczema is not responding to the treatment requiring topical steroids for months on end.
What about other exposures?
When eczema does not respond to treatments as would be expected we often perform Patch Testing – see page on Contact Dermatitis. This can be helpful to attempt to identify external allergens that you may be coming in contact with that are making your skin worse.
Topical treatments didn’t work what next?
We are so lucky nowadays to have many excellent treatments that have been recently developed and that are in development. However, older methods also work. Depending on the patients wishes, Dr. Contestable offers patients light box treatment for eczema which can be very helpful. Biologic medications (specifically Dupilumab) can work very well for patients who have severe cases or do not respond to topical treatments. More biologics are under development and tablet form medications, JAK inhibitors, are showing great promise. So have faith! If you have eczema the present and future is very bright!