How To Treat Your Eczema

Cynthia Bailey, MD|July 25, 2016

​When I see a person with Eczema prone skin in my practice, I give them a tutorial on the basic building blocks of good skin care for Eczema control. You too can manage your Eczema with just a few basic steps.  Start now to treat your Eczema!

Eczema is a term that most people use to refer to the medical condition known as Atopic Dermatitis.  Atopic Dermatitis is fairly common and can be a very frustrating skin condition.  The rash creates itchy areas of skin with dry scales and red patches with scratch marks.  Over time the skin becomes thick, moist and infected.  It can start at any age for people who have inherited the tendency for it.  The most common places for the rash are in the folds of the elbows or behind the knees, but it can affect any part of the body.  In this post I'm going to focus on how to treat Eczema, so to read more about what exactly this frustrating skin condition is, visit my post from July 4, 2016, "What Is Eczema?".  

How should you wash your Eczema-prone skin? 

Soap can over-strip skin oils, thus weakening the thin skin barrier of Eczema even further.  Soaps and cleansers are also common sources of fragrance and preservative allergens.  Here is the advice I emphasize with my Eczema-prone patients: 

  • Use soap only on those areas of your skin that need it such as your feet, armpits, buttocks and groin.  The rest of your skin may only need a simple rinsing with water.
  • When you bathe, be sure that the temperature of the water is at most lukewarm, not hot.  Hot water will pull more natural skin oils out of your fragile skin.  It also brings more blood to the skin surface which can fuel inflammation that leads to Eczema and itching. 
  • Rinse your skin well after contact with any soap or cleanser to remove product residue. 

The specific soap or skin cleanser you use is really important.  Use only gentle and fragrance-free skin cleansers such as VaniCream Cleansing Bar or Toleriane Skin Cleanser.  These are SYNDETs, meaning they are created by skin care scientists to remove oil and dirt with a neutral pH product.  Naturally made soaps are another option as long as they retain glycerin and are not loaded with fragrance, no matter how 'natural'.  Traditionally made soaps have an alkaline pH and some research suggests this can weaken the skin barrier.  In my professional opinion, this is not an issue when natural glycerin-rich soaps are used.   Glycerin is produced during the soap making process and can be removed and sold for other uses or retained in the soap.  Glycerin is moisturizing and healing to Eczema prone skin.  Thus, for people wanting only 100% natural skin care, I have glycerin rich natural soaps including the Naturally Best Bar Soap and the All Natural Foaming Hand Cleanser.  Bathing your skin is not harmful to Eczema if done with these tips in mind.  In fact, it can be therapeutic and help Eczema heal as long as you carefully follow this advice.  Getting your skin wet and patting it dry is the best way to prep it for absorbing moisturizer.  Your skin is like a sponge and after bathing it is filled with moisture which you will trap when you apply your moisturizer within the "magic 3 minutes" after toweling dry.  As a dermatologist, it is also the time I want my Eczema patients to apply any topical medicine I may have prescribed.

How do you moisturize your Eczema-prone skin so that it will heal?

The most effective moisturizers are thick and oil-rich products, however these are not always practical to use.  One helpful trick is to apply your moisturizer within the "magic 3 minutes" after bathing and patting your skin dry so that your thick and rich moisturizer will spread nicely.  The more oil your moisturizer contains the better, since it will be locking in water, preventing evaporation.  Ointment-based moisturizers are more effective than creams or lotions because they often contain more oils.  That being said, most people don’t like the greasy feel of ointments.  That is why I created my All Natural Face, Hand and Body Lotion; it is rich in hypoallergenic botanical oils, yet has a nice and light feel on the skin.  My patients say that it leaves their skin feeling healthy and moisturized but not greasy. If you are prone to Eczema, it important to use only fragrance-free moisturizers because fragrances are often allergens that can trigger rashes.  In my professional opinion, the more often you moisturize your skin the better, though there aren’t really any scientific studies that prove this.  As I mentioned, the best time to moisturize is after washing, but you can also apply moisturizer to dry skin too.  This keeps your skin supple, prevents painful fissures, itchy scales and also helps to repair the skin barrier.  This all helps to prevent infection.

How do you prevent itching with Eczema?

  • Keep your skin cool and moisturized.  Heat causes skin blood flow to increase and brings in the building blocks of inflammation.  It can make Eczema worse. 
  • Keep your nails short to prevent traumatizing the skin when you do scratch.  It sounds simple, but it's important.
  • When skin is itching you can spritz cool water on it or apply an ice pack wrapped in a towel or a towel moistened with cold water.

In severely itchy Eczema, we even use a treatment called “wet wraps.”  With this treatment, moisturizer or topical medicine is applied underneath the cool and wet wraps.  This is a highly effective treatment and can really quiet down a severe flare of Eczema.  Wet wraps serve the dual purpose of helping to moisturize skin and deliver medicine, while at the same time preventing scratching.  In the 'olden days' of my dermatology residency training we would hospitalize patients who needed this treatment.  Nurses would wrap patients in cloth and ladle cool water on them for hours.  It was a form of torture but a very successful treatment for a severe Eczema flare. 

How can you prevent getting a skin infection when you have Eczema?

Many people who are prone to Eczema are also prone to having the skin infecting germ called "Staph Aureus" on their skin (we say they are prone to being colonized by Staph Aureus).  It's almost like they are custom designed to get skin infections because once they scratch open a wound, the germ moves in and causes impetigo (we say that the atopic dermatitis becomes impetiginized). Bleach baths are a great treatment to reduce skin colonization with Staph Aureus.  Bleach can be added to the bath several times a week to help kill the staph bacteria.  This has been shown to really decrease the risk of infection! Bleach odor wafting up from your bath may not sound as appealing as lavender but it's really not that bad.  The amount of bleach needed is very little – only half a cup of bleach added to a full bathtub.  I advise people to sit in this lukewarm bleach bath for 5-10 minutes, pat their skin dry and then apply moisturizers and/or topical medicines as prescribed by their doctor.

Can your clothing make your Eczema worse?

Yes it can.  Clothing can impact the severity of your Eczema in 2 different ways.  The first trigger is related to the physical factors.  Scratchy fabric such as wool will drive you to itch, scratch and get worse.  Synthetic fabrics that don't breath will cause skin to heat up, increase blood flow and potentially fuel Eczema.  I recommend soft clothing that breaths such as cotton. The second danger with clothing is allergens in the fabric.  These usually get into fabric during laundering.  I stress the importance of using a fragrance-free detergent and use enough water to make sure the rinse cycle gets all the soap out.  It is helpful to rinse your clothing twice to be sure all detergent residue is removed.  I also advise against using fabric softeners and anti-static dryer sheets.  These can leave a fragrance residue on clothing, and fragrance is a notorious allergen to hypersensitive Eczema-prone skin.  When you buy new clothing, the fabric may have allergens like fabric sizing chemicals or dyes.  It's advisable to wash all new clothing before you first wear it.

Eczema can be a very frustrating skin condition, but if you take steps to prevent flair-ups and take good care of your skin, it can be managed.

What triggers your Eczema? How do you treat it? Do you have any special tricks that you apply? Join the conversation - we'd love to hear from you!  

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