Dermatology Treatments : How to Treat Severe Eczema
Topical corticosteroids are the standard treatment for eczema, but many other options are available.
There's no cure for eczema, a chronic skin condition marked by rash-like symptoms.
People with atopic dermatitis (the most common type of eczema) and other forms of the condition often go through symptom-free periods (remissions) followed by flare-ups, when symptoms can become severe.
Eczema mainly causes dry, itchy skin, which inevitably causes people to scratch or rub the affected area.
This can result in inflammation, rashes, blisters, and skin that "weeps" (oozes clear liquid), among other skin symptoms. Bacterial, viral, and fungal infections can also develop because eczema breaks down the skin barrier.
There is no cure for eczema. The goal of eczema treatment is to reduce symptoms, heal the skin and prevent further skin damage, and prevent flare-ups of symptoms.
Medications, moisturizers, and at-home skin-care routines are all part of an effective treatment plan for eczema. (1)
Corticosteroids for Treating Eczema Symptoms
Topical corticosteroids are the standard treatment prescribed for eczema during flare-ups.
Applied directly to the affected areas of skin, these ointments, creams, or lotions may:
- Reduce inflammation
- Tame allergic reactions
- Ease irritation or soreness
- Reduce itching and the desire to scratch
Topical corticosteroids come in varying degrees of strength and are most effective when applied within three minutes of showering. They should not be used as a moisturizer and should only be applied to areas of the skin that are affected by eczema.
Over time, these medications can thin the skin, cause changes in the color of the skin, or cause stretch marks. More severe side effects include eye problems (glaucoma and cataracts), blemishes (acne, pink bumps, and pus-filled follicles), adrenal suppression, and topical steroid addiction. (2)
If topical corticosteroids are ineffective for your eczema, your doctor may prescribe a systemic corticosteroid, which is taken by mouth or injected.
Systemic corticosteroids are only recommended for short periods of time, since they affect the entire body and can cause a number of serious side effects, including osteoporosis, hair loss, and gastrointestinal issues. (3, 4)
Other Topical Medications for Eczema
Another category of medications for eczema are called topical calcineurin inhibitors (TCIs). These prescription drugs include Protopic (tacrolimus) and Elidel (pimecrolimus). (2)
TCIs don't contain steroids. Instead, they control inflammation and reduce eczema flare-ups by suppressing the immune system.
Though TCIs don't come with the same side effects as topical corticosteroids, they can still only be used for short periods of time, and they come with a boxed warning about the possible risk of cancer that is associated with these drugs.
A new class of topical drugs for eczema are called PDE4 inhibitors, which work by blocking an enzyme called phosphodiesterase 4 (PDE4) from producing too much inflammation in the body. There is currently only one PDE4 inhibitor available: Eucrisa (crisaborole), which was approved by the U.S. Food and Drug Administration (FDA) in 2019. (2)
In especially severe cases, your doctor may prescribe an oral immunosuppressant, such as Neoral, Sandimmune, or Restasis (cyclosporine), Trexall or Rasuvo (methotrexate), or CellCept (mycophenolate).
These drugs carry potentially serious side effects, such as an increased risk of developing dangerous infections and cancers.
If you develop an infection on your skin that's affected by eczema, your doctor will prescribe antibiotic, antiviral, or antifungal drugs to treat it, depending on the particular cause. (4)
Oral Antihistamines for Eczema
Your doctor may also recommend that you take certain antihistamines for eczema — such as diphenhydramine, hydroxyzine, or doxylamine succinate — to help you sleep through the night.
Antihistamines may help prevent nighttime scratching, which can further damage your skin and cause infections. (3)
Various protectant repair creams may also help ease eczema symptoms by restoring essential skin components, like ceramides, fatty acids, and cholesterol. (5)
Light Therapy and Other Treatments
Light therapy, or phototherapy — treatment with ultraviolet waves — is often effective for people with mild to moderate atopic dermatitis.
Skin improvements generally don't happen immediately after phototherapy, but rather after one to two months of treatments several times a week, according to the National Eczema Association. It's effective for up to 70 percent of people with eczema.
Burns, increased aging of the skin, and a higher risk of skin cancer are potential side effects of light therapy, particularly if the treatment is given over a long period of time. (6)
Wet-wrap therapy is another option for severe eczema. Sometimes given in a hospital, this treatment involves applying topical medicines (corticosteroids) and moisturizers to affected areas, which are then sealed with a wrap of wet gauze. (7)
Home Remedies for Eczema
In addition to seeking treatment from your doctor, you may be able to take various steps at home that reduce your itching and need for medications.
These measures include:
- Keeping your fingernails short, and avoiding scratching your skin
- Moisturizing your skin frequently with ointments (petroleum jelly), creams, and lotions that are free of alcohol, fragrances, dyes
- Using a humidifier, particularly if the air is dry
- Avoiding skin irritants, such as wool or man-made fibers (wear soft cotton clothing instead), strong soaps and detergents, and situations or environments that cause sweating
- Avoiding airborne allergens, such as pollen, pet dander, and dust mites
When bathing, it's also important to take short baths in cool or lukewarm water. Use gentle body washes and cleansers, and avoid scrubbing or drying the skin for too long.
Apply a moisturizer immediately after drying yourself. (7)
Natural Remedies, Lifestyle Changes for Eczema Symptom Relief
In addition to the measures above, some people have used the following natural or alternative therapies for eczema:
- Add oatmeal, baking soda, or fragrant-free bath oils to your bathwater (8)
- Get a massage with essential oils, such as chamomile, chickweed, licorice, or thyme
- Manage stress through yoga, meditation, biofeedback, or mindfulness training (9)
Dietary Changes and Supplements for Eczema
For some people with atopic dermatitis, various foods can be triggers that cause flare-ups due to allergic reactions.
An elimination diet, or food challenge — in which you cut certain foods out of your diet for a while, then slowly add them back in and monitor how your skin responds — can help you determine which foods may be triggering your eczema.
According to the University of Maryland Medical Center (1), some people have had eczema relief by using the following:
However, literature reviews have found unconvincing evidence that such supplements are actually effective for eczema symptoms.
Video: Dry Skin and Eczema Treatment - OnlineDermClinic
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