Eczema management and treatment

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Eczema (atopic dermatitis) management may be required for many months or even years, but by having the right plan in place, the condition can be manageable.

Eczema cannot be cured, it can only be managed, so it is important people find a doctor or nurse with experience in eczema that they trust and take their advice on treatment and everyday management.

There are three important messages for eczema management:

1. The skin must be washed with non-soap cleansers.
2. Use ENOUGH moisturiser each day.
3. Use topical steroid creams/ointments following your doctor’s/nurse practitioner’s advice.

Bathing

It’s best to take short (5 minute) warm (not hot) baths or showers once daily, preferably in the evening using a non-soap based wash or oil. Always avoid soap or bubble bath.

Gently remove any eczema crusts while in the bath or shower, as it will help the steroid cream/ointment you apply after bathing work more effectively.

If shampooing your hair, use a product that is made for people with sensitive skin to avoid irritation.

When you finish your bath/shower, pat yourself dry with a soft, clean towel and apply steroid cream first (if using) and then moisturiser, as recommended by your doctor or nurse practitioner.

Moisturising

Moisturising the skin reduces water loss, improves dryness, decreases itch and protects the skin from things that can make eczema worse such as pollen, dust mites, sand and wind.

It is important to moisturise regularly (twice daily or more often if the skin is dry) and in adequate amounts. The best time to apply is straight after bathing while the skin is still damp, as this is when it will be best absorbed by the skin. If you are also using a steroid cream, apply the steroid cream first and then the moisturiser.

Apply moisturiser to the whole body and face, even if no eczema is present. Apply in a downward direction (the direction the little hairs grow on your skin) and be careful not to miss anywhere like behind the ears, ankles, feet and eyelids. Remember to include the areas where you don’t usually have eczema. The skin is one organ so you need to moisturise all your skin.

What Moisturiser to Use?

It is best to use creams and ointments as they are thicker and last longer than lotions. Lotions are water based and thin, so they won’t keep your skin moist for as long as creams and ointments and may also cause stinging if skin is already red and itchy.

Do not use moisturisers that contain common allergy causing foods such as cow’s milk, goat’s milk, oats and nut oils as they may lead to the development of food allergies in babies, children and sometimes even adults. Plant extracts such as lavender and tea tree oil may irritate the skin so avoid them also. Read more here.

Many patients are concerned about potential side effects of using steroid creams/ointments to treat their eczema, and as a result may be undertreating their eczema flares. As a guide, one fingertip unit is the amount of ointment from the bend in the finger to the fingertip, which will cover an area equal to two adult hands.

Topical steroids are an essential part of management, and when used correctly under supervision are very safe in the long term. It is important to use enough topical steroid (most patients do not use enough steroid cream.)

It is important to see your allergy specialist/dermatologist/eczema nurse practitioner/GP regularly so that you have a treatment plan, and access to the latest management advice and treatment options available.

You should seek help about your eczema when:

• You do not know how to treat your eczema
• You are following your eczema treatment plan but your eczema is not improving or getting worse
• If there are changes in your eczema. For example, it is painful, weeping, the skin around is redder than usual, there is pus
• You have concerns or questions about your treatment plan
• If your eczema is impacting other aspects of your life. For example, your mental health, sleep, relationships, access to childcare

What happens if my eczema is severe?

People with eczema that is difficult to manage or control or eczema that is moderate or severe, should work out a treatment plan with their allergy specialist or dermatologist.

There are new treatments being developed and approved regularly so it is important to keep in touch with your allergy specialist or dermatologist if your eczema does not improve.

There are more complicated treatments (involving the immune system) available for the small number of people who have severe dermatitis not controlled by topical therapy. This must be prescribed and supervised by a specialist.

In recent years, successful and affordable treatments for severe eczema have been approved and placed on the Pharmaceutical Benefits Scheme in Australia. These treatments are for people with severe eczema aged over 12 years.

What is an eczema treatment plan?

All individuals with moderate to severe eczema or eczema that is persistent should have a treatment plan from their allergy specialist or dermatologist.

ASCIA has an Action Plan for Eczema (Atopic Dermatitis) that you can ask your allergist, dermatologist or GP to complete for you. The plan outlines how to:

• best look after and protect your skin
• treat a flare-up
• control and prevent infection and
• avoid triggers and things that irritate your skin.