:. Skin care in atopic eczema

Eczema poses a great challenge in terms of skin care and treatment regardless of the stage of the disease. The treatment methods are aimed at basic skin care, dry eczema and infected / exuding eczema. Treatment will not cure eczema per se, but only serves to relieve the burden.

 

Daily skin care

Even during periods without visible eczema, the non-lesional skin is still always dry. The main preventive measure is regular moisturizing. The skin should be moisturized at least twice daily with a moisturizer that is neutral in pH and devoid of perfume. Oil bath can be a good supplement to moisturizing, but it should not be seen as a replacement. Bath and shower oils work best when used in the bathtub, but can also be used in the shower. Showers should not be longer than 15 minutes.

To wash your skin it is recommended to have little soap / shampoo. These should not be perfumed and pH neutral. Bath oil can replace soap due to its cleansing effect, especially during exacerbations.

 

Dry eczema

For erythematous eczema with itching, cortisone cream is recommended. Initially, Cortisone cream is applied once or twice daily. After symptomatic improvements, moisturizing frequency and possibly also cortisone strength can be gradually tapered with a step down approach. Taking breaks from cortisone cream is also necessary to avoid adverse reactions in the skin. Do request a treatment form / tapering form from your doctor.

If cortisone creams do not give satisfactory results, Elidel cream or Protopic ointment may be appropriate. Unlike the cortisone creams, these may be applied daily or as a maintenance therapy for a more prolonged course.

Wet wraps can be used in children to relieve itchiness and moisturize the skin effectively, while preventing the child from scratching himself. The skin is well moisturized before covering it with a layer of moist dressings (tubifast bandage) followed by a layer of dry bandages. Consult a doctor / nurse to discuss if wet wraps may be applicable to your child.

Antipruritic medications (antihistamine tablets / liquids) may be very useful to control the itch and allow the child to go to sleep more easily.

Phototherapy in a Dermatology Department may be appropriate for eczema in older children and adults should creams be ineffective. Natural sunlight has a beneficial effect on eczema in most patients. Solarium tanning has little effect on eczema and is not recommended.

 

Infected / exuding eczema

Infected eczema means the eczema is exacerbated by bacterial infection. In this situation, the rash becomes more severe; initially exuding fluid and eventually forming scabs. Successful treatment for this kind of eczema hinges on effective eradication of the bacteria.

Current treatment options are:

1. Potassium Permanganate baths (“KP baths”) and Sodium hypochlorite baths (“Bleach baths”): Dries out weeping rashes (Read more). 

Instructions for KP baths:
Dilute KP solution (3%) in water. It can be used in a tub for the entire body or as local bath, possibly also used in moist dressings on the rash. Bath for 10-20 minutes. Apply once daily until the infection is controlled, usually a course of 5-7 days. KP can discolor skin, clothing and the sink. To avoid discoloration of the nails, put on petroleum jelly or nail polish in advance. The bathtub must be scrubbed immediately to avoid discoloration, alternatively, a plastic cover may be used inside the tub (available at pharmacies).

Instructions for Bleach baths:
(To be updated)

 

2. Alsol liquid cover: limits the growth of bacteria and fungi.
   Wraps can be made by using cotton fabrics (e.g. from an old t-shirt) – cut to appropriate size to cover the affected area, soak/moisten it with Alsol liquid and apply on the rash. The turnaround is at least 10-20 minutes, preferably longer.
    
    
3. Antibiotic creams: kills bacteria that have colonized the skin.
   Creams can cause skin irritation and typically should not be given longer than 7 days. KP bath is a better means to keep the bacteria count down, and they will often do without such creams.