5 Dermatologist Tips for People With Severe Eczema
Eczema is a condition in which inflammation in the skin causes dry, itchy, rashy patches to form on the skin. The most common form of eczema is called atopic dermatitis. “Atopic” means it’s related to an allergic reaction, “derma” refers to the skin, and “itis” means inflammation is involved. Atopic dermatitis can appear anywhere on the skin and is known to be extremely itchy, making it a difficult condition to live with every day. Sometimes, eczema can be so severe that it requires more serious medication and strict lifestyle habits to treat. Fortunately, with the right information and treatment, you can take control of your eczema. Here are the most common tips I share with my patients:
1. Don’t scratch!
Many of my patients deal with the same cycle: they develop an itchy dry spot, scratch it, then the scratching opens up the skin and creates weepy, crusting spots, which are even itchier. Sometimes, it feels like a chicken-or-egg scenario; is the itch causing you to develop a rash because you scratch, or is the rash causing you to itch so you scratch? In my experience, it’s a combination of both. Either way, it’s crucial to not scratch that itch. If you irritate the skin with scratching, wounds open and they can get infected, requiring antibiotics. Over time, as this cycle stretches on over years, your skin can thicken and change color. In darker skin types, these areas can turn white, and in lighter skin types, the skin may turn brown. That’s why the most important advice I can give people with eczema is to avoid scratching. I tell my patients to do their best to resist the urge to scratch, and instead, apply moisturizer to the itchy area.
2. Specific parts of the body need specific treatments.
Our goal when treating eczema is to calm down inflammation. We try to do this using many different tools. Your dermatologist will most likely start you out on over-the-counter (OTC) products like cortisone cream, which is a mild steroid used to calm the inflammation. There are also prescription topical steroids that treat more severe eczema. Different strengths of these steroids work better for different areas of the body. In areas where the skin is thicker, like the arms, legs, and back, a stronger topical steroid is best. For sensitive areas like the face, groin, or armpit, we want to stick to mild steroid creams because over time, the steroids can make the skin even thinner and lead to pigment changes. I instruct patients to apply the steroid twice a day for two weeks during a flare, and once things have calmed down, I have them just apply it on the weekends.
3. It’s crucial to find the right moisturizer.
Moisturizing is key when treating eczema, but not all lotions are created equal. I recommend oatmeal-based products, as they’re known to decrease inflammation and soothe irritated skin. I also make sure my patients know to avoid products with fragrances, dyes, and other chemicals that can make eczema worse. Look for products containing ceramides, which can give the skin a new barrier to protect it and suppress inflammation. Depending on the severity of your symptoms, I might have patients try a prescription skin barrier cream. When the skin gets inflamed, irritants and allergens are more likely to penetrate the skin and cause more inflammation. That’s why it’s important to use creams that “seal” the skin, as if we’re closing the door to the irritants. These skin barrier creams also lock in moisture and are safe to use over your whole body every day.
4. Don’t be afraid to consider an oral or injectable medication.
For severe eczema, topical creams are not going to be enough. Fortunately, oral drugs are available to treat eczema at the root, including oral steroids and immunosuppressants. Immunosuppressant drugs suppress the immune system to block inflammation but have significant side effects if taken long term. Recently, new injectable medications called biologics have also come to the market. They’re derived from living organisms and block chemical messengers that cause inflammation to develop. These injectable drugs, including dupilumab (Dupixent), are new and must be prescribed by experienced dermatologists. My patients with severe eczema have seen a lot of success with these biologics. The most common side effect is conjunctivitis, more commonly known as pink eye.
5. Commit to taking care of your skin.
I tell my patients it’s not only about what I prescribe them in my office, it’s also about what they do at home. If they just take the pills, injections, or use the topical steroids I prescribe, they’re not going to get better until they start changing some of their habits, especially their skincare routine. It’s important to avoid taking hot showers and baths and only use a mild soap in certain areas of the body like the groin and underarms. Soap dries out the skin, and it’s not necessary to apply it everywhere. If you use a lot of soap in hot water and don’t moisturize, your eczema symptoms will worsen, causing itching that makes you scratch and open up sores, which continues the cycle. Instead, use soap lightly in lukewarm water, and immediately moisturize when you get out of the shower. Together with your prescribed medications, these healthy habits will help you gain control of your severe eczema and go on with your life.