Finding Solutions for Eczema

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Severe Eczema: 9 Things Doctors Want You to Know

  • smiling female dermatologist holding files
    “Severe eczema can disrupt your life, but we can help you.”
    For people with severe eczema, even the simplest tasks in daily life can be a challenge. But fortunately, the news from experts is good: “Patients should know that the days of walking around with [severe] eczema should be over,” says Lawrence Eichenfield, MD, a board-certified dermatologist in San Diego. He and other top specialists explain what eczema really is, talk about new treatments for the infuriating itch of severe eczema, and offer tips for preventing flares of this common skin condition.



  • Woman with skin condition
    1. “Eczema may seem like an allergy, but it isn’t.”
    “Eczema is dry skin that turns into inflamed skin. There’s no allergen; your skin isn’t reacting to anything in particular. It just develops the irritation and inflammation from the inside,” says Chynna Steele, MD, a board-certified dermatologist in metro Atlanta. “It isn’t an allergy; it’s your immune system inappropriately responding,” says Adam Friedman, MD, a board-certified dermatologist at The George Washington University School of Medicine & Health Sciences in Washington, D.C.



  • woman scratching neck
    2. “Severe eczema often develops from one particular form of the disease.”
    Eczema is an umbrella term for a group of six skin conditions. Severe eczema is usually due to the form called atopic dermatitis. “If you suffer with atopic dermatitis, you always have it. There are times when it may flare, there are times when it may get a little bit better, but generally your skin is really inflamed and itchy,” says Dr. Steele. “Atopic dermatitis can have the most impact on individuals, mostly because it can be chronic and variable in terms of its persistence and severity,” says Dr. Eichenfield.

  • Black woman hugging her knees
    3. “If eczema is affecting your daily life, it’s considered severe.”
    “Even if it doesn’t look severe, if [the] disease is tremendously impacting [someone’s] life, that would elevate the status as moderate to severe,” says Friedman. “A lot of times severe eczema has cracks and abrasions in the skin, usually from scratching, and the skin can actually get thickened,” says Dr. Steele. “If you have significant itchy rashes that don’t come under control with moisturizers or occasional use of over-the-counter hydrocortisone, go see a board-certified dermatologist,” says Dr. Eichenfield. 



  • Patient and doctor
    4. “We can’t cure severe eczema but we can contain it.”
    Severe eczema, or severe atopic dermatitis, is something you’ll have to contend with on an ongoing basis, but doctors are upbeat about treatment for most people. “We can manage it to the point where a patient may not even know they have it. We know from studies—what we call ‘quality of life’ impact—that when you have a patient with severe eczema, they are profoundly affected, but when you bring in therapeutic controls for their disease, it lifts the burden,” says Dr. Friedman.



  • woman-sitting-up-in-bed-with-insomnia
    5. “Without treatment, severe eczema can cause other complications.”
    “Moderate and severe eczema can have a tremendous impact on an individual, including rashes, infections, sleep disturbance, and connections to other medical conditions,” says Dr. Eichenfield. “I regularly see patients who have 70% of their body involved with itching, oozing rash. They’re up all night scratching and can often have secondary infections requiring lots of antibiotics. It impacts their ability to go to school or work, making them miserable and contributing to anxiety and depression. It can impact their ability to have relationships, and there’s a whole set of secondary associations that include asthma, food allergy, hay fever, and even neurological effects,” he says.



  • Man applying skin cream
    6. “Severe eczema medications have come a long way recently.”
    Doctors used to rely on steroids, which can have significant drawbacks, to treat severe eczema—but now the treatment arsenal is expanding. Your doctor can prescribe a new, non-steroidal cream called crisaborole (Eucrisa). You can also get an injectable medication called dupilumab (Dupixent). “It’s what we call a biologic and it does work wonderfully. We didn’t have anything to treat those severe patients before, other than using toxic medicines that you could only use for several months,” says Dr. Steele. “We have people who have gotten used to having miserable skin disease. Those patients should understand that we’re in a different world now, and that we can do a much better job of fixing things,” says Dr. Eichenfield.



  • woman trying out lotion on skin in pharmacy
    7. “The trickiest thing about severe eczema is staying on top of it.”
    “This is something that needs to be managed on a day-to-day basis, and the biggest part is maintaining the healthy skin barrier,” says Dr. Friedman. “You try to put moisture back into the skin, and you try to improve what would otherwise be compromised function of the skin barrier,” says Dr. Eichenfield. “Then there’s anti-inflammatory medicine, which is going to handle the inflammation in both the rashes and some of the secondary aspects of eczema.” Adds Dr. Steele: “If you’re a person who’s prone to having severe eczema, whether it’s a flare or the in-between time, you always have to be careful. You always have to be mindful of [the condition] when you’re choosing skin care products.”



  • Woman at the drugstore
    8. “Look for three things in your moisturizer for severe eczema.”
    “There are three categories of ingredients that should be in a moisturizer,” says Dr. Friedman. “You want something that is going to occlude the skin—that will trap the water under it and force it into the skin—because our skin is a good raincoat and it’s hard for water to get in,” He adds: “Then, there are humectants, which will pull water into the skin. These things will bind a thousand times their weight in water. Lastly, you want an emollient, which will soften the skin immediately, even though it will take time to have its full effect on the skin.”



  • woman-holding-out-pill-in-hand
    9. “Prevention is the best medicine when it comes to severe eczema.”
    Dr. Steele advises using a humidifier when the air is very dry and suggests taking an antihistamine. “You can take it orally and spare your skin the topical steroid,” she says. “Keep your skin well-moisturized and use gentle skin care, nothing with perfumes or dyes. Also, look for a cream that has ceramides, which are kind of the paste between the skin cells and are involved in the skin barrier,” she adds. Use warm instead of hot water in your shower or bath and avoid harsh soaps; in fact, Dr. Friedman discourages the use of any soap during a flare. With good, informed care and new medicines, you can control your severe eczema rather than letting it control you.



Severe Eczema: 9 Things Dermatologists Want You to Know

About The Author

Nancy LeBrun is an Emmy- and Peabody award-winning writer and producer who has been writing about health and wellness for more than five years. She is a member of the Association of Health Care Journalists and the American Society of Journalists and Authors.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Feb 25
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