How to Treat and Prevent Eczema

Although there’s no cure for eczema, you can take a lot of simple steps to help keep it in check. And when a flare does happen, your doctor can help you with various treatment options. Keep in mind that there’s no perfect solution that works for everyone. From moisturizers to medicine, finding out what’s best for you may take some trial and error, and it can change over time.

Everyone with eczema has their own triggers. It helps to learn yours so you can avoid them whenever possible. Common ones include:

• Allergens, like animal dander, dust, mold, and pollens
• Certain foods 
• Dry skin
• Harsh soaps and detergents
• High temperatures 
• Rough or itchy fabrics
• Skin products with dyes or fragrances
• Stress
• Sweat
• Tobacco smoke

Daily skin care is essential, and moisturizers are your first line of defense to keep your skin from drying out. You have three basic types to choose from:

Ointments, like petroleum jelly, are thick and great at holding in moisture, but they can be greasy.

Creams are a good middle ground -- not as greasy as ointments but still get the job done.

Lotions are the least thick, so they’re not quite as effective or long-lasting.

To get best results:

• Create a routine so you apply it to your whole body twice a day, including right after a shower or bath.
• Be gentle. Don’t rub it in. Smooth it on.
• Spoon it out of the container or use a pump. If you use your fingers, you leave your germs behind and that could lead to an infection.
• Moisturize your hands every time you wash them.

Baths and showers are both very helpful, but you can overdo it. Try to:

• Shower or bathe once a day for 10-15 minutes, max.
• Use lukewarm water, not hot. 
• Wash with a mild soap that doesn’t strip away your body’s oils.
• Only soap up your face, armpits, genitals, hands, and feet. Use water everywhere else.
• Don’t scrub with a washcloth or loofah.
• Gently pat yourself dry with a soft towel.
• Bathe at night to best lock in moisture.

To get more from your bath, try adding:

Baking soda, about a quarter cup, for itching.

Bath oil to moisturize your skin.

Bleach to reduce swelling and skin bacteria. For a standard size tub, add half a cup of bleach and fill with water to the overflow drainage holes. Soak for 10 minutes, 2-3 times a week.

Oatmeal to help with itching. Use colloidal oatmeal, which is like an oatmeal gel.

Salt, about a cup, when you have flare-ups.

Soaps, detergents, and other products can be harsh on your skin, so it pays to choose wisely. Here’s what to look for:

• Avoid antibacterial and deodorant soaps. They’re usually harder on your skin.
• Choose products that don’t have dyes or fragrances added.
• Get products with as few additives as possible.
• Use mild laundry detergent.
• Skip the fabric softener.

Your clothes touch your skin all day long, so you want to think about what you’re wearing and how it feels. The basic rule is to avoid friction. That means coarse, tight, or scratchy clothes, like wool, are out. Go soft and breathable. Cotton is usually a good choice.  Also, dress for the season. Heat and sweat can trigger flare-ups, so it’s important to stay cool.

It’s easier said than done, but scratching is rough on your skin and can cause sores that lead to infection. Try these ideas:

• Put a wet cloth on areas that itch.
• Cover itchy areas to keep from scratching them.
• Gently rub with your fingertips instead of scratching.
• Keep your fingernails short to limit harm.
• Wear thin gloves while you sleep.

If it seems too hard to control the urge, you may want to see a therapist to break that habit.

If self-care measures don’t prevent flare-ups, your doctor may suggest medicines you rub on your skin:

Corticosteroids have long been used to treat eczema. They come in a range of strengths. You usually stop using them once the flare-up is under control. 

Calcineurin inhibitors affect how your immune system works. They can curb flare-ups but have serious side effects, so you’d probably only use them if other treatments fail.

Your immune system helps you fight off infection. But with eczema, it tends to overreact. So it gets triggered when there’s nothing to protect against, and that leads to flare-ups. Biologic drugs block this immune system response to keep it in check. Dupilumab (Dupixent), which gets injected under your skin, is the only biologic drug approved for eczema.

If you have severe itching that won’t stop, your doctor may suggest drugs called antihistamines. You usually take them by mouth, and you can get over-the-counter or prescription versions. Some types of antihistamines make you drowsy. That might be a problem during the day, but could be a benefit if you get itchy at night.

If you have severe eczema that’s hard to control, you might get stronger corticosteroids than the ones you rub on your skin. Depending on the type, you either take these as pills or your doctor gives you a shot. They’re very effective, but you can’t use them for too long because the side effects can be harmful.

You have bacteria on your skin all the time. That’s normal! It’s part of being a healthy human. But with dry skin that might have cracks or sores, those bacteria can get in your body instead of just on it. That’s when you might need antibiotics. They don’t help with eczema, but they treat the infections it can cause. If you need antibiotics, it would probably only be for a short time. In some cases, you may take them longer to help limit skin bacteria.

With medium to severe eczema, you might also get what’s called a wet dressing or wet wrap treatment. For this, you get bandages with corticosteroids wrapped around the flare-up. In some cases, it can work within a few hours. Often, you get this treatment at a hospital because it’s a lot of work and takes a nurse who’s skilled at it. But you can ask your doctor about how to do one at home.

Also called phototherapy, your doctor uses a machine to expose your skin to special types of light. The most common one for eczema is narrowband ultraviolet B (UVB), though other types might be used in different cases.

You usually need two or three treatments a week for 1-2 months before you see results. Each session lasts just a few minutes at most. It tends to work well, but it ages your skin and raises your risk of skin cancer.

If stress triggers your flare-ups, it can help to find ways to better manage it. While you can do your best to avoid stressful situations, it’s bound to pop up. You can work with a therapist to learn relaxation techniques and skills to manage stress. You can also try some things on your own, such as mediation, yoga, tai chi, and progressive muscle relaxation. The key is to practice regularly so you get the most benefit.