Eczema can be well-managed by following all three steps below, and keeping up with skin care, even when the eczema seems to be in control.
- Bathing and moisturizing to repair skin barrier
- Prescription treatments to reduce inflammation and bacteria
- Trigger avoidance to reduce flare ups
Bathing allows moisture to enter the skin. Coating the skin after every bath or shower, with an emollient (moisturizer) helps to seal that moisture in the skin. This is necessary in patients with eczema as their natural skin barrier, which would normally trap moisture in the skin, doesn’t work well. This leaves the skin dry, rough and sensitive to irritants. It is a common myth that drinking an adequate amount of water during the day will hydrate the skin. It is in fact the bathing and moisturizing technique that hydrates the skin. Decades ago, doctors often recommended that eczema sufferers limit baths and showers; however, experts now recommend bathing as an important part of controlling eczema.
After bathing, gently pat the skin dry, and then immediately apply your moisturizer to skin that is still damp. Apply prescription products, as recommended by your physician. Apply a moisturizer several times throughout the day. Moist skin will reduce itchiness, which in turn helps to control the disease, as flares occur or increase in response to itching. Frequent bathing (even 2 to 3 times daily) followed by a moisturizer should be your first defence in managing eczema and flares!
Many adults prefer showering over taking a bath, for reasons of preference. Showering is fine for people with eczema, as long as the water is not too hot. Use a gentle cleanser and/or shower oil. After your shower, gently pat the skin dry (avoid rubbing the skin). While leaving the skin still slightly damp, immediately apply your moisturizer (and/or prescription products as indicated by your doctor).
The bathing regimen should be followed diligently during a flare-up, and after a flare-up as preventative and moisturizing maintenance. Bathing can be cut back to once per day when the skin is smooth, soft, and properly moisturized. You should continue to moisturize the skin several times daily, even when the skin is healthy.
Bathing – Step by Step
Follow these bathing steps to hydrate the skin, at least once a day, and up to three times a day when the skin is flared.
What you will need:
- A bathtub or bathing basin for babies or toddlers
- An emulsifying oil (optional)
- a gentle cleanser
- a moisturizer
- prescription treatments, e.g. topical corticosteroids, etc, if necessary
- a timer, watch or clock
- a soft natural fibre towel (wash these regularly in hot water, as bacteria from eczema can spread through towels and bedding)
Steps to Bathing the Eczema Sufferer:
- Fill the bath with lukewarm water (add some emulsifying oil if you choose). The skin will absorb some of the water (and oil if you add it).
- Immerse the patient in the water, trying to cover as much of the body as possible. Do not immerse the head in water. If eczema is on the face, or areas of the body not soaking in the water, gently apply a soft wash cloth soaked in the water/oil mixture to those areas. Soak for at least 5 minutes but not longer than 20 minutes.
- Use a gentle cleanser on areas of the body that need additional cleaning.
- Take care when handling babies and toddlers, as they will be slippery.
- Gently dry off excess water with a soft towel, or briefly air dry if the air is warm. You may leave the skin slightly damp.
- Next, apply your medications, exactly as prescribed by your doctor. If your medicated treatment contains a corticosteroid (e.g. Hydrocortisone, Fucidin® H), you would typically apply now to the still damp skin. For the non-cortisone based prescriptions, such as Elidel® or Protopic® ensure the skin is completely dry before applying.
- When applying prescription products, carefully avoid the healthy skin.
- Apply your moisturizer to the remaining patches of healthy skin. The entire body can and should be moisturized between bathing with your regular, non-prescription moisturizer. If most of the skin is covered in eczema, use your prescription products after the bath, and then apply a coat of moisturizer to the whole body at least 30 minutes after the prescription products.
How do I select the best bathing and moisturizing products?
The best products for bathing and moisturizing are:
- Products that have few ingredients and that are formulated for sensitive skin and eczema. You want thick moisturizers that will both moisturize the skin, and provide a barrier.
- Products that fit your budget. More expensive is not necessarily better.
- Products that the eczema sufferer will tolerate and will actually use! If you or your child dislikes the greasy feeling of petrolatum, then find a moisturizer that works for you!
See a list of products that have earned our Seal of Acceptance
Medical management is an important part of controlling eczema, and medications (including topical creams and ointments) should be used as prescribed by your physician. Do not discontinue, or alter the treatment plan without consulting your physician. Speak to your physician or your child’s physician about the best treatment option for the individual. Medical management includes anti-inflammatory topical treatments, antibiotics, barrier repair, and antihistamines.
Anti-inflammatory topical treatments:
Topical Corticosteroids are prescribed to reduce inflammation and itching. Strengths range from mild to very strong. When used under the direction of a physician, topical corticosteroids are very effective and safe. In fearing side effects eczema sufferers, or their caregivers, often use the treatment too sparingly, or too infrequently. Possible side effects include thinning of the skin if preparations are used excessively or for extended periods. Follow your physician’s recommendations exactly, and address any questions or concerns you have with your physician.
Topical Immunomodulators (e.g. Elidel®, Protopic®) are prescribed for inflammation and itching, and can be used for short, intermittent periods of time unless otherwise directed by your physician. A possible side effect is a mild to moderate burning sensation. These treatments are not recommended for children under the age of 2 years.
Topical Antibiotics are prescribed for secondary infection, which can worsen the eczema and may make it more difficult for the eczema to respond to treatment until the bacterial infection has been cleared. Localized patches of infected or resistant eczema may be treated by topical antibiotic creams and ointments. Mupirocin (e.g. Bactroban®) or fusidic acid (e.g. Fucidin® ointment) have shown to be beneficial.
Combination Topical Treatments (e.g. Fucidin® H) combine Fucidin® with a mild hydrocortisone, which helps to both reduce inflammation and clear the secondary infection with one application. Clearing infections is an important part of eczema management.
Oral Antibiotics are prescribed for more significant skin infections. There is often secondary infection on eczema patches, even when there may be no other obvious signs of infection. Oral antibiotics are preferred over topical antibiotics when the infection is extensive.
Skin Barrier Repair Emulsion:
EpiCeram ® is a new non-steroid barrier repair emulsion that is safe to use at all ages. EpiCeram® is a therapeutic skin barrier repair emulsion which has a unique composition of key lipids (fats) that are recognized to be lacking in the skin of many patients with atopic dermatitis (eczema). When compared head-to-head with a mid-potency topical steroid, it was shown to have similar benefits in improving eczema. EpiCeram® is a therapeutic skin barrier repair emulsion which has a unique 3:1:1 composition of essential lipids that are missing in the skin of patients with atopic dermatitis (eczema). Speak to your doctor about this treatment.
Oral Corticosteroids (e.g. Prednisone• ®) are rarely used, and reserved for the most severe cases. There are long-term side effects with prolonged use, and because eczema is a chronic condition, this is not a permanent solution for severe chronic eczema.
Antihistamines are used to relieve itching and aid in sleep. Itching tends to increase at night (daytime distraction also helps reduce daytime itching). As you increase hydration of the skin (through bathing and regular moisturizing) and manage your eczema, you will decrease the need for antihistamines, as night time itching decreases when the skin is moist and healthy. Use of antihistamines for children 6 years of age and under should be discussed with his/her physician.