Hand’s down, judicious use of moisturizer tops the list of eczema treatments dermatologists use on themselves and their kids. Here’s why: The skin barrier is inherently damaged in eczema, and as a result, irritants can sneak in and water can escape, resulting in dry, itchy patches of skin. Moisturizers help protect the barrier, and when it comes to moisturizers, the greasier the better.
In the winter, Peter A. Lio, MD, gets hand eczema from washing and using hand sanitizer so many times each day. “We love to use CeraVe cream, Eucerin Eczema Relief, Eau Thermale Avène XeraCalm A.D Lipid-Replenishing Balm, and Theraplex Eczema Therapy,” says Dr. Lio, a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago. “These are all gentle products that are made for sensitive skin and help keep the skin healthy and strong.” The National Eczema Association also provides a list of all the moisturizers that earned their seal of approval. When shopping for a moisturizer, make sure it is fragrance-free as scents can irritate eczema-prone skin. Key ingredients to look for include ceramides, glycerin, Shea butter, lipids, and hyaluronic acids. For best results, apply moisturizer to damp skin after taking a shower or bath in lukewarm water to lock moisture in and keep irritants out. (Follow these dermatologist-approved rules for using moisturizer, and you’ll never go wrong.)
Itching and infection SOS
Itching is by far the most vexing eczema symptom largely because it kick-starts the itch-scratch cycle that aggravates eczema and can lead to infections. This is why Jeffrey Fromowitz MD, FAAD, a dermatologist in Boca Raton, Florida, is a fan of prescription Alevicyn spray and gel as an eczema treatment. “These can easily be applied on the skin, and they have anti-itch and anti-bacterial properties.” (You can also give this simple eczema-relieving trick a try.)
Adding colloidal oatmeal to your bath is one of the 10 home remedies for eczema, and it really soothes the itch, says Michele S. Green, MD, a dermatologist at Lenox Hill Hospital in New York City. You can DIY by pouring one cup of store-bought oatmeal to your lukewarm bath as it fills or purchase products such as Aveeno Baby Cleansing Therapy Moisturizing Wash that contain oatmeal. This is a win-win as bathing provides hydration to thirsty eczema-prone skin as the oatmeal soothes the itch and irritation. It’s also possible that the sheer relaxation of taking a bath reduces stress which is known to trigger eczema flares.
Topical steroids are potent anti-inflammatory agents that can help rein in even the most severe eczema spots, Dr. Green says. “If moisturizing and other preventive measures don’t work, we turn to steroids,” Available in over-the-counter and prescription strengths, topical steroids do have some side effects if used too often, including the risk of thinning skin. (Read on for the nine important things to know if you have eczema,)
Advanced barrier repair
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Dr. Fromowitz’s young nephews have eczema, and he recommends prescription Epiceram Barrier Repair for moisturization as an eczema treatment. This is his go-to for moderate to severe eczema, and it is steroid-free. Epiceram is designed to mimic the natural proportions of essential fats that are found in healthy skin, but are lacking in eczema-prone skin, “Universally, barrier function is perturbed in all eczema patients, and this can help reverse the damage,” he says. (Here’s how you may be damaging your skin barrier function without realizing it.)
If someone is flaring, Emma Guttman-Yassky, MD, PhD, vice-chair of research, department of dermatology and professor of dermatology, Icahn School of Medicine at Mount Sinai in New York City, will start with a strong topical steroid used twice daily for one week, and then switch to a moderate strength steroid for four weeks, twice daily before decreasing it gradually to about once or twice a week. If the flares are in delicate areas such as the face or skin folds, she may use a steroid alternative such as tacrolimus (Protopic) or pimecrolimus (Elidel). These creams block an immune system chemical called calcineurin that plays a role in inflammation. Another topical, crisaborole (Eucrisa), blocks PDE4 enzymes within the skin that have been linked to inflammation. Both Protopic and Elidel carry black box warnings, citing a possible increased risk for cancer. A black box, also known as a boxed warning, is the strongest warning that the US Food and Drug Administration can offer. “Eucrisa doesn’t have black box,” Dr. Guttman-Yassky says.
Dr. Guttman-Yassky had eczema as a child, and still experiences mild bouts during the dry, winter months. “I recommend short bleach baths at least twice a week for about 10 minutes,” she says. “There is a good deal of evidence that people with eczema may be more prone to staph bacterial infections and these bacteria can also trigger new lesions, but bleach baths help remove bacteria from the skin,” she says. The NEA suggests pouring a half-cup of household bleach into a full tub of water, or one-quarter cup for a half tub. But water baths can be just as effective and may be less likely to sting, according to a 2017 study out of Northwestern Medicine in Chicago. People with eczema are more prone to asthma, and bleach bath fumes may also lead to asthma attacks if the bathroom doesn’t have great ventilation. (Here’s a 10-step asthma action plan to prevent your next attack.)
Kid-friendly herbal itch relief
Steven Q. Wang, MD, director of dermatologic surgery and dermatology at Memorial Sloan-Kettering Cancer Center in Basking Ridge, New Jersey, knows all too well how eczema flares can impact the entire family. Dr. Wang’s son has eczema, and the family has experienced many a sleepless night as a result. Breaking the itch-scratch cycle is crucial, which is why he created Dr. Wang’s Herbal Rescue Balm. “Steroids do have side effects including thinning skin, stretch marks, dilated blood vessels, and even topical steroids, if used in delicate areas, could have systemic side effects,” he says. The balm contains herbs with anti-inflammatory and anti-itch properties. “We put the balm on the skin and then cover it with some gauze to prevent the hands and nails from reaching the skin, and this provides an added occlusive effect for herbal balm to do its job on really troubled areas.” Don’t miss these 10 all-natural psoriasis and eczema treatments.