Top 10 Tips for Controlling Eczema

If you type “eczema” into a search engine on the Internet, you’re bound to be inundated with links to hundreds of products that claim to be “eczema cures.” You’ll be told again and again that nothing worked, except a particular miracle dry skin cream, or a special all-natural lotion, or a secret eczema-curing recipe, or the removal of a single food from a diet. The truth is, no one really knows for sure what causes eczema or how to cure it, and there is evidence that there may be a strong hereditary element to the skin condition. While various creams and lotions often work temporarily, again and again, for all too many, the eczema returns. Some eczema sufferers eventually outgrow their condition, but many will have to manage it for the rest of their lives. This is why it is more realistic to speak of controlling eczema than of curing it.

Atopic eczema is commonly described as “the itch that rashes.” It involves long-term inflammation of the skin. Eczema sufferers have chronically dry skin, and the itchiness of that dry skin urges the sufferer to scratch. Rashes soon follow. Fingers, hands, wrists, feet, ankles and the folds of skin at the elbows and knees are all common places to find eczema. In young children especially, it is often found on the cheeks, forehead and fronts of legs. Eczema appears at first as small red bumps. Because it so tempting to scratch the rashes, the skin of eczema sufferers can easily become infected. Rashes can become scaly, blistering or weeping as a result.

Even if you are unable to cure your eczema permanently, you can at least control it. You can manage to keep the discomfort to a minimum and to minimize the number of infections. Here are the top 10 tips for controlling eczema that I learned during my many years as both an eczema sufferer and the mother of an eczema sufferer:

1. Avoid known triggers.

If you have eczema, it’s a good idea to get tested for common allergens. While allergies may not directly cause eczema, they can certainly exacerbate it. Common food allergies in eczema sufferers include soy, milk, and eggs. Common environmental allergens include dust mites, trees, grass, and mold. Certainly eczema sufferers should avoid known allergens as much as possible, but don’t expect the removal of an allergen to be a cure-all.The causes of eczema are complex, and it is often difficult or impossible to eradicate certain allergens completely from you environment.

It is also possible to outgrow allergies and develop new ones. For instance, my daughter was allergic to milk as a toddler, and when we switched her to soy milk, the eczema on her cheeks did clear up (though it remained elsewhere on her body). Unfortunately, while on soy milk she outgrew her milk allergy and developed a soy intolerance. Removal of soy from her diet did not “cure” her eczema, but ingestion of the soy protein does seem to exacerbate it.

It is often difficult to figure out what triggers your eczema, but if you notice a correlation between a particular food or skin product or environmental factor and the worsening of your rashes, take note and avoid that trigger as much as possible.

2. Avoid products and activities that dry out your skin.

Soaps and shampoos tend to dry the skin. Use a soft, hypoallergenic soap such as Cataphyll or one of its generic equivalents. Avoid shampoos and conditioners with added fragrances. Do not use antibacterial soaps or hand sanitizers, especially if you have eczema on your hands, as they tend to be especially drying. Also avoid long, hot baths or showers. Use lukewarm water instead. Stay out of the hot tub and the Jacuzzi, or, if you really have to relax in one, limit your time and immediately apply a moisturizer upon exiting.

What about swimming? Some eczema sufferers find that chlorine, which is drying, worsens their eczema, but others find it has the advantage of killing bacteria on the skin and actually improves their eczema. Obviously, if you have a strong negative reaction to chlorine, you should avoid swimming in chlorinated pools. If not, feel free to swim; just rinse off when you’re done with the pool for the day and apply a moisturizer while your skin is still wet. If you have open cracks from your eczema, it’s a good idea to avoid swimming in lakes, rivers, ponds, and the ocean, as these can contain bacteria that lead to skin infections in the already immunity-compromised eczema sufferer.

3. Keep your hands clean and your nails trimmed.

Eczema sufferers can’t help but scratch. Scratching, however, can lead to infection, especially if your hands aren’t clean. Trim your nails and clean under them regularly. Because eczema frequently breaks out on hands, handwashing may be uncomfortable and you may be loathe to do it regularly, but it’s important you do so. Just make sure you avoid drying soaps and put an ointment on after washing to prevent them from drying out.

4. Moisturize, moisturize, moisturize.

Apply a cream, lotion, ointment, or oil regularly to moisturize your skin, at least three times a day. Avoid moisturizers with fragrances. In general, the fewer the ingredients, the better (because that simplicity makes avoiding triggers easier). The next tip discusses the superiority of ointments, but some people will still prefer lotions or creams. Many over-the-counter hypoallergenic lotions and creams are available, but around-the-house options include such solutions as avocado and the inexpensive, easy-to-spread Crisco. However, make sure you’re not allergic to or intolerant of any of the ingredients in home-made eczema remedies. Crisco, which is surprisingly popular with many eczema sufferers, might have been a cheap emollient for my daughter if only it did not contain soy.

5. Favor ointments over creams and lotions.

Dermatologists who specialize in eczema are more likely to prescribe ointments than lotions or creams. Ointments, being 80% oil (creams and lotions are 50% oil or less) tend to be better moisturizers, and, at its heart, eczema is an issue of dry skin. While creams are easier to spread over larger areas, ointment is better at sealing in moisture and creating a protective layer on the skin, which is especially important if your eczema has caused your skin to crack open in places.

Aquaphor and its generic equivalents are popular everyday emollients, but Vaseline, which is considerably cheaper, also serves the purpose. However, Vaseline is much thicker than Aquaphor and may not be preferable in the summer time. Since it’s often difficult to identify eczema triggers, the fewer the ingredients in your emollient the better. Of course, you can use straight up oils as well (olive oil being a popular home remedy), but liquid oils do not create as thick a protective barrier as an ointment and are generally less soothing on cracked skin.

6. Wet your skin before applying lotions, ointments, or creams.

If your skin is dry, rubbing on an emollient, even an ointment, is basically useless. Your skin needs to be damp to ensure that you are sealing in moisture that will soften the skin. Pat dry after a bath or shower and apply an emollient, such as Aquaphor, within three minutes of exiting the water. If you have eczema on your hands, always wash and pat dry your hands (avoiding drying soaps, of course) prior to applying ointment. In the summer, it’s great to make use of pool breaks by applying emollient just after exiting the water.

7. Beware sunscreens and suntan lotions.

Suntan lotions often exacerbate eczema. The catch is that different products trigger eczema in different people. While one child with eczema may have a reaction to Banana Boat Kids and prefer Coppertone Water Babies, another may do just fine with the first product but break out with the second. You need to find a suntan lotion that works for you, and you may want to spot test it somewhere on your skin first. Lotions with higher SPFs are more likely to be triggers; stick to an SPF of 50 or less, which is more than sufficient to prevent burns for most people. PABA-free suntan lotions are usually a safer bet, as many eczema sufferers have reported reactions to that ingredient. Natural suntan lotions may at first seem the best solution, but read the list of ingredients carefully to make sure it doesn’t contain something to which you are allergic or intolerant; after all, most eczema sufferers are allergic to something in nature. If every suntan lotion on the shelf seems to make you break out, talk to your doctor about the possibility of prescription suncream.

Finally, because eczema is sometimes associated with a Vitamin D deficiency, you don’t want to go overboard in blocking the sun. In fact, it’s a good idea to get 10-15 minutes of direct sunlight daily without sunscreen. However, you also want to be careful not to burn, and excessive sun exposure increases your risk of cancer, so don’t stay out long without suntan lotion.

8. Take bleach baths.

In a society where “natural” and “chemical-free” products are increasingly popular, the idea of adding bleach to your bath may revolt you. Yet it’s becoming an increasingly common recommendation of dermatologists and pediatricians for eczema sufferers.

Why would you do such a thing? As has already been mentioned, it’s easy for eczema to get infected, and that’s when the real problems begin. Indeed, research shows that staph bacteria can be found on the skin of as many as 90% of atopic eczema suffers. Adding a little bleach to your bath helps to kill infections that may be on the skin.

Twice a week, fill your tub with lukewarm water and add ½ cup of bleach. Soak for about six minutes. You’ll want to rinse off quickly in the shower after your bath and then immediately apply an emollient to counteract the drying effect of the bleach. Obviously, if this practice makes your eczema worse, you’ll want to discontinue it, but recent research has shown it to be beneficial for many.

9. Use antibiotic ointments as needed on cracked skin.

If your skin becomes cracked, apply a topical antibiotic ointment, such as Bacatracin or Neosporin, to prevent infection. This will both moisturize and help to protect you against infection. Use only as necessary, however, as prolonged use of topical antibiotics can result in the growth of bacteria that is resistant to the antibiotic. If an infection is not prevented or worsens, you may need to see your doctor to receive an oral antibiotic, but with the bleach baths and antibiotic ointments, such a course may be avoided.

10. Minimize your itch.

The more you scratch, the more you rash. You can minimize your itch with emollients (see tips 4-5 above), but you will likely need something stronger at times, such as an over-the-counter, 1% hydrocortisone ointment. In severe cases, you may need to see your doctor for a prescription-strength ointment or cream. You can also reduce itching, especially at night when it is most bothersome, with an oral antihistamine such as Benadryl or its generic equivalents. If the itching is particularly bad and you can’t seem to break the itch-scratch-rash cycle, talk to your doctor about the possibility of prescribing a stronger oral antihistamine.

Another great itch reliever is a Domeboro soak. This over-the-counter product is dissolved in water. You can then soak your hands in feet in it, or soak bandages in it to make wraps for effected areas. This provides temporary relief of itch and helps to soften the skin. Apply ointment immediately after your Domeboro treatment. A tip for relieving ezcema on the hands or feet of children using Domeboro is to soak a pair of sock in the solution and then put the socks over the hands or feet; cover these wet socks with another pair of dry socks. This double-sock treatment can be done overnight without Domeboro as well: wash the hands or feet, apply ointment, apply the wet sock, and then cover it with a dry sock. In the morning, the skin will be softer. Apply more ointment immediately upon waking. You can also use cloth gloves.

Eczema is a cryptic curse. Its causes are complex and difficult to decipher; every eczema sufferer reacts differently to different products, and what works one day for any given individual may not work the next. Yet if you keep these ten tips in mind, you’ll have some useful tools for controlling your eczema. Use what works; discard what doesn’t. I promise no cure, but as a lifelong eczema sufferer who is also the mother of an eczema sufferer, I extend this advice, and my sympathy, to you.