What doctors wish patients knew about managing eczema

Eczema, a condition characterized by itchy, inflamed skin, can be a source of significant discomfort for millions of people worldwide. Managing eczema effectively requires a combination of lifestyle changes, the right treatments, and a deep understanding of the condition. Virginia Mason Franciscan Health dermatologist Edward Esparza, MD, PhD, shares valuable insights on how to manage eczema, emphasizing the importance of consistent moisturizing, avoiding heat, and recognizing common triggers.

Understanding Eczema

Eczema, also known as atopic dermatitis, tends to occur in drier areas of the skin, such as the arms, legs, and torso, while sparing more moist areas like the hands and feet. This observation highlights the role of natural body moisturizing properties in preventing eczema. However, for those who do develop the condition, managing it can be frustrating due to the constant need for moisturizers that may feel greasy or hard to absorb.

The Importance of Moisturizing

Moisturizing is key to improving eczema symptoms. According to Dr. Esparza, the safest treatments for eczema are moisturizers, which prevent dehydration and soften the skin. Brands like Vanicream and Eucerin Eczema Relief cream are recommended for their natural hydrating properties. However, it's essential to choose a moisturizer that works for you, as different people have different preferences.

### Tips for Choosing a Moisturizer:
- **Choose a Fragrance-Free Cream**: Harsh chemicals and fragrances can irritate the skin.
- **Select a Cream That Works**: Experiment with different types of moisturizers until you find one that minimizes outbreaks.
- **Use It Consistently**: Apply moisturizer at the same time every day, regardless of whether your eczema is flaring or not.

Avoiding Heat

Heat can be a significant trigger for eczema flare-ups. Dr. Esparza advises patients to turn down the temperature when bathing or washing hands. Hot showers may provide temporary relief by numbing the itch, but they ultimately stimulate more itch in the long run. He recommends limiting showers to five minutes and keeping the temperature lukewarm.

### Tips for Bathing:
- **Limit Bath Time**: Keep baths short, especially for children.
- **Use Lukewarm Water**: Avoid hot water, which can stimulate more itch.
- **Apply Moisturizer After Bathing**: Immediately apply moisturizer after bathing to lock in hydration.

Recognizing Triggers

Understanding why eczema flare-ups occur is crucial for effective management. Common triggers include seasonal changes, such as the onset of winter when heaters are turned on, and workplace exposures. Even with protective equipment, some workplace materials can still irritate the skin.

### Common Triggers:
- **Seasonal Changes**: Heater use in winter can be a common trigger.
- **Workplace Exposures**: Certain materials or chemicals in the workplace can irritate the skin.

Using Topical Steroids

Topical corticosteroids are a common treatment for eczema. These medications control inflammation by quieting the fire of inflammation, explained Dr. Esparza. They range from mild hydrocortisone to strong clobetasol. However, it's essential to use the right strength for the right amount of time to avoid thinning the skin or causing stretch mark-like areas.

### Using Topical Steroids:
- **Start with Mild Strength**: Begin with hydrocortisone for mild cases.
- **Use the Right Amount**: Apply topical steroids only to affected areas and for a limited time.
- **Monitor Progress**: Gradually adjust the strength or duration of treatment based on symptoms.

Non-Steroidal Options

For those who cannot or prefer not to use topical steroids, non-steroidal options like topical tacrolimus, crisaborole, and ruxolitinib are available. These alternatives can provide relief without the risk of skin thinning associated with steroids.

### Non-Steroidal Options:
- **Topical Tacrolimus**: A non-steroidal option that inhibits inflammation.
- **Crisaborole**: Another non-steroidal topical treatment for eczema.
- **Ruxolitinib**: A more recent addition to non-steroidal treatments.

Quitting Smoking

Smoking can be particularly problematic for eczema patients as the smoke irritates the skin. Quitting smoking is not only beneficial for overall health but also for managing eczema symptoms more effectively.

### Quitting Smoking:
- **Reduce Skin Irritation**: Smoking can cause skin irritation and exacerbate eczema.
- **Improve Overall Health**: Quitting smoking has numerous health benefits beyond managing eczema.

Wet-Wrap Therapy

In severe cases, wet-wrap therapy is an effective method used in combination with topical agents. This technique involves applying topical agents to the skin, followed by a layer of tubular wet bandage and an outer layer of dry bandage. This approach intensifies the effect of moisturizers by providing a smooth skin texture and preventing water loss.

Bleach Baths

Bleach baths have been considered effective in reducing the colonization of Herpes simplex and Varicella zoster viruses. This method is particularly useful for patients who experience eczema herpeticum, a condition caused by Herpes simplex virus that requires systemic acyclovir treatment for prompt initiation.

### Bleach Baths:
- **Reduce Viral Colonization**: Bleach baths can reduce the colonization of viruses like Herpes simplex.
- **Eczema Herpeticum**: For patients experiencing eczema herpeticum, bleach baths can be part of the treatment plan.

By understanding these tips and recommendations from Dr. Esparza, patients can better manage their eczema. Consistent moisturizing, avoiding heat, recognizing common triggers, using topical steroids judiciously, and considering non-steroidal options are all essential steps in controlling this chronic condition. For those struggling with eczema, knowledge is power, and seeking professional advice from a dermatologist or primary care physician with experience treating eczema is crucial.

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Additional Resources

For more information on managing eczema, consider visiting the American Medical Association's resources on delivering care, which cover a range of health care topics affecting physicians and patients. Additionally, the Healthgrades website provides detailed information on Dr. Edward Esparza's extensive experience in dermatology and his approach to managing skin conditions like eczema.

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Conclusion

Eczema is a challenging condition to manage, but with the right approach, it is possible to alleviate symptoms and improve quality of life. By following the advice of dermatologists like Dr. Esparza, patients can better navigate the complexities of managing eczema. Whether it's consistent moisturizing, avoiding heat, or recognizing common triggers, each step towards managing eczema is a step towards comfort and relief.

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References

• Delivering Care - American Medical Association
• Dr. Edward Esparza, MD - Healthgrades
• What doctors wish patients knew about managing eczema