Eczema (Atopic Dermatitis)
Why do I have Eczema?
Eczema (or atopic dermatitis) is a chronic skin condition that is caused or worsened by many different things. There seems to be a genetic component because eczema can run in families. Dry climates, cold weather, fragrances, harsh soaps, stress, poor diet, and many chemicals and allergens (like pet dander, pollen, or dust mites) can make eczema worse. Eczema also flares when you are sick. Increased hand washing and hand sanitizing because of COVID are not helping. During severe eczema flares, the skin can get so dry that it cracks and splits open, making lotions, creams, and chemicals touching the eczema skin very painful.
How do I avoid eczema flares?
Moisturize EVERY DAY, at least morning and night, but several times daily when needed.
Thick, greasy ointments like Vaseline or Aquaphor work best, but most people find them too greasy or heavy for daily use.
Creams are the next best option. My strong preference is either CeraVe Moisturizing Cream or Vanicream Moisturizing Cream. These do not leave a greasy or sticky feel.
NOTE: Lotions have more alcohol in them, which can dry your skin even more. To prevent dry skin or eczema, use an ointment or cream, not a lotion.
Bathe or shower DAILY (or every other day).
Use as little soap as possible. Use very mild/fragrance-free soaps. Wash dirty areas with soap first, rinse off the soap, then fill the tub with clean water if bathing.
If there is scratched/broken skin, use bleach baths at least once a week: add 1/4 cup of household bleach (Clorox, etc.) to the tubful of lukewarm bath water.
Soak for 10-15 minutes.
Gently pat dry and immediately apply moisturizers to your damp skin.
Go fragrance-free.
Fragrance makes eczema worse - it is one of the most common causes of skin allergies
Use only fragrance-free washes, shampoos, and moisturizers.
Switch your household laundry detergent, fabric softener, and/or dryer sheets to fragrance-free for 1 month - if it helps the eczema, stick with it.
How do I treat eczema flares?
Use steroid (cortisone) ointments.
Nothing works better to calm down the redness and irritation of eczema than steroids.
To minimize irritation, use an over-the-counter hydrocortisone ointment (instead of cream) twice daily to eczema spots. This option is safe for all ages and all body sites.
To make it more effective, after applying hydrocortisone ointment, cover or wrap the area in plastic wrap for 30 minutes. This keeps the hydrocortisone on the eczema and pushes it deeper into the skin.
WARNING: Overuse of topical steroids like hydrocortisone can cause skin thinning, stretch marks, and easy bleeding or bruising.
MOISTURIZE:
Eczema skin doesn’t moisturize naturally as it should. You have to moisturize eczema skin frequently to do the work the skin isn’t doing naturally.
Apply a moisturizing cream or ointment after rubbing in the hydrocortisone. My strong preference is CeraVe moisturizing cream for eczema.
NOTE: Lotions have more alcohol in them, which burns when you put lotion on broken skin and can dry out the skin even more.
Additional Tips and tricks for eczema:
These tips are not universally helpful for everyone with eczema, but with eczema (I have two kids with eczema), there’s a lot of trial and error to see what works best for each person’s eczema.
Use a cool-mist humidifier: In dry climates or indoors when heaters are running, the humidity is low and dries out your skin. Run a cool-mist humidifier in the bedroom overnight or in your main rooms during the day.
Use an antibiotic ointment or medical-grade honey.
Apply antibiotic ointment or Manuka honey twice daily to any red or oozing areas of broken skin.
NOTE: A prescription antibiotic ointment called mupirocin works better than over-the-counter options.
If many areas of red/oozy skin are present, you may need a prescription oral antibiotic.
Antihistamine treatment: I find that antihistamines sometimes help, especially at night-time, to improve sleep and help with itching/scratching:
Cetirizine (Zyrtec) in the morning and at dinnertime
Diphenhydramine (Benadryl) about 30 minutes before bedtime
Vinegar soaks: These are immensely helpful for any scratched, broken, or damaged skin. See my page on Vinegar Soaks.
Bleach baths: You are essentially turning your bath into a chlorinated swimming pool - this not only helps minimize bacterial overgrowth on eczema skin, but some people find bleach baths really reduce itching before bedtime. It is safe for all ages and skin types.
Avoidance measures: Avoid exposure to things that make eczema worse:
Rough or scratchy clothing (especially wool)
Pets and pet dander if eczema flares around dogs or cats
Harsh soaps or detergents
Tobacco smoke
Air pollution - stay inside during high air pollution days.
Reduce stress: Just like other chronic health conditions, eczema gets worse with stress. This site has lots of simple, helpful tips for reducing stress. When a big deadline at school or work, a difficult conversation, or an illness or death happens, you can expect your eczema to get worse. If you know a stressful event is coming up, start treating your problem areas before they flare.
Eat healthier: Most people with eczema notice that when they eat poorly (fast food, junk food), their eczema flares. Often we eat worse when we are stressed. A good way to improve eczema and reduce flares is to switch as many meals as you can to whole-food, plant-based options.
What if my eczema isn’t getting better?
Usually, the steps above can help most people get their eczema better. Sometimes people have sensitive skin or are allergic to one or more chemicals that touch their skin. If over-the-counter options are not working, there are stronger prescription topical medications or patch testing that can be used to look for common skin allergies. Look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.