Although there is no simple cure for atopic eczema, a variety of treatments can ease the symptoms of an eczema flare-up. Children with atopic eczema normally find that their symptoms naturally improve over time.
Medication used to treat atopic eczema includes:
- emollients - used all the time for dry skin
- topical corticosteroids - used to reduce swelling and redness during flare-ups
These two medicines provide effective treatment for most cases of eczema, even severe eczema.
Your GP will prescribe emollients for dry skin, and the weakest effective topical corticosteroid. Different strengths are needed for different parts of the body.
Other medicines that may be used include:
- antihistamines, for severe itching
- oral corticosteroids, for severe symptoms
- antibiotics, for infected eczema
- topical calcineurin inhibitors, such as pimecrolimus and tacrolimus
Your GP will prescribe additional medication as and when it is needed.
As well as medication, the following self-care advice should also help.
Self-care
You can use several self-care treatments at home to manage your or your child's eczema symptoms.
Reducing scratching
Eczema is often itchy. Scratching it will aggravate the skin more and will eventually cause it to thicken, like a piece of leather. If you scratch your skin, it increases the risk of your eczema becoming infected with bacteria. See Atopic eczema - complications for more information.
There may be times when you or your child cannot help scratching. Keeping nails short will minimise any damage to the skin. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Other techniques for avoiding skin damage from scratching include tapping or pinching the skin until the itch has gone.
Avoiding triggers
Your GP will work with you to establish what triggers your or your child's eczema flare-ups, although eczema may get better or worse for no obvious reason. See Atopic eczema - diagnosis for more information.
If you establish what triggers a flare-up, you can try to avoid contact with the triggers. For example:
- If wool or some man-made materials irritate your skin, avoid wearing these and stick to natural materials, such as cotton.
- If heat aggravates your eczema, keep the rooms in your home cool.
- Avoid using any soaps or detergents that you think may affect your skin.
Although house dust mites have been shown to trigger eczema flares, you are not recommended to try to get rid of dust mites from your home. The process is very time consuming and difficult to carry out effectively, and there is no clear evidence that it helps.
Similarly, although living in an area that has hard water is associated with slightly higher levels of eczema in younger children, installing a water softener does not seem to make any difference.
Diet
If you or your child have atopic eczema, do not make any significant dietary changes without first speaking to your GP. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. However, it may not be healthy to cut these from your diet without medical advice, especially in young children who need plenty of calcium, calories and protein provided by these foods.
If your GP suspects that you have a food allergy, you may be referred to a dietitian. This is a healthcare professional who specialises in diet and nutrition.
If you are breastfeeding a baby who has atopic eczema, get medical advice before making any changes to your regular diet.
Emollients
Emollients are substances that help soften and smooth your skin to keep it supple and moist. They are the most important treatment for dry skin associated with atopic eczema. See the Health A-Z topic about Emollients for more information.
As atopic eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent it from becoming more irritated. Emollients stop water being lost from the outer layer of the skin, and add water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.
Choice of emollient
Several different emollients are available, some of which you can buy over-the-counter without a prescription. Your GP can recommend a suitable product.
You may need to try a few different emollients to find one that suits you. You may also be prescribed different emollients for different uses, such as:
- an ointment for very dry skin
- a cream or lotion for less dry skin
- an emollient to use on your face and hands
- a different emollient to use on your body
- an emollient to use instead of soap
- an emollient to add to bath water or use in the shower
The difference between lotions, creams and ointments is the amount of oil and water they contain. Ointments contain the most oil so can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least oil so are not greasy but can be less effective. Creams are in the middle.
If you have been using a particular emollient for some time, it may eventually become less effective or it may start to irritate your skin. If this is the case, speak to your GP as another product can be prescribed instead. The most common reason for emollients not working is that they are used for inflamed skin without the help of an anti-inflammatory treatment, such as topical corticosteroids.
How to use emollients
Use your emollient all the time, especially between flare-ups, even when you do not have symptoms. Keeping separate supplies of emollients at work or at school can be a good idea.
To apply the emollient:
- Use a large amount.
- Smooth the emollient into the skin in the same direction that the hair grows.
- Do not rub the emollient in.
- For very dry skin, apply emollient every two to three hours.
- After a bath or shower, gently dry the skin and then immediately apply the emollient, while the skin is still moist.
- Do not share emollients with other people.
- Do not put your fingers into an emollient pot, but instead use a spoon or pump dispenser. This reduces the risk of spreading infection.
Creams and lotions tend to be more suitable for red, inflamed areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.
It is very important to keep using your emollients during a flare-up because this is when the skin needs the most moisture. During a flare-up, apply emollients frequently and in generous amounts.
An adult with moderate eczema over quite a lot of their body should use around 500-600g (1.1-1.3lb) of emollient a week. A child should use about half this amount. Check the amount of your emollient on the packaging to work out roughly how long the pot or tube should last.
Side effects
The most common side effect of using emollients is stinging, which is often due to eczema not being sufficiently treated. Emollients alone rarely control eczema unless the eczema is very mild.
It is also possible for the emollient to block your pores, which is why you should apply it in the same direction that the hair grows.
If you have atopic eczema, your skin is very sensitive and can sometimes react to certain ingredients within an emollient. If your or your child's skin reacts to the emollient, speak to your GP. They will check to see if you are using enough topical corticosteroids or can prescribe an alternative product.
Some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, they should not be used near a naked flame.
Emollients that are added to your bath can make your bath very slippery, so take care getting in and out of the bath.
As long as you are aware of these hazards, you should be able to use emollients safely.
Topical corticosteroids
When your or your child's skin is red and inflamed from an atopic eczema flare-up, your GP will probably prescribe a topical corticosteroid. Topical means something that is applied directly to your skin. Corticosteroids work by quickly reducing inflammation.
Corticosteroids are any type of medication that contains steroids, a type of natural hormone. Hormones are powerful chemicals that have a wide range of effects on the body. See the Health A-Z topic about Topical corticosteroids for more information.
You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used illegally by bodybuilders and athletes. When used correctly, corticosteroids are a safe and effective treatment for eczema.
Choice of topical corticosteroid
Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema. They can be very mild, such as hydrocortisone, moderate, such as clobetasone butyrate, strong or very strong. Severe cases of atopic eczema will require a stronger corticosteroid than milder cases. You may be prescribed:
- a cream to be used on visible areas, such as the face and hands
- an ointment to be used at night or for more severe flare-ups
If your atopic eczema is moderate to severe, you may need to apply topical corticosteroids between flare-ups, such as at weekends, as well as during them.
If you need to use corticosteroids frequently, see your GP regularly so they can check that the treatment is working effectively and that you are using the right amount.
How to use topical corticosteroids
Apply the treatment sparingly to the affected areas. Always follow the directions on the patient information leaflet that comes with the corticosteroid. This will provide details about how much you should apply, such as the number of fingertip units (see box, above left).
During an atopic eczema flare-up, do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day. To apply the topical corticosteroid:
- Apply your emollient at a different time of the day to the topical corticosteroid, otherwise you will make the corticosteroid inactive or weaker, or spread it to areas where it is not needed.
- Apply a small amount of the topical corticosteroid to the affected area - see the box, above left, for a guide to the amount you should use.
- Use the topical corticosteroid once a day for 5-10 days, or for 5 days if the affected area is on your face or genitals, or in your armpits.
- Apply the treatment for 48 hours after the flare-up has cleared so that the eczema under the skin is treated.
If you or your child are using corticosteroids for a long time, you may be able to apply them less frequently. Your GP will advise you about how often you should apply them.
Speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.
Side effects
Topical corticosteroids may cause a mild burning or stinging feeling as you apply them.
If strong topical corticosteroids are used for too long, they may also cause:
- thinning of the skin, particularly in the crease of the elbow or knee joint
- visible blood vessels, particularly on the cheeks
- acne
- increased hair growth
Generally, using a stronger topical corticosteroid or using a large amount of topical corticosteroid may increase your risk of side effects. For this reason, use the weakest preparation that controls your symptoms well.
Antihistamines
Antihistamines are a type of medicine that stops the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an allergen.
Antihistamines may be prescribed during flare-ups to help you cope with the itching that atopic eczema causes. Antihistamines can be sedating, which cause drowsiness, or non-sedating. See the Health A-Z topic about Antihistamines for more information.
Non-sedating antihistamines
You may be prescribed a non-sedating antihistamine to take once a day for a month if you have severe itching or associated hay fever. If this helps, you may continue taking the non-sedating antihistamine in the long term. You should be reviewed every three months to see if you still need the medication.
These antihistamines may still cause some drowsiness. For example, loratadine can cause drowsiness in 1 in 100 people.
Sedating antihistamines
If your itching affects your sleep, you may be prescribed a sedating antihistamine to reduce the itching at night and improve your sleep. Sedating antihistamines are prescribed on a short-term basis, usually for a maximum of two weeks at a time, as they seem to lose their effect quickly.
You or your child may still feel drowsy the following day, so make sure you let your child's school know that they may not be as alert as normal. If you are taking sedating antihistamines, avoid driving the next day if you still feel drowsy. The sedative effect is likely to be stronger if you drink alcohol.
Oral corticosteroids
In rare cases, if you have a severe flare-up, your GP may prescribe oral corticosteroids. These are also used for flare-ups of asthma. They contain steroids, as topical corticosteroids do, but are swallowed. See the Health A-Z topic about Corticosteroids for more information.
You may be prescribed prednisolone to take once a day, usually in the morning, for one to two weeks.
If oral corticosteroids are taken often or for a long time, they can cause side effects, such as:
For this reason, your GP is unlikely to prescribe oral corticosteroids more than once a year without referring you to a specialist (see referral, below).
Infected eczema
Infected eczema is often sore, very red and oozing with occasional yellow pus spots in it. If your or your child's eczema has become infected, you will usually be prescribed an antibiotic.
Oral antibiotics
If you have an extensive area of infected eczema, your GP may use a swab to take a sample of the skin. A swab is a small piece of absorbent material, such as gauze or cotton, attached to the end of a stick or wire. The sample can then be tested to see what is causing the infection and which antibiotic it will respond to.
You will usually be prescribed an antibiotic to take by mouth. The antibiotic most commonly prescribed is flucloxacillin, which is usually taken four times a day for seven days. If you are allergic to penicillin, you may be prescribed:
- erythromycin - to take four times a day for seven days
- clarithromycin - to take twice a day for seven days
If your infection is severe or does not improve after one week, you may be given antibiotics to take for another week.
Topical antibiotics
If you have a small amount of infected eczema, you will normally be prescribed a topical antibiotic. This medicine, which is an ointment or cream, is applied directly to the affected area of skin.
Topical antibiotics should not be used for longer than two weeks because the bacteria may become resistant to the medication.
If you use topical antibiotics for longer than two weeks, your skin may also become sensitive to the product and become irritated. If your symptoms get worse, stop using the topical antibiotic and return to your GP.
Preventing infections
Once your infection has cleared, your GP will prescribe new supplies of any topical medication or treatments that you use, such as emollients or topical corticosteroids. This is in case your old ones are infected. Once you have received the new supplies, dispose of your old treatments safely.
The most important way to control infection is to control the underlying inflammation with topical corticosteroids. The inflammation causes the bacteria to live in this area of skin and needs to be treated.
If areas of your eczema are prone to infection, you may be prescribed a topical antiseptic. This type of treatment is also applied directly to your affected skin and works by helping to kill bacteria. Commonly prescribed topical antiseptics include chlorhexidine and triclosan.
Referral
In some cases of atopic eczema, your GP may refer you for assessment and treatment by a dermatologist, a specialist in treating skin conditions. Your GP may refer you if:
- Your GP is not sure what type of eczema you have.
- The prescribed treatments are not successfully controlling your eczema.
- You have eczema on your face that is not responding to treatment.
- The eczema is causing significant problems in your daily life, such as disturbing your sleep.
- It is not clear what is causing your eczema.
Further treatments
Some of the treatments a dermatologist may offer you are explained below. These types of treatments are not suitable for everyone, and can only be carried out by experienced skin-care specialists.
Possible treatments include:
- more support on using your treatments correctly - including demonstrations from nurse specialists on how to apply the preparations in adequate quantities
- phototherapy - where your eczema is exposed to ultraviolet (UV) light
- bandaging - where medicated dressings or wet wraps are applied to your skin
- topical calcineurin inhibitors - a type of medicine that reduces inflammation
- an immunosuppressant medication - which suppresses your immune system, the body’s natural defence system
- very strong topical corticosteroids - to treat areas that have not responded to treatment
- psychological support
- alitretinoin (see below)
Alitretinoin
Alitretinoin, sold under the brand name Toctino, is a medication for severe, long-term hand eczema that has not responded to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist and can only be used by people who are 18 years of age or over.
Alitretinoin is a type of medication called a retinoid. Retinoids reduce the levels of irritation and itchiness associated with eczema.
Alitretinoin comes as a capsule that most people are recommended to take once a day for 12-24 weeks.
Alitretinoin should never be taken during pregnancy because it can cause severe birth defects. Also, avoid taking alitretinoin when breastfeeding because the medication can enter your breast milk and harm your baby.
Due to the risk of birth defects, the use of alitretinoin is not recommended for women of child-bearing age. If you are a woman of child-bearing age, you will only be prescribed alitretinoin if you agree to the following strict rules:
- You fully understand why you should not get pregnant and what you need to do to prevent it.
- You agree to use one or preferably two methods of contraception, including a barrier form of contraception, such as condoms.
- You must start using these contraception methods from one month before starting treatment until one month after finishing treatment.
- You agree to have pregnancy tests before, during and after treatment.
- You must confirm that you are aware of the risks and the precautions you need to take, for example by signing a form stating this.
Some common side effects of alitretinoin include:
- headaches
- dry mouth
- a reduced number of red blood cells, known as anaemia
- warm and red skin
- increased levels of fatty substances called cholesterol and triglyceride in the blood
- joint pain or muscle pain
- dry eyes or eye irritation
Uncommon side effects of alitretinoin include nose bleeds and sight problems, such as blurred vision. If you have vision problems, stop treatment immediately and contact your dermatologist.
There have also been reports of people suddenly having thoughts of hurting or killing themselves while taking retinoids, which are related to alitretinoin. However, this has never been reported with alitretinoin.
It may be helpful to tell a close friend or relative that you are taking alitretinoin and ask them to tell you if they notice changes in your behaviour or are worried about the way you are acting. If you have any concerns, let you dermatologist know.
For a full list of side effects, see the patient information leaflet that comes with your medicine or the alitretinoin medicines information above.
Complementary therapies
Some people choose to use complementary therapies to treat atopic eczema, such as food supplements or herbal remedies. Although some people find these therapies helpful, there is a lack of evidence to show that they are effective in treating atopic eczema.
If you are thinking about using a complementary therapy, speak to your GP first to ensure that the therapy is safe for you to use. For example, some herbal treatments can cause serious side effects of the liver and may require blood tests for monitoring. Continue to use any other treatments your GP has prescribed.
