Eczema Treatment Utah County
Common symptoms of eczema include patches of dry and red skin that can be extremely itchy and that worsen when scratched. It is common for the itchy sensation to appear before the rash. Dr. Myers is experienced in diagnosing and treating this common issue.
What is eczema?
Atopic Dermatitis or Atopic Eczema (the most common form of eczema) is a skin condition that is caused by barrier defects in the outer layer of the skin. Healthy skin contains natural substances such as ceramides and lipids that help keep in moisture. In eczema patients, these natural substances are missing or are found in lower quantities. This causes the barrier to be impaired. An impaired skin barrier increases water loss from the body that can dry out the skin. Since the skin barrier is defective, it allows external factors such as soaps, clothing, or weather to irritate the skin. The body can also create immune responses to potential allergens from the environment (such as pollens, dust, pet dander, bacteria, etc.) that get on the skin.
The immune response to these allergens is the symptoms commonly associated with eczema, including patches of dry and red skin that can be extremely itchy and that worsen when scratched. It is common for the itchy sensation to appear before the rash, and in fact, eczema is often called “the itch that rashes”. If the affected skin is repeatedly scratched, the patch may become crusty or ooze. Atopic Eczema commonly affects children, but it can continue into adulthood or start later in life. Eczema usually starts in infancy from the ages of 2 months to 12 months. While eczema is not contagious, it is hereditary. The severity of eczema ranges from mild to severe. Treatment differs on the degree of eczema.
What treatments are available?
Unfortunately there is no “magic cure” for treating eczema. However, treatment can greatly relieve the skin and prevent further breakouts. The best way to treat eczema is to heal the skin barrier and decrease the inflammation. To do this, Dr. Myers often uses a combination of healing moisturizer creams and steroidal creams. Topical corticosteroids are commonly used to decrease redness, inflammation, and itchiness associated with eczema. They work by decreasing the overactive immune reaction in the skin. Topical corticosteroids range from weak over the counter hydrocortisone to stronger prescription strength steroids. Often a patient will use a topical corticosteroid for a few days, then when the rash has improved, they stop the medication and inevitably the rash returns. The reason for this is that the topical steroid only treats the symptoms of eczema. What is missing is a long term plan to heal the skin barrier. That is why Dr. Myers combines corticosteroids with a topical healing cream (Cerave, Curel, etc.). These healing creams contain the naturally occurring ceramides and lipids that the skin needs to be repaired. These creams alone could help improve eczema symptoms, but would take much longer without being combined with a corticosteroid to quickly reduce inflammation and itchiness. This combination effectively treats the symptoms of eczema, as well as the underlying problem.
When a patient’s eczema is improving (eczema is light or gone), the transition to a lighter eczema treatment is recommended. The treatment is not combined with a corticosteroid and, instead, a thicker lotion is used. We often suggest Cetaphil Restoraderm, Aveeno Eczema, or any thick lotion (often called “intensive care”, “maximum strength”, or “extra dry”). Lotions are often preferred because they are less thick and absorb faster. These are best used as maintenance since they can “burn” if eczema is broken open such as in moderate or severe eczema. Newer eczema lotions with hydrating repair factors like ceramides and lipids are good lotion options. It is still important to apply these products after bathing, showering, or swimming to prevent the wet to dry cycle. Note: any lotion or moisturizer can be used. Lotions aren’t as strong as the steroid/cream combo, so return to using these more potent treatments liberally if flaring with moderate to severe eczema.
To help ease the discomfort eczema causes, a patient can use wet wraps at home. Wet wraps are done to decrease the inflammation in the skin, hydrate, and provide a cooling effect to the skin, as well as to prevent scratching. First, hydrate the skin by soaking in warm bath water for 5-15 minutes. After the bath, pat off excess water from the skin and apply the prescribed cream or cream/cortisone combo to the damp skin. This should be done within 1-3 minutes after soaking. Immediately after the medicine is applied to the skin, put on the moistened, 100% cotton, tightly fitted, long underwear (or pajamas). The long underwear should be immersed in warm water, wrung out, and put in drier for a few minutes so that it is damp but not dripping wet. It is important that this layer holds the moisture for 2-6 hours. If it begins to dry out, wet it again (optional). Next, apply a dry, 100% cotton sweatsuit (or for children pajamas) over the moistened layer. This layer is to prevent the wet layer from drying out and also helps keep the patient warm. If hands or feet are involved, use damp white cotton socks for the feet and damp Dermpak® gauze or other cotton gloves for the hands. You may buy the gloves at a drugstore. If, while wearing the wet wraps, the patient becomes chilled, use extra blankets for warmth.
One crucial step in eczema care is to minimize the wet to dry cycle. The repeated drying of the skin after getting wet can dry out and inflame the skin, allowing eczema to return. That is why it is important to trap in moisture after bathing, showering, or swimming. Dr. Myers recommends applying the combination product right after every shower/bath or after swimming while the skin is still slightly wet. This locks in the moisture and breaks the wet to dry cycle that can cause skin problems.
For itch, antihistamines can be helpful as a part of the regimen of eczema treatment: Claritin (loratadine), Allegra (fexofenadine), or Zyrtec (cetirizine) are non-sedating antihistamines that decrease histamine (cause of itch). These are over the counter and have a wonderful safety record. Sometimes, repeated scratching opens up the skin and makes it susceptible to bacterial infections. If Dr. Myers determines a skin infection is present, antibiotics can be used to treat the infection. Swimming or “swimming pool baths” can help to control the amount of bacteria on the skin (possibly reducing the need for antibiotics) and can reduce the severity of eczema flares. Depending on the particular case, other medications may be advised; phototherapy or other treatment procedures can be utilized if needed.
Dr. David Myers
Dr. David Myers is a board certified dermatologist and Fellow of the American Society for Mohs Surgery. His expertise and attention to detail make him a trusted doctor in his community.