How to Treat Eczema

Hello, I am Dr. Neal Schultz, and welcome to DermTV. The real eczema is called atopic dermatitis and we discussed that in another episode. Today, I am going to give you some at home tips on how to control and manage your atopic dermatitis. The most important symptom that people with this type of eczema have is incessant itching; it drives them crazy. When you examine them, you can see scratch marks, especially in the front of the elbow and behind the knee. And the peculiar thing is: while the scratching helps to relieve the itching, it makes it worse, because the more you scratch, the more you further irritate the skin, and the more irritated it gets the more it itches. So, you are essentially in an itch-scratch loop, and you have got to break that loop. The best way to do it, unfortunately, is not with the oral antihistamines; they really do not work very well. And if you use heat to stop the itching, while it feels wonderful for a few minutes, it causes a rebound increase in itching afterwards, so do not use hot water in a shower to stop your itching. The best way to do it is with either cold water or with menthol. With cold water or even better ice cubes, just gently run over the area; it stops the itching immediately without doing any damage. Menthol and mentholated moisturizers like Sarna lotion, S-A-R-N-A, are very good because the menthol causes a cooling sensation and it fools your brain. It fools your brain into forgetting about the itching and all you feel is cooling, and the cooling is much less noxious. One other tip for stopping the itching is just pressure. Rather than scratching, just squeeze the area, but very tightly and firmly, and that can also stop the itching. The next issue that you have to deal with is infection because all of that scratching caused little breaks in the skin and those little breaks create little valleys where bacteria can hide, and also all the inflamed skin is all flaky and scaly and bacteria just love to use that for nutrients and to live there. Whether those bacteria are causing an actual infection, whether they are just living there and making their metabolic byproducts which themselves are irritating to your atopic skin and further causing more itching, you have to stop the bacteria. And that is easily done with over-the-counter antibiotic ointments like bacitracin or Polysporin. We try not to use antibiotics topically that contain neomycin only because the neomycin sometimes causes further sensitization and itching. The next step is to deal with the actual inflammation of the rash and that is best done with just over-the-counter cortisones, 0.5 or 1 percent hydrocortisone, better in an ointment vehicle than in a cream because the skin is so dry. And that brings us to the last part which is the dryness, the flakiness and scaliness. Two ways to approach that: either with occlusive moisturizers like Vaseline, petrolatum, or Aquaphor or else by replacing the lost surface lipids. Lipids are fats, and in this very inflamed skin, the fats that hold these normal cells together is missing. So, we try to use moisturizers that contain ceramides, and ceramides are lipids that need to be restored to the surface of the skin. An example of an over-the-counter product containing ceramides is Atopalm, A-T-O-P-A-L-M, available in pharmacies without a prescription. If all of these measures do not succeed in giving you some relief from your itching and from the eczema, then of course your are going to see your dermatologist who will either give you prescription strength cortisone, oral antibiotics or topical immunomodulators like Elidel or Protopic, all of which at prescription strength will surely bring your eczema under control. Please join me again at DermTv.com. If you have a question, please send it to me by visiting: DermTv.com/question. I am Dr. Neal Schultz, and thank you for watching today.