In the United States, eczema is a prevalent and potentially serious condition. Characterized by dry, itchy skin, the most common form of eczema is called atopic dermatitis. The majority of patients can control their condition with basic treatments like a moisturizing routine, but more difficult cases require a combination of lifestyle changes and medication. There is no cure for moderate to severe eczema, but by understanding helpful strategies, patients do have the possibility of maintaining long-term control.
1. Simple lifestyle changes can go a long way.
Even in severe cases, simple steps like taking a cool or warm bath instead of a hot one, as well as keeping your bathing time shorter, can make a big difference in decreasing flare-ups. Cutting out household products containing skin irritants can also ease eczema. Use only fragrance-free laundry detergent, ditch dry, scratchy sheets, and only add fabric softeners in an early wash cycle. Avoid wearing wool or mohair, which are known triggers for many eczema patients, as well as any other rough or scratchy clothing. Check your soap or shampoo for harsh ingredients.
2. Don’t underestimate stress management.
Reducing stress and anxiety is easier said than done, but what you feel on the inside can have an impact on the outside of your skin. For patients with difficult-to-manage eczema, stress can feed into the vicious cycle of worsening symptoms. I recommend finding ways to relax in your daily routine and learning techniques for handling stressful situations when they arise. Getting enough sleep is a big part of achieving this balance, and can thus lead to fewer bad flare-ups.
3. Learn how your diet plays a role in flare-ups.
People with eczema are more likely to have allergic conditions like asthma or hay fever. The same may be true for certain food allergies. We are finding that eczema patients are more likely to be sensitive to milk and dairy products, so talk with your doctor about this possibility. It’s still important to eat a healthy balanced diet, but you might find certain individual foods, like nuts, could make your eczema worse. For extreme cases of eczema, small adjustments like identifying and avoiding trigger foods can make all the difference.
4. Minimize itching and scratching.
For many patients, the symptoms of burning and itching are the worst part of the condition. For patients who really struggle to control itching, I recommend keeping your fingernails short so scratching doesn’t lead to bleeding, as bleeding sores can lead to skin infections. Keeping a regular routine of moisturizing after bathing and before bed is vital to reduce itching. While there are many medications and over-the-counter skin creams and ointments for eczema, something as basic as petroleum jelly can be very effective.
5. Work with your doctor to find a tailored treatment plan.
There is a wide spectrum of treatment options for moderate to severe eczema cases and I recommend that you and your doctor consider your specific triggers when deciding on a plan of action. For many patients, the first line of treatment might be topical corticosteroids—steroidal ointments of varying degrees of strength designed to ease redness and itching. Other oral medications like antihistamines can help reduce itchiness. Remember: medication is one part of a multi-pronged approach to treating hard-to-manage eczema. It shouldn’t take the place of other lifestyle changes like managing stress and adjusting your diet if needed.
6. Ask your doctor about biologics for eczema.
There are several new drugs approved to treat moderate to severe cases of atopic dermatitis, or cases that can’t be managed successfully using topical medications or other treatments. Biologics are highly advanced, injectable drugs that stop the immune system from overreacting to certain irritants, thus easing symptoms of eczema like itchiness and inflammation. For patients who can’t control their eczema with other forms of treatment, I recommend talking to your doctor about the two biologic medications approved for treating eczema: dupilumab (Dupixent) and omalizumab (Xolair).