Treatment

When eczema symptoms appear, quick and effective treatment is necessary. The skin can be treated directly with emollients, which are moisturizers that soothe and hydrate the skin, a course of tablets can be prescribed, or the person can be treated with ultraviolet light. In addition to these treatments, basic skin care is essential.

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Localized treatment

Localized treatment refers to treatment with a liquid solution (alcohol-based or gels), creams or salves. Salves are thicker than creams and are, therefore, more difficult to apply. If you have dry eczema, salves are usually the most effective treatment, whereas with wet or weepy eczema, creams or lotions are preferable.

Moisturizing creams

In people who have eczema, the horny layer of the skin (the outer skin layer of the epidermis) becomes dry and flaky patches and cracks appear. The horny skin layer is made up mostly of water and various lipids (fats). The skin’s moisture levels can be restored by using a moisturizing cream. It is important that the moisturizer has a high fat content (lipids), as this is more effective for eczema treatment than moisturizers with a low fat content. It is also important to choose a moisturizer that you find pleasant to use, as this will help you to remember to apply it throughout the day. If you have eczema, you should choose an unperfumed moisturizer to avoid any possible allergies developing. Almost all creams/salves contain preservatives in order to limit the growth of bacteria and fungi. If you are allergic to preservatives, it is important to make sure that the moisturizer you choose does not contain the preservatives which cause your allergy. The product’s list of ingredients will show the preservatives added. Emollients, or moisturizers, are an important part of eczema treatment, and although these products can be bought without a doctor’s prescription, it is advisable to ask your doctor or dermatologist which cream is best for you.

Adrenal cortical steroid/hormone cream

Adrenal cortical steroid, or hormone, cream has long been the cornerstone of eczema treatment. The cream has been on the market since the mid-1960s, and this means that both its effects and side effects are well known.

Adrenal cortical steroid cream is extremely effective in treating eczema; often, it can bring an eczema flare-up under control in just a few days. However, in most cases, treatment should continue for several weeks, and when the eczema has healed, use of the cream should be slowly reduced to avoid having any early relapses.

For example, if you have used the cream twice a day for a week, it is usual to reduce this to once a day for a week, eventually cutting down treatment to every other day. Long-term maintenance treatment spanning months should be discussed with your doctor – this is particularly relevant if you have hand eczema.

Adrenal cortical steroid, or hormone, cream comes in four strengths (group 1-4). Group 1 is a mild steroid cream that can be bought without a doctor’s prescription. This cream is used mostly for children and for adults wanting a mild cream for the face. In most cases it is not effective enough to treat hand eczema in adults. At the other end of the spectrum is the Group 4 cream, which although particularly effective, can quickly cause side effects. Which group of adrenal cortical steroid cream a person should use depends partly on the person’s age, inasmuch as children should usually be treated with a milder cream than adults, and partly on which area of the body needs treatment. Eczema on the face requires a milder cream than eczema on other areas of the body. Similarly, different creams might be used for the hands, as the skin on the backs of the hands is more sensitive than that on the palms.
Treatment with a strong steroid cream is often well tolerated on the palms of the hands, but if the same cream is used on the backs of the hands, side effects develop quickly.

The main side effect from treatment with adrenal cortical steroid cream is that the skin becomes thin and transparent. The change can be seen immediately but will gradually disappear when treatment stops. If only small areas are treated (e.g. eczema on the face, hands or feet) the amount of adrenal cortical hormone absorbed by the body is negligible and side effects are unlikely to occur. If large areas of the body are treated, the hormone can be absorbed through the skin; however, large amounts must be used before side effects develop. Despite the possible side effects, adrenal cortical steroid cream or salve is still an important and effective treatment for eczema. It is sometimes necessary to continue this treatment for long periods; if this is the case, a treatment plan should be discussed with a doctor or dermatologist.

Tacrolimus and pimecrolimus

In 2002, two new medicinal products for eczema treatment were launched on the Danish market, namely protopic salve (tacrolimus) and elidel cream (pimecrolimus). Both products suppress the skin’s immune system locally and are effective in treating atopic eczema (childhood eczema).

The products do not have the same side effects as adrenal cortical steroid cream and are well-suited for long-term use. The role these products play in the treatment of contact eczema and other forms of eczema (apart from atopic eczema) is, as yet, unclear. At present, it is only in Denmark where the products are registered as treatments for atopic eczema.

Treatment with tar preparations

Tar has a long tradition as a treatment for eczema. Tar is suitable for treating long-term dry, flaky eczema. However, the treatment presents difficulties as the tar smells and rubs off on clothing etc. For these reason its use is declining.

Light treatment

Ultraviolet light (UVB or UVA) therapy is effective treatment for long-term eczema that cannot be managed with localized treatment alone. Ultraviolet light therapy is given at a dermatology clinic or at hospitals in their dermatology departments.

Treatment with tablets

A course of treatment with tablets may be necessary if the eczema is so severe that it cannot be managed with localized treatment with creams or salves alone. If the eczema is acute, treatment with adrenal cortical steroid cream is usually very effective. This treatment will typically last for several weeks until the eczema heals. Prolonged systematic use of steroid creams may, however, cause a number of side effects; for this reason long-term use of steroid creams is unusual. There are a number of other medications that influence the immune system and which are better suited to long-term treatment of severe eczema. If long-term treatment is necessary, seek the help of a dermatologist, who will be able to give advice and information about the different medications in relation to the individual eczema patient.