Eczema

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Eczema (or dermatitis) are terms referring to inflamed skin. There are various symptoms. Commonly there is an itchy red rash, possibly with swollen skin and blisters. Longer standing eczema is also itchy but is often dry and thickened. Either may have scratch marks. About 3 in 10 people who visit their GP with a skin problem are diagnosed with eczema. The number is increasing.

Eczema can look different in different parts of the body and on different skin types. If in doubt about a skin rash consult a GP for advice.

Dr Fox only prescribes for a skin rash that has been previously diagnosed as eczema by a GP or specialist.

Atopic eczema

Atopic eczema - the most common form of eczema - occurs in 'atopic' individuals. This means that they, or a close relation, may also have asthma or hay fever (allergic rhinitis). Atopic eczema can start in childhood, before the age of 1 year. The symptoms can be anything from small patches of minor irritation to a severe rash covering the whole body.

Treatment of eczema

Moisturising emollients

Eczema and other skin conditions are often associated with dry skin. This is linked to an altered barrier function of the skin. There is a lack of protective oils in the skin to keep irritants out, hence the beneficial use of moisturisers. The loss of the barrier function is caused by inflammation and leads to drying of the skin. Dry skin in turn makes the inflammation worse. Moisturising, emollient treatments (lotions, creams, and ointments) can often settle inflammation. Emollients are the most important part of any eczema treatment.

There are numerous dry skin treatments available on prescription from GPs, or in pharmacies. A pharmacist will be able to advise.

See also Why are emollients so important? and NHS: Emollients.

Steroid creams and ointments

Active patches of inflamed skin are usually treated by GPs with topical steroid (creams and ointments). The steroid reduces inflammation, which helps to restore the barrier function of the skin. There are different strengths of steroid. Stronger steroids are used where inflammation is very active and severe.

Dr Fox offers a range of mild to potent strength steroids, as cream or ointment, to treat mild to moderate/severe eczema. More severe eczema, requiring extremely potent steroid treatments, should be managed by a GP or skin specialist (dermatologist). Creams tend to be easier to apply. Ointments are greasier but more moisturising to the skin and are therefore more effective. Ointments may be better applied at night.

After active eczema has been reduced using topical steroid treatments, it can usually be kept under control by keeping the skin hydrated (moist and oily) with emollient moisturisers.

Using these medical moisturisers often prevents flare-ups of eczema and dry skin conditions and can reduce the need to use steroids.

See also NHS: Topical corticosteroids.

Mild, moderate, or severe eczema?

• Mild - some areas of dry skin, occasional itching, small red patches.
• Moderate - areas of dry, thickened skin, itching, redness, scratch marks.
• Severe - large areas of thickened dry skin, constant itching, redness, scratch marks and raw areas, bleeding, mild weeping, cracking, and skin colour changes.
• Very severe - as severe above but more widespread changes, not responding to treatment.
• Infected - weeping, crusted, pus spots, and fever or feeling generally unwell - contact a GP.

Scalp eczema

Scalp eczema is more complicated to treat as it is difficult to use emollients and lotions because of the hair.

Dr Fox recommends using a specialist shampoo such as E45 Dry Scalp shampoo or Capasal shampoo, which can be bought without prescription in a pharmacy.

Itching scalp eczema can be treated with lotion formulations of steroids. They should be applied to the clean and dry scalp, and massaged into the affected skin. It is usually easiest to part the hair in stages and massage the lotion into the skin down the parting. This is easier with an assistant.

The following video relates to similar products being used for psoriasis, but shows the lotion application technique clearly (from 49 seconds):

Video from Guy's and St Thomas' NHS Foundation Trust.

Betamethasone products (Betnovate, Betacap, Diprosone) are usually applied once or twice daily. Elocon is a once daily treatment.

Cautions

Eczema usually comes and goes. Patches of skin inflammation, particularly if new, that do not go after a few weeks or are spreading, may not be eczema. If an inflamed skin patch is not improving, see a GP or skin specialist.

Some moisturisers, especially beauty products, contain antiseptics or perfumes to which some people are sensitive. If the skin stings after using a moisturiser and it does not settle in a half an hour, it is best not to use that moisturiser again.

Paraffin based emollient moisturisers, steroid creams, and ointments are flammable. Clothing and bedding may absorb the product. They should be washed regularly and frequently to reduce fire risk and kept away from naked flames.

Betnovate scalp, Betacap lotion, and Diprosone lotion do not contain paraffin. However the manufacturers still recommend care around use as they are also flammable. It is advised not to blow-dry hair after these products have been used on the scalp.

Use the most effective steroid cream, ointment, or lotion, and use for as short a time as possible, preferably only 2 or 3 days but no longer than 2-4 weeks. Steroid use, including topical steroids, can cause permanent damage and thinning of skin. This is especially important in areas where skin is already thin such as on the face and around the eyes. Only hydrocortisone should be used on the face, not the stronger preparations. Using a stronger steroid for a shorter time on the body is generally better than a long course of a mild steroid.

You must have a confirmed diagnosis of eczema from your GP and have been prescribed steroid creams or ointments in the past to order them from Dr Fox.

Using emollients and moisturisers for eczema

Emollients and moisturisers should be used liberally and frequently to restore the oils and barrier function to the dry and inflamed skin of eczema. They are usually combined as one product in lotions, creams, and ointments, with ointments being the greasiest but most effective. Lotions contain more water and so need more preservative, which may make some skin worse. Soaping, bathing, and showering removes the natural body oils so should be reduced as much as possible. Many emollient moisturisers can be used as soap substitutes in the shower or bath when mixed with water. However they don't lather which can take time to get used to. Some people use emollient bath additives, but these do not replace direct moisturising with an emollient, and can make the bath dangerously slippery.

See also Which emollient should I choose?

Using steroid skin treatments for eczema

Dr Fox prescribes a range of steroids as a cream or ointment from mild to potent strengths. Only two products can be purchased at a time. They should only be used to treat mild to moderate eczema. More severe eczema should be managed by a GP or skin specialist.

It is important to continue using moisturising emollients at the same time. Apply the emollient at least 15 minutes before applying a thin amount of steroid. The recommended amount can be measured in 'fingertip' units. Using more steroid cream or ointment than recommended will increase the risk of side effects.

Apply the steroid cream or ointment according to the instructions (in the patient information leaflet included with the medicine pack) until the eczema has settled. This may only take a couple of days or a bit longer but do not use continuously for more than a few weeks at a time.

Once the eczema has settled, continue applying emollient moisturiser frequently, to reduce the risk of a flare-up and the need to use steroid creams or ointments again.

Topical steroid withdrawal reactions

Although rare, some patients who have been using steroid treatment long-term may have a topical steroid withdrawal reaction. Symptoms include intense redness, stinging, and burning of the skin that can spread beyond the initial treatment area. If these symptoms have been experienced previously on stopping topical steroids, alternative treatments should be considered.

Buy treatment

Dr Fox supplies eczema treatment on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Further information

• FAQs: Eczema
• NHS: Eczema
• NHS: Emollients
• NHS: Topical corticosteroids
• How to use topical steroids (video)
• National Eczema Society - Emollients
• National Eczema Society - Topical steroids

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