Eczema is the name given to red, scaly itchy skin. There are a variety of different types and different causes for eczema. Most people develop patches of eczema as a consequence of their dry sensitive skin type. Other people with normal skin types can get eczema from excessive washing or irritation from harsh chemicals. Some eczemas occur as part of the course of an internal disease or as a reaction to medications. Rarely, eczema occurs as a true allergic reaction from direct skin contact with a specific substance.
All types of eczema will respond to treatment with cortisone creams, lotions or ointments. These products come in a wide range of strengths, from very mild to ultrapotent. One should be careful to avoid overuse of the very strong cortisone creams. Applying a very strong cortisone cream daily to an area of skin for weeks to months can cause permanent damage to that skin, including excessive wrinkling, color changes and appearance of tiny blood vessels. This occurs most easily on thin-skinned areas such as the face, neck, breasts, genital area and creases in the arms and legs. To avoid this side effect, use very strong cortisone creams initially twice daily for 1 to 2 weeks until the eczema clears, then taper their use to only 2 or 3 times per week as needed to keep the eczema in remission. If the eczema flares during maintenance, treatment, then increase use of the cortisone cream to twice daily for several days until the flare is again suppressed. After this, resume the maintenance schedule of only 2 or 3 times per week as needed. If the eczema is completely gone, then stop the cortisone cream altogether.
Many eczemas are chronic and recurrent, related to sensitive skin type. Flares of this kind of eczema can be minimized by practicing good skin care. This includes minimizing bathing as much as possible, washing with soaps or liquid body washes designed for dry sensitive skin (e.g. Cetaphil, Dove, Neutrogena, Oil of Olay and many others). After bathing, pat the skin dry with a towel and then immediately apply thick emollient creams or lotions to lubricate and moisturize the skin surface (e.g. Cetaphil, Eucerin, Dermasil, Moisturel or others). The more dry and sensitive the skin type, the thicker the moisturizer cream needed. Some people may require fairly greasy creams in order to get adequate lubrication to the skin. Regular daily use of such moisturizers after bathing is the single most important thing you can do to help prevent your eczema problem.
In some cases, severe flares of eczema require treatment with internal cortisone in the form of shots or pills. This is reserved for severe cases that are unresponsive to creams or very widespread. While very effective, internal cortisone treatments must be kept to a minimum in order to avoid numerous long-term side effects.
Comfortable cotton clothing will help minimize irritation to the skin. Wool is best avoided. Fragrance-free laundry detergents are helpful and fabric softeners or dryer sheets should be avoided. Cosmetics and lotions applied to the skin should be fragrance-free with minimal preservatives or botanical/vitamin additives. Stick with products labeled hypoallergenic or designed for sensitive skin. Any product that causes itching or irritation upon contact with your skin is best avoided, but realize that when your eczema is active and inflamed almost any product can temporarily worsen itching and irritation, including prescription cortisone creams.
Most people with eczema remain prone to this problem lifelong due to their innate sensitive skin type. However, with proper skin care and regular use of moisturizers and cortisone creams, your eczema should be quite manageable.
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