By Professor Hywel Williams, Nottingham University, 1st September 2011
1. Treat skin inflammation with topical corticosteroids Many people think that topical corticosteroids cause damage to the skin, and therefore avoid using them altogether, or use them in tiny inadequate quantities. Whilst it is true that these anti-inflammatory creams can thin the skin if the wrong one (eg very strong) is used in the wrong place (eg centre of the face) for too long (eg 1 year continuously), they are very safe when used properly. It is very difficult to control skin inflammation (redness and itching and flaking) with just moisturisers alone.
2. Learn more about your topical corticosteroids Learn more about the different strengths of topical corticosteroid preparations from your doctor – stronger ones may be needed for the body and limbs, and weaker ones for the face. Scalp preparations are also available. Use a cream/ointment that works for you. Use it for a few days at a time rather than whenever you feel like it, so that the eczema under the skin is also treated. Always build in a break period of a few days rather than use them continuously. That way, it is very unlikely that you will develop any side effects.
3. Moisturise regularly Keeping your skin moist with a good moisturises is important, especially in between a flare up. Regular use of a moisturiser (emollient) helps to prevent flares and protect the skin from cracking. Take time to look after your skin daily even when it does not look red.
4. Find a moisturiser that you like Many moisturisers and emollients are now available through the NHS or over the counter. Try a few until you find one or two that you like. Sometimes a thinner cream is nicer for the face, whereas a thicker one is better for the body and during winter. Find one that is fragrance free. Recent research has shown that aqueous cream may irritate the skin. The best time to moisturise your skin is just after you have got out of the bath or shower.
5. Avoid soaps and bubble bath Soaps and detergents can take away too much protective oil from your skin. Instead, use soap substitutes such as cream moisturisers or thicker emollients mixed with water. Recent research has shown that water softeners do not help eczema, so there is no need to shell out for one unless you want one for protecting your water appliances.
6. Protect your skin Wearing gloves for washing up or for outdoor gardening or working on the car is important to protect your hands from repeated damage. Used oversized rubber gloves with cotton liners for wet work if rubber ones make your skin more itchy and sweaty. Cotton gloves are usually fine in the garden.
7. After swimming Swimming is good for you, but the combination of water and chlorine can irritate and dry out your skin. Put plenty of moisturiser on your skin before you go swimming and again after you have dried off after the shower. Put the moisturiser on at the pool rather than wait to get home, but which time your skin has dried out again.
8. Come to terms with the condition Get used to the idea that there is no single "allergic" cause. Eczema is a combination of inherited factors combined with various things in the environment that can bring out eczema. Sometimes these things are allergic, such as dust, pollen and certain foods, and a lot of the time, they are non-allergic such as irritation from soap, wool clothing and changes in weather.
9. Watch out for skin infections Sometimes, the skin of people with eczema becomes infected. The skin may become sore, red and oozy and may develop pus spots. If this happens, you may need antibiotics from your doctor. Sometimes, the cold sore virus can spread rapidly on eczematous skin – see your doctor urgently if you think a cold sore has spread on your eczema.
10. Don't put up with terrible eczema Plenty of good advice is available from your local doctor or skin specialist. Lots of additional treatments are available for people whose eczema that does not seem to respond to usual first line treatment.
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