ALLERGIES
How do you treat eczema?
Posted Tue, 30 May 2000

• Avoid precipitating factors - the most important step in managing eczema is to identify possible "trigger" factors. Stress management may be useful if stress is a factor. Various foodstuffs may be removed from the diet.

• Corticosteroids - these remain the main treatment of atopic eczema. Doctors usually try to find the least potent steroid cream which will control symptoms. Only very mild steroid creams - 1% strength - should be used on the face and in young children. Sometimes strong steroids need to be used to control particularly bad exacerbations, but should only be used for short periods, and never on the face. Topical steroids come in different formulations, either creams or ointments. Creams are often preferred because they are less messy, but ointments are often better because they help dry skin. Creams can actually dry the skin out, which can make eczema worse.

• Tar - is a traditional treatment for atopic eczema and is safer than corticosteroids. Pastes containing tar are applied under light bandages. The problems are an unpleasant smell, and the possibility that dry skin may be irritated.

• Moisturising preparations - also called emolients, are an essential part of treatment, as they help to lubricate dry skin. They should be used as a soap substitute, in the bath, or applied to the whole body while still wet from the bath. The choice of ointments or creams is a personal one. Ointments are often more effective, but are messy because they are greasy. Creams such as aqueous cream and E45® are less greasy, but need to be applied more often.

• Evening primrose oil - is a controversial treatment. Some people believe that it is of no value at all, while others are convinced that it helps. Evening primrose oil capsules are expensive, and people need to take eight to 12 each day for six weeks to see whether or not it is working.

• Treating infection - is important in controlling eczema, either with oral antibiotics, or antibiotic/antiseptic lotions.

• Chinese herbs - are popular, but problematic because it is not clear what is in them. There are reports of excellent responses, but equally, some have been found to contain steroids. There have also been reports of kidney damage in people using these preparations, even when they are used according to instructions. However, there is collaboration between Western dermatologists and Chinese practitioners to attempt to create a standardised preparation based on some of the most frequently used herbs.

Most people will respond to the simple treatments outlined. However, some people have eczema which is severe and widespread and defies all conventional treatment. These unfortunate individuals need to see a dermatologist since they may need to be treated in hospital, or with highly specialised forms of treatment such as UV therapy or immunosupressive drugs.