If you have atopic dermatitis, you have sensitive skin and mucous membranes that easily react with eczema. Atopic skin is particularly dry and microscopically cracked. This allows irritants and allergens in our environment, such as perfume, soap, preservatives, etc., to penetrate the skin more easily and cause eczema. It is therefore important to regularly moisturize the skin to maintain an intact skin barrier, which protects us against all the irritants and allergens present in our surroundings.
You should use moisturizer regularly and always after bathing or showering. When you have active eczema, you should apply a rich moisturizer every morning and evening, or more frequently as needed. It is also important to continue moisturizing during periods of remission to maintain an intact skin barrier and prevent the recurrence of eczema.
To succeed with your moisturizing treatment, it is essential that you find a cream you like, preferably in a pump bottle. Pump bottles make the application easier, especially in a busy everyday life.
Some people love rich creams, while others dislike them. Pharmacies offer creams in all variations, from lightweight lotions to very rich creams, often referred to as balms. Some moisturizers also have soothing and itch-relieving effects.
You should not shower too often or for too long, and especially avoid very hot water. Water, especially hot water, reduces the normal lipid layer on the skin, leading to increased dryness.
Soap also dries out the skin. We recommend using a shower oil, cleansing cream, or mild soaps with a pH below 5.5 instead. Oil baths can also be used when needed. After bathing or showering, pat the skin dry instead of rubbing it with a towel.
A 15-minute wheat bran bath can provide relief from itch. Take a few handfuls of wheat bran in a cloth bag and place the bag in a pot of warm water. Then mix the solution into the bathwater. Alternatively, you can let the bag steep directly in the bathwater. You can read more about dry skin.
If your eczema becomes moist and crusty, it is often due to secondary infection. This is more likely to occur with atopic dermatitis because the skin is dry, and the skin barrier is no longer intact. Bacteria, which are normally present on our skin, can more easily penetrate the skin and cause inflammation. Good hygiene helps prevent this.
If there are signs of secondary infection, you can apply an over-the-counter antimicrobial cream, which can be purchased at the pharmacy. This can be combined with cortisone creams. There are also combination creams available by prescription that have both cortisone and antimicrobial effects.
For pronounced secondary infection, potassium permanganate baths or compresses can be used. Potassium permanganate can be purchased over-the-counter at the pharmacy and should be mixed at a ratio of 1 part potassium permanganate to 9 parts water. Baths or compresses should be used for approximately 15 minutes daily until the infection subsides.
Note: Be aware that potassium permanganate can stain bathtubs, skin, and clothing.
Sunlight and light therapy can help reduce inflammation in the skin and may be beneficial for all types of eczema. Very dry indoor climate, cold weather, sweating, wet work, wet gloves, pets, and more can worsen eczema.
It is recommended to wear clothing made of natural materials such as cotton or silk rather than synthetic materials. Synthetic materials do not breathe well and can make you more prone to sweating and feeling clammy, which can exacerbate eczema.
The bedroom should be kept cool and should be off-limits to any pets.
Hydrocortisone is a mild cortisone cream (group I) and works well on areas with thin skin, in children, or for mild eczema conditions.
Your doctor may prescribe other and stronger cortisone creams as needed. Cortisone creams are available in creams, ointments, lotions, and solutions in four different strengths (group I-IV). Your doctor will determine what you need based on the extent, location, age, and severity of your eczema. There are also immunosuppressive creams/ointments that can be used as an alternative to cortisone creams, corresponding to group I and II cortisone creams.
When applying cortisone cream, apply it in the same way you would apply a moisturizer and massage it well into the affected areas. It is okay if you accidentally apply cortisone cream on healthy skin. As ageneral rule, you should apply it every evening until the eczema improves (e.g., 1-3 weeks) and then gradually reduce to twice a week for maintenance treatment. This applies to chronic eczema that keeps recurring. In this case, you can adjust the treatment up or down as needed and continue with twice-weekly maintenance treatment during good periods. On other evenings, use a good moisturizer, such as Canoderm. It may also be beneficial to apply moisturizer approximately 10 minutes after applying cortisone cream.
