I’ll piggy-back off of Ariel’s skin care post to talk about atopic dermatitis, more commonly known as eczema. Atopy typically refers to an allergy or hypersensitivity, and dermatitis quite literally means skin inflammation. It is common for people with eczema to also have environmental or food allergies, and/or asthma.
I’m personally invested after developing eczema during my first pregnancy, and trying to get it under control ever since. Both of my children struggle with it as well, and it's been interesting how it’s changed over time.
Eczema is unique in that it can actually be present and itchy before visible. It can appear as dry skin, scaling, redness, oozing, and crusting. It is almost always itchy, and often occurs to the hands and skin folds (inside of elbows, behind the knees, wrists, behind the neck, behind the ears.)
Treatment includes both prevention of flares and minimizing symptoms.
PREVENTION
Emollient cream
-Applied at least daily (but 2-3x/day is better) immediately following baths or showers. Use mild, gentle soaps in the shower like Dove. Avoid scalding, excessively hot showers, which dry the skin.
-It is important to go with a cream over lotion as they are thicker and help the skin retain more moisture. I love Cerave and Cetaphil. Eucerin and Vanicream are excellent as well.
-This can replace or be alternated with emollient cream.
3. Avoiding triggers (allergens, excessive bathing, NOT applying moisturizer after bathing, dry weather conditions, stress, using hard water, exposure to harsh detergents)
-Use hypoallergenic/dye and fragrance-free detergents
-Keep a humidifier running on low in your bedroom especially during winter/dry months
-Limit perfumes, fragranced soaps and lotions
-Wear rubber gloves when exposed to cleaning products and when doing dishes
EXACERBATION TREATMENT
Continue the above in addition to:
Apply over-the-counter hydrocortisone 1% cream to affected areas 2-3x/day
If ineffective you may need to discuss prescription options with your healthcare provider, which may include one or a combination of the following:
Prescription-strength steroid lotions, creams, or ointments (hydrocortisone, triamcinolone, betamethasone, desonide, etc.) *a tiny amount of topical steroids is absorbed into the bloodstream; thus, with very frequent use can cause increased risk for thinning of skin, osteoporosis, diabetes, and adrenal gland suppression*
Eucrisa - this is a non-steroidal topical ointment that blocks an enzyme called PDE4, which can be overactive in stimulating your immune system to cause inflammation to the skin
Allergy treatment with oral antihistamines (Claritin, Allegra, Zyrtec, Xyzal, or Vistaril)
Severe eczema occasionally requires treatment with bleach baths, injection biologic treatments like Dupixent, phototherapy, immune pathway suppressants, treatment of bacterial and fungal infections
MY REGIMEN
Mornings - Luke warm shower (this is my goal, but I do like it HOT HOT HOT), minimally towel off, apply Cetaphil cream all over
I usually only require hydrocortisone cream a few times/month, but this may be more often in the winter time
The same regimen can be used for children, and during pregnancy, but please be sure to limit topical steroid use and seek guidance from you medical provider.
**I also apply Urea 40% cream to my feet before bed to help reduce those ugly foot calluses!**
Typically my patients who have frequent flares are not following at least one of the above :)
I do not recommend steroid use to the face
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