Dry skin and eczema help

Originally Published: January 6, 1995 - Last Updated / Reviewed On: May 31, 2012
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Alice:

In a recent question about abnormal hair-growth, the writer mentioned a long history of hydrocortisone use as a means of treating eczema. I too have a long history of severely uncomfortable and troubling eczema. During the worst outbreaks, I have visited several different dermatologists, and all have prescribed topical hydrocortisones, such as Hytone or Topicort, as well as anti-itching pills, such as Atarax. One prescribed Diprolene ointment, which I used for a year, until my next dermatologist dismissively told me it was far too strong and could be damaging.

I would like to know once and for all how damaging the extensive and long-term use of any of these creams is. Please give me one of your straightforward answers; I have been frustrated by the differing views and lack of concern among the dermatologists I have visited. I am tired of being told it is "just eczema." I already use the gentlest cleansing products available, tons of moisturizing cream, rinse all my clothes twice, wear soft fabrics, etc. I am still absolutely tortured by itching, often resorting to scratching at my skin with a hairbrush. The eczema reappears without fail in the same places, even on my face, and is particularly bad after stress periods, when I absolutely cannot control my itching or scratching. Isn't there anyone anywhere doing research on this? Is there anything else I can try? I am not averse to vitamin, holistic, or homeopathic therapies, if there are any. Please help. This is really a very ugly and upsetting problem.

--Helplessly Itchy

Dear Helplessly Itchy,

Eczema (a.k.a., "atopic dermatitis") is a skin disease with red, blistering, oozing, scaly, brownish, thickened, and itchy skin lesions. Eczema runs in families with allergies, such as hay fever or asthma. Eczema causes constant itching in a vicious itch-scratch-rash-itch cycle. Stress, dry skin, environmental temperature and/or humidity changes, bacterial skin infections, and wool and synthetic garments often make the condition worse.

No one knows what causes eczema. There is no cure, but several treatments for eczema are available. It is impossible to know exactly how any one treatment will affect each and every patient. Treatment involves a good deal of trial and error.

Corticosteroid creams or ointments applied topically are the most effective medications known. They vary widely in strength, however (the first two you name are quite mild hydrocortisones, whereas the last treatment you mention is strong and can be damaging). The major hazard of topical steroids is skin atrophy. This results from regular use of stronger creams, especially on the face, but this would be unusual with hydrocortisone. The other problem with long-term use is potential ineffectiveness after a time, which can be avoided by using simple emollients (moisturizers) for a week or more, after which the cream may again become effective.

Emollients, sedating antihistamines at night, antibiotics, bandaging, and avoidance of irritant detergents, clothing, fabrics, perfumes, dyes, and metals, among other things, are other treatments. Phototherapy -- exposure to ultraviolet radiation in gradually increasing increments -- and a diet which eliminates potentially irritating foods can help some people. The most common foods eliminated are nuts, tomatoes, milk, eggs, and cereals. A dermatologist and/or nutritionist may be able to help with this approach. If your eczema continues to bother you, seeing a dermatologist regularly may help.

Acupuncture, Chinese herbs, and evening primrose oil (applied topically) are other possible treatments. For more information on alternative or complementary medicine, contact the Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine at (888) 644-6226, or the American Foundation for Alternative Healthcare, Research, and Development at (914) 794-8181. Since stress can exacerbate eczema, you could sign up for a stress reduction/relaxation course. If you are at Columbia, contact Alice!, Columbia University's Health Education Program, at x4-5453 for schedule information on stress management workshops that are offered during the Fall and Spring semesters.

Alice

P.S.:

Relief from Dry Skin

Dry or sensitive skin can leave many of us itching and scratching, too, especially in the winter. There are some ways, however, to get relief. For one, water dries out skin. Taking shorter showers and baths in warm (not hot) water and patting yourself dry can help. Also, use soaps and moisturizers that won't dry your skin -- look for ones that are hypo-allergenic and unscented, and avoid antibacterial products. In the winter, keep the air in your home moist by using a humidifier or vaporizer, or placing pans of water on the radiator.