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. Though the specific cause(s) of eczema are unknown, it’s frequently seen in people or families who have allergies, hay fever or asthma. It 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. While there is no cure, there may be a few additional options for treatment that you might want to try.
It sounds like you’re doing a lot already to help lessen the burden of itching and scratching in your life. Applying emollients several times a day, using mild soaps and cleansing products, and avoiding clothing that may irritate your skin are all recommended strategies in the battle against eczema. It also seems like you’ve kept regular dermatology visits to explore possible options for treatment, which is good since it usually involves a good deal of trial and error and every approach will affect each patient differently.
Speaking of trial and error, you mentioned a few treatments you’ve already tried. Corticosteroid creams or ointments applied topically are some of the most effective medications for treating eczema. They vary widely in strength — the first two you name (Hytone or Topicort) are quite mild hydrocortisones, whereas the last treatment you mention (Diprolene) is strong and can potentially be damaging. A possible side effect of topical steroid use is skin atrophy (where the skin gets thin and fragile). This can result from regular use of stronger creams, especially on the face. However, this would be unusual with hydrocortisone. The other possible problem with long-term use is potential ineffectiveness after using it for a while. This can be avoided by using simple emollients (moisturizers) for a week or more, after which the corticosteroid cream may again become effective.
To continue your search for the treatment that works best for you, consider talking with your health care provider about options that you haven’t yet tried. Here are some additional treatment ideas you might want to consider:
- Emollients are moisturizers that can be bought in the form of lotion, ointment, gel, or cream. They keep the skin moist, especially when applied right after getting out of the shower or bath. It’s recommended to use emollients multiple times a day for best results. Because regular soap can dry out the skin, you could also try using emollient soaps if you aren’t already. They don’t foam like regular soap, but they are just as good at cleaning you up! Even after eczema symptoms lessen or disappear, using emollients can prevent symptoms from returning.
- Coconut oil has been shown to ease childhood symptoms of mild to moderate eczema, with one scientific study finding coconut oil more effective than mineral oil (which is often used as an emollient).
- The combination of coal tar and UVB radiation, known as “Goeckerman therapy,” is sometimes used to treat psoriasis and may also be helpful in treating severe cases of eczema.
- Some health care providers may encourage those with eczema to take sedating antihistamines at night, or they may prescribe an antibiotic.
- Bandaging or dressing impacted skin.
- Phototherapy, which consists of exposure to ultraviolet radiation in gradually increasing increments, may also prove to be beneficial.
- A diet that eliminates potentially irritating foods can help some people struggling with eczema. 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.
- Acupuncture, Chinese herbs, and evening primrose oil (applied topically) are other possible treatments. These alternative approaches still require the guidance of a health care provider. For more information on alternative or complementary treatments for eczema, you may want to explore the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine website.
This list may serve as a starting point for exploring additional options with a health care provider. If you are able, consider visiting a nurse practitioner or general practitioner if you’re concerned about the costs of frequently seeing a dermatologist. Those professionals can often assist with mild-to-moderate forms of eczema. Additionally, since stress can exacerbate eczema, you may also consider signing up for a stress reduction/relaxation course or talking one-on-one with a mental health professional about making an individualized plan to cope with stress.
Here’s to less itching and more smiling!Alice!