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Dry skin and eczema help

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 is a form of dermatitis that weakens the protective barrier of your skin, making you more sensitive to outside elements. Unfortunately, this often leads to a cycle of itching and scratching, which irritates the skin and leads to more itching. While the exact cause of this condition isn’t known, there are a number of factors that may contribute to eczema, such as a compromised immune system, your genetic history, your work and life environment, and stress—as you have noted. There are a variety of ways that you can ameliorate the symptoms—many of which you have mentioned trying—but identifying what it is that may be triggering these flare ups could ultimately be what helps you make the decision of best to treat it. Read on for some prevention and treatment strategies. 

While “eczema” is often used as an umbrella term, there are several types of this condition. It’s worth mentioning that you can have more than one form of eczema at the same time: 

  • Atopic dermatitis: A condition that causes dry, itchy skin as well as rashes. Though flare-ups may become less frequent over time, there is no cure. 
  • Contact dermatitis: A reaction that occurs when an allergen or an irritant touches your skin and causes painful, itchy rashes. 
  • Dyshidrotic eczema: A chronic condition that causes small blisters and dry, itchy skin on the hands, fingers, and feet. 
  • Neurodermatitis: A condition that causes one or more small patches of itchy, dry skin on the body. 
  • Nummular eczema (also known as discoid eczema): A chronic condition that causes raised, round spots on the skin that are often itchy and crusty. 
  • Seborrheic dermatitis: A condition that causes itchy, red, greasy patches on the scalp as well as white or yellow flakes of dandruff. 

Since each person’s eczema can have different triggers, treatment can vary depending on what exactly it is that irritates your skin. While you can’t change your genetics, you might be able to make emotional and environmental changes that can lead to some relief. 

Applying emollients (also known as moisturizers) 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. Short, warm baths also seem to be more effective in reducing symptoms as they are less stressful on the skin than longer, hot baths. Using humidifiers and drinking plenty of water will ensure that you stay hydrated from the inside out. When it comes to emotional triggers, finding healthy ways to manage stress and anxiety can be helpful in preventing flare-ups. It also seems like you’ve kept regular dermatology visits to explore possible options for treatment, which is commendable because managing eczema 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 commonly recommended to treat eczema. They vary widely in strength—for example, out of the ones you mentioned, Hytone is a mild hydrocortisone, whereas Diprolene is strong and can be potentially damaging. Topicort, which is also called Desoximetasone, falls somewhere in the middle with potency ranging from moderate to highly potent. 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 ineffectiveness. This can be avoided by using simple emollients for a week or more, after which the corticosteroid cream may again become effective. 

While eczema cannot be cured, symptoms can often be reduced or kept at bay through other forms of treatment besides the creams that you’ve tried. Some examples include: 

  • Emollients in the form of lotions, ointments, or gels. It’s usually recommended that you apply them right after bathing and continue to use them throughout the day to stay moisturized. Emollient soaps can also be used in place of regular soaps to prevent your skin from getting dry. 
  • Coconut oil. Some studies have shown coconut oil to effectively ease mild to moderate eczema symptoms. 
  • Elimination diets. Cutting out foods that commonly trigger eczema (such as nuts, tomatoes, eggs, milk, and cereals) can potentially reduce symptoms. A dermatologist or a dietitian can provide more information on this approach. 
  • Sedating antihistamines or antibiotics. These medications can help reduce itchiness and help you fall asleep at night. Your dermatologist or primary care provider can provide additional guidance on these medications. 
  • Bandaging the affected skin. This protects the affected skin from the elements. 
  • Phototherapy. This form of treatment involves exposure to ultraviolet radiation in gradually increasing intervals. 
  • Coal tar and UVB radiation. This combination, also known as “Goeckerman therapy”, is often used to treat patients with psoriasis and might be helpful in treating people with severe forms of eczema. 

In addition to these remedies, there are some forms of alternative and complementary medicine that some have used to treat eczema such as acupuncture and certain herbs. However, these approaches have either limited or conflicting evidence when it comes to their efficacy in reducing symptoms. 

If you are able, consider visiting a primary care provider 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 course or talking with a mental health professional about making an individualized plan to cope with stress. Ultimately, being able to identify what triggers your eczema and making the appropriate environmental or emotional changes will set you on the right track for less flare-ups. 

Here’s to less itching and more smiling! 

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Last updated Mar 24, 2023
Originally published Jan 06, 1995

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