Treatment:

SKIN CARE AT HOME

Taking care of your skin at home may reduce the need for medications.

Avoid scratching the rash or skin if you can:

• Relieve the itch by using a cold compress and taking antihistamines to reduce severe itching.
• Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.

Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. A humidifier in the home will also help.

Avoid anything that makes your symptoms worse. This may include:

• Foods such as eggs in a very young child (always discuss with your doctor first)
• Irritants such as wool and lanolin
• Strong soaps or detergents, as well as chemicals and solvents
• Sudden changes in body temperature and stress, which may cause sweating and worsen the condition
• Triggers that cause allergy symptoms

When washing or bathing:

• Keep water contact as brief as possible and use less soap than usual. Short, cooler baths are better then long, hot baths.
• Do not scrub or dry the skin too hard or for too long.
• After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.

MEDICATIONS

Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a prescription.

• Some antihistamines can cause sleepiness, but they may help with scratching while sleeping.
• Newer antihistamines cause little or no sleepiness. Some are available over the counter. These medications include fexofenadine (Allegra), loratadine (Claritin, Alavert), and cetirizine (Zyrtec).

Most causes of atopic eczema are treated with medications that are placed directly on the skin or scalp (called topical medicines):

• At first, you will probably be prescribed a mild cortisone (or steroid) cream or ointment. If this doesn't work, you may need a stronger steroid medicine. You may need different strengths of steroids for different areas of skin.
• Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old. TIMs include tacrolimus (protopic) and pimecrolimus (Elidel). Ask your doctor about concerns over a possible cancer risk with the use of these medicines.
• Creams or ointments that contain coal tar or anthralin may be used for thickened areas.
• Barrier repair creams containing ceramides

Other medicines that may be used include:

• Oral or injected corticosteroids when the eczema is severe
• Antibiotic creams or pills if the skin is infected
• Allergy shots (immunotherapy)
• Oral immunosuppressants, such as cyclosporine, methotrexate, or mycophenolate mofetil

Expectations (prognosis):

Eczema is a chronic condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

In children, it often clears beginning around age 5 - 6, but flareups will often occur. In adults, it is generally a long-term or recurring condition.

People with eczema tend to have dry skin that flares up more in the winter, when the air is cold and dry.

Complications:

• Infections of the skin caused by bacteria, fungi, or viruses
• Permanent scars

Calling your health care provider:

Call for an appointment with your health care provider if:

• Eczema does not respond to moisturizers or avoiding allergens
• Symptoms worsen or treatment is ineffective
• You have signs of infection (such as fever, redness, pain)