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How to Treat and Prevent Eczema

Dry skin and eczema flares up in the winter. What causes eczema? How do you know if what you have is eczema versus dry skin? And how can you best treat and prevent these dry, irritating conditions?

 

By
Sanaz Majd, MD,
December 8, 2016
Episode #228

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If you’ve ever been to Southern California, you know that the weather can be dry all year round—it is, after all, the desert. Winter is even worse.  Every year around this time, I start to feel akin to a dried up alligator, desperate for the swamp. Needless to say, dry skin is a symptom that many patients also suffer from this season, regardless of their habitat.

You may have heard of a related skin condition called eczema that tends to flare up around this time of year, as well. What is eczema? How do you know if what you have is eczema or simply dry skin? How can you best prevent and treat these dry, irritating skin conditions?

What Is Eczema?

In essence, eczema is extremely dry skin. Think of dry skin severity as a spectrum. On one end is dryness that is mild and not bothersome. And on the other end of the spectrum lies severe, scaling, red, and sometimes crusty and blistering distinct patches. These patches feel dry, irritated, and inflamed. They tend to be very itchy, and not uncommonly contain scratch marks and scabbing within as a result.

The fancy doctor lingo that refers to eczema is termed “atopic dermatitis,” where “derm” refers to the skin, and as I’ve mentioned throughout previous posts, “-itis” reflects inflammation. In this case, “derm” and “-itis” means inflammation of the skin.

And the word “atopic” denotes an allergic type of immune system response. Those with asthma and allergies, which are also immune mediated, have a higher risk of also suffering from eczema. In fact, for some very lucky folks, all three tend to go hand-in-hand.

Most cases of eczema develop before the age of five, and a big genetic component has been found in studies of twins with eczema. Environmental factors, such as changes in temperature, heat, dry environments, and chemical skin exposures can trigger symptoms. There is no good evidence that food allergies cause eczema in any way. Also according to studies, only less than 20% of cases persist beyond childhood.

Affected babies often display eczema patches most commonly on the face. That's precisely why baby mittens are a genius invention ... if only they worked (I tell parents to use socks instead). On the other hand, the face is rarely affected in adults with eczema. Hopefully, socks on the hands will never become a fashion trend for adults. The most common body parts affected in adults are the elbow creases and the back of the knees. But it can occur on the back of the neck, legs, hands, feet, and anywhere on the body.

How to Treat Eczema

Before you give up those aspirations of becoming a skin model, know that treatment does exist for acute flare ups of eczema and depends on the severity. If the dryness is mild, a simple moisturizer applied anywhere from 1 to 3 times a day may do the trick. But for those more severe outbreaks, a little extra prescription help from your doctor may be warranted.

The most commonly used method is a prescription steroid. But sorry Hans and Franz, these steroids will not do a thing to bulk up those muscles. First of all, the most typical treatment is a topical steroid, not oral. And second, these steroids are not the same ones used for body enhancement. Steroid ointments tend to have deeper penetration and improved results over steroid creams or lotions.

Steroid topicals themselves also lie on a spectrum. The least potent is an over-the-counter cream you may already have in your medicine cabinet, called “hydrocortisone,” that comes in both 0.5% and 1% strength. Then there are a multitude of other prescription options with greater potency. Eczema on the hands, feet, and elbows (some of the thickest skin on our bodies) may require the most potent forms. And for areas where the skin is thin, the least potent is prudent. This is because one of the most feared side effects of these steroid topicals is skin thinning, if heavily applied or used for prolonged durations. The typical recommendation is to apply a very thin layer, only on the affected areas, often no more than twice a day and for no longer than two weeks.

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