By: Dr. Dendy Engelman. MD, FACMS, FAAD, RxSaver Medical Expert
More than 31 million people in the United States have some form of eczema, meaning approximately 1 in 10 individuals will develop this red, itchy, and occasionally painful skin condition. Unfortunately, there is no cure for eczema.
However, many treatments may be effective. So, if you notice symptoms in your infant or child, or you begin developing this skin rash, don’t assume the condition will plague you for life. You can successfully manage the symptoms, and likely learn how to prevent flares with the help of a dermatologist. Here are 4 things dermatologists want you to know about eczema management.
What is eczema?
Eczema is a common inflammatory skin condition that presents as red, itchy, dry skin. Most often, the onset of eczema begins in childhood appearing as skin rashes on the front of the elbow and behind the knees. (Contrary to what many people think, rashes which appear on the cheeks of babies are more often an allergic reaction to something they’re coming into contact with, than an onset of eczema). While eczema can develop on the face, it is more likely to first appear elsewhere.
It should be noted that you can develop eczema at any time during life, even though it commonly appears for the first time in children. It’s also worth noting that those who have eczema during childhood may find it goes away as you age.
There are varying levels of severity of eczema, ranging from mildly annoying, to severely painful. Mild forms of childhood eczema may clear up never to return. Conversely, very severe cases can be challenging to control, and incredibly uncomfortable.
What causes eczema?
We haven’t pinpointed a singular cause of eczema, but we do know that it is a manifestation of a defect in proteins in the skin. Normal, healthy, eczema-free skin has a barrier, which locks in moisture, preventing dry, flaky, itchy, red skin.
We also know that those with over-reactive immune responses are more prone to eczema. For example, individuals who also have allergies and asthma frequently also develop eczema. The combination of these three conditions is called the atopic triad.
Finally, there is a genetic component in play, when it comes to eczema. However, eczema is not inherited as frequently as other skin conditions such as psoriasis. It is completely normal for parents who do not have eczema to have a child with the condition, and it is normal for parents with eczema to have a child who does not have it.
What types of medications are available for eczema?
There are a variety of topical, oral, and injectable medications available to help calm or prevent eczema flares. If you or your child has developed a red, itchy, dry, or peeling rash, schedule an in-office or telemedicine appointment with a dermatologist to confirm your diagnosis, and to receive appropriate treatment based on the severity of your eczema.
Topical Creams for Eczema
If you have a mild case of eczema which has appeared on your feet or hands, you may only need to begin with an over-the-counter cream. Please note, you’re going to want to avoid gels or lotions, sticking with thick creams and ointments. Vaseline (petroleum jelly) for example, provides strong moisturization, although many patients don’t love using it. If you are treating eczema on your hands or feet, consider applying petroleum jelly at night and then covering the affected area with gloves or socks, to keep it in place, without ruining your linens.
If you need something stronger than an OTC cream, dermatologists are very comfortable prescribing prescription-strength hydrocortisone creams (AKA steroid creams) for use on the hands and feet.
There are also drug coupon sites, such as RxSaver, which offer coupons that can save you up to 85% on your prescription. The RxSaver price for hydrocortisone cream at major retail pharmacies starts at $4.18. The skin on the face is far more delicate than the hands and feet, so if you’re dealing with eczema on your face, you should avoid using steroid cream. You may be prescribed a topical such as tacrolimus(brand name Protopic) or pimecrolimus (brand name Elidel), which are both steroid-free treatments for eczema. The RxSaver price for tacrolimus at major retail pharmacies starts at $16.54 The RxSaver price for pimecrolimus at major retail pharmacies starts at $189.32
Allergy Medications for Eczema Treatment
Eczema can grow increasingly itchy and bothersome at night, as you’re not distracted by your daily tasks or responsibilities. This can make it challenging to sleep, which is why an antihistamine may help to reduce the histamine load, and make you drowsy, so you can sleep. Some over-the-counter antihistamines that may help you sleep and thereby reduce scratching during the night include Zyrtec, Claritin, Allegra, or Benadryl.
Prescription-strength antihistamines such as levocetirizine (brand name Xyzal), or hydroxyzine hcl(brand name Atarax), may also help reduce itching associated with eczema.
The RxSaver price for levocetirizine at major retail pharmacies starts at $12.47 The RxSaver price for hydroxyzine hcl at major retail pharmacies starts at $11.64
Light Therapy for Eczema
Drug-free UV light therapy to treat eczema is an older treatment for eczema, but for some individuals, it remains an effective treatment. It can be particularly effective if eczema covers large swaths of your body, which would require a great deal of topical medication to treat.
Injectable Eczema Medications
Those who suffer from moderate to severe eczema may benefit from Dupixent injections. Dupixent is the first biologic medication that has been approved by the FDA to treat eczema in adults and children over the age of 6. Dupixent may or may not be covered by your insurance, so be sure to look for manufacturer coupons and programs to help with the cost, if you don’t have insurance, or if your insurance doesn’t cover it.
Misconceptions About Eczema
Individuals who suffer from eczema need to know that having this common skin condition is not your fault. It is not the result of poor hygiene and it also isn’t contagious. You should also know that your eczema flares may go away, sometimes for long periods. If you’re in the middle of a flare, there is no reason to believe it will always be this uncomfortable, so don’t give up hope!
There remains plenty of discussion amongst dermatologists about whether long baths reduce eczema symptoms, or cause them to flare. Some schools of thought hold that taking a long bath should be avoided at all costs, while others believe they can be very hydrating. Although there are differing opinions when it comes to the question of soaking in a tub, all dermatologists agree that if you have eczema you need to moisturize your skin within seconds of getting out of the tub. Immediate hydration can be the key to preventing flares.
Finally, there is no reason that you need to wait for eczema to get really bad before seeing a dermatologist. You also shouldn’t stop using any medicine that is working before you see your dermatologist, just so that they can see how bad your flares can get.
Eczema Self Care Tips
If you have eczema, there are plenty of steps you can take to reduce the incidence of flares. Reducing your stress levels, taking care of your allergies, and using detergents, cosmetics, and creams specifically designed for sensitive skin (fragrance-free) can help.
Likewise, keep an eye out for triggers that cause eczema to flare. To identify your unique triggers, begin tracking your symptoms in a symptom journal, and look for patterns.
- Does your eczema tend to flare up every three months when your quarterly reports are due for work?
- Does it flare when you touch certain materials?
- Does it worsen when you spend time with certain family members?
- For women, does your eczema worsen when you’re getting your period?
By tracking your symptoms, you effectively become your own historian, who can identify triggers and patterns. That way, you can avoid them, or at least be prepared with your medication and treatment, to use as soon as symptoms begin to show.
Hydrocortisone cream: 1% / 1 tube Tacrolimus: 1 mg / 60 capsules Pimecrolimus: 1% / 1 tube Levocetirizine: 5 mg / 30 tablets Hydroxyzine hcl: 25 mg / 60 tablets
*Lowest online price at national pharmacy chains Costco, CVS, RiteAid, Walgreens and Walmart as of 10/7/2020. Prices vary by location and pharmacy, see RxSaver.com for actual pricing in your area.
Dendy Engelman, MD, FACMS, FAAD, is a board-certified and nationally-acclaimed dermatologic surgeon. Widely celebrated for her expertise in neurotoxins, injectable fillers and chemical peels, she provides a wide range of treatments including fat removal, mole excision, Mohs surgery, and skin cancer treatment. She is also a fellow of the American Academy of Dermatology, American Society of Dermatologic Surgery, and American College of Mohs Surgery. She regularly appears as a dermatologic expert on national shows including Good Morning America, TODAY, The Dr. Oz Show, The Doctors, Inside Edition & many more. Dr. Engelman is the Dermatology expert for RxSaver.
