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Treating atopic eczema in adults
Having eczema (dermatitis) can be challenging. While there is no cure for eczema, the key to keeping it well controlled is to avoid irritants, keep your skin well moisturised, bathe regularly and when needed, use topical (rub-on) steroids.
These photos show skin before and after moisturising.
Avoid irritants (triggers)
Avoid things that make your eczema worse (flare-up). Common irritants (known as triggers) include soap, detergent, wool and heat. Once you know your triggers you can try to avoid them. For example, wear soft cotton and keep room temperatures cool.
Keep your nails short
Scratching leads to inflammation and itching (this is called the itch-scratch cycle). Keeping your nails short will stop you scratching yourself.
Moisturise your skin
The main aim of eczema treatment is to keep your skin moisturised and hydrated.
Moisturising products, known as emollients, are applied directly onto your skin to soften it, relieve dryness, reduce itch and provide a protective barrier for your skin.
Moisturisers are available in creams and ointments. Ointments moisturise your skin better than creams but are also thicker and greasier. Because ointments are greasy, some people like to use a cream during the day and an ointment at night. Moisturisers can also be used for washing as a soap substitute as soaps and bubble bath can make eczema worse.
There are many types of moisturisers so you might want to ask your pharmacist for advice. If you have moderate or severe eczema, talk to your GP.
You can buy moisturisers directly from your pharmacy or get them through prescription from your GP.
Tips on applying a moisturiser:
- Apply two to three times a day or as frequently as needed to keep your skin moist. It's important to use moisturisers all the time, not just when you have symptoms.
- Always wash and dry your hands thoroughly before applying.
- When you apply moisturiser, smooth it onto the skin in the direction that your hair grows.
- Do not rub it in – let your skin absorb the moisturiser on its own.
- Use after a bath or shower. Pat your skin dry and apply moisturiser while your skin is damp.
- Apply to all areas of your body not just the affected areas.
Watch this video on how to apply moisturisers.
Bathe or shower daily
Have a bath or shower every day to help moisturise your skin.
- Limit bathing time to 10 to 15 minutes and try not to have the water too hot as it can dry out and irritate your skin.
- Avoid soap (including liquid soap) as it can dry out your skin. Use soap substitutes such as Sorbolene. You can apply this to your skin before bathing then wash it off. You can buy these without a prescription.
- Avoid using bubble baths, which can be extremely drying and irritating. Instead try bath oils which can hydrate your skin, coating it with a film of oil to trap water in the skin. You can buy bath oils or dissolve a teaspoon of emulsifying ointment under the hot tap.
- If your scalp is affected use a less irritant shampoo such as E45 Dry Scalp Shampoo. T-Gel is a gentle tar shampoo that may help treat dry scalps.
- Avoid hair conditioner as it can cause irritation.
- If you often get infected eczema, it may help to add an antiseptic to the bath such as Oilatum Plus or QV Flare Up. Do not use though more than once a week. These products can be quite expensive. An inexpensive option is a bleach bath. Bleach comes in different strengths. This factsheet tells you how much to use. Do not have a bleach bath more than twice a week.
Topical corticosteroids for more severe eczema
Topical steroids come in creams and ointments and help by reducing inflammation, making your skin less red and itchy. They are applied directly to your skin and come in several different strengths.
Usually, you use stronger strength topical steroid cream (or ointment) on your body and weaker strength on your face and in skin folds. It's important to use the correct strength.
Your doctor will tell you the correct strength to use and for how long, depending on how severe your eczema is and what part of the body it's on.
Use the steroid cream when your skin is red and inflamed and stop using it once the redness settles down. Continue using your moisturiser while using the cream.
How to apply topical steroids:
- Always apply as directed by your doctor or specialised nurse.
- Apply before or after your moisturiser.
- Always wash and dry your hands thoroughly before applying.
- Gently rub it into affected areas only.
- Wash your hands thoroughly after applying.
How much steroid cream to use:
- Generally, use one fingertip unit (FTU). This is a thin line of cream from the last joint of your index finger (the finger next to your thumb) to your fingertip. This is enough to cover an area that is double the size of the palm of your hand.
- Use more cream depending on the part of the body affected. Read more about the FTU and how to use it here.
- Read more about the different types of topical steroids and formulations.
- This video describes the different types of topical steroids and how to apply and use them safely.
- The amount also varies with age – see Treating atopic eczema in children for information about treating a child.
Manage infection
Eczema-prone skin is more likely to get infected and this will make the eczema worse. Infected eczema will not improve with your usual treatments. It can be weepy, crusty or have pus-filled blisters. It can be a small patch or cover a large area of skin.
If you think your eczema is infected, see your doctor as soon as possible. They may prescribe a short treatment with antibiotics, which should clear the infection.
If you get skin infections often, it may help to add an antiseptic into your bath using Oilatum Plus or QV Flare Up. They're quite expensive, an inexpensive option is to have a bleach bath.
If you have showers rather than baths, add a gel like Microshield to your soap substitute twice a week to prevent infections.
Getting help for eczema
Speak to your GP if:
- your eczema is not improving
- you have infected eczema.
If you need to find a general practice team, you can search on this map.
If you have severe eczema that is not responding well to treatment, your GP may refer you to the Christchurch Hospital Dermatology Department, where you will be seen as an outpatient by a doctor who specialises in skin conditions (a dermatologist).
If you prefer, you can pay to see a private dermatologist. Find a private dermatologist on Healthpoint.
Written by HealthInfo clinical advisers. Page created August 2021.
SourcesReview key: HICOD-326084
