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The Key to Managing Chronic Eczema

Brandith Irwin, MD - Blogs
By Brandith Irwin, MDBoard-certified dermatologistMarch 16, 2017
From the WebMD Archives

Your skin is an amazing organ: It has a very capable barrier function, a good blood supply to call in nutrients, and the ability to repair itself. It has its own local immune surveillance system, a support system with collagen, elastic fibers, etc. (like a scaffolding on a construction site), and its own system of nerves.

But sometimes that brilliant design is disrupted, and problems, like chronic eczema, emerge. One of the most common causes of chronic eczema is genetics – some people have genes that cause alterations in the skin’s barrier properties and immune functions, which makes them more likely to get eczema, grow certain bacteria, and have ongoing problems. Chronic eczema is also caused by the environmental irritations – friction, chemicals in soaps and skincare products, cold or dry weather, etc. And, believe it or not, eczema is often made chronic by the very the medications, especially creams and antibiotics, that doctors give patients to try to treat the problem.

Treatments Sometime Backfire

While the oft-recommended steroid creams do have an anti-inflammatory function, if used more than 2-3 weeks, they start to inhibit collagen production, impair the skin’s natural immune functions, and decrease cell turnover (which, over time, leads to thinner and more susceptible skin). And antibiotics, while sometimes necessary when eczema leads to infection, alter and impair the natural “biome” on the skin, robbing it of all the good microorganisms (which are protective).

So, these treatments meant to help your eczema can actually make your skin thinner, more susceptible to friction, more susceptible to bacteria, and less able to mount its own immune response and natural anti-inflammatory activity.

Focus on Restoring Skin Health Instead

So rather than get stuck in the endless cycle of eczema and infections where relapse occurs as soon as treatment is stopped, what you really need to do is restore the health of your skin. When eczema has been present for a long time, building up the skin’s natural defenses will take a while. It is a slow process, usually taking 2-4 months – but it’s worth it. Here are some ways you can start:

  • First rule of protecting “broken” skin: moisturize!! Literally, 20-30 times a day at first. Of course, what you moisturize with is important. Try to find a “body or hand cream” that is quite thick (not thin), convenient, not too expensive, as chemical-free as possible, and really feels good on your skin. Some of our patients do fine with Vanicream (not the lotion) or CeraVe cream, some Shea butter, or things like the L’Occitane hand cream with Shea butter (but has fragrance), or olive oil creams. (see Dr. Irwin’s glossary of skincare ingredients).
  • Remember that even natural skin creams can have irritating things in them. Some of the natural creams have plant extracts that can cause problems, as people with eczema often have allergies to plants and pollens. Try some different ones to find one you love and tolerate well (no stinging, burning, itching etc.).
  • If you have hand eczema, every time your hands touch water, you must re-moisturize.
  • Absolutely no commercial soaps ever! Not even once a month. You cannot use the soaps in hotels, airplanes, airports, movie theaters, offices etc. Carry a small bottle of your own cleanser with you or just use water.
  • Learn to read the basics of labels. Many prescription creams for eczema have awful chemicals in them. Avoid propylene glycol, synthetic fragrances, preservatives (as much as possible), and lanolin/wool wax alcohol for starters. Creams with very short lists are better than creams with long lists. Avoid “natural” creams with a lot of plant extracts in them.
  • If you’ve been using a steroid cream longer than about 3 weeks, you can’t just “cold turkey” off it. You have to gradually wean your skin off its addiction so the skin’ natural processes can gradually take over. This takes about 2 months. If you’ve been using the steroid cream daily, start by diluting it to half strength with cream and still using it daily. In 1 -2 weeks, if your skin is doing well, go down to every other day for 2 weeks, then 2 times a week for two weeks, then once a week for two weeks and then off. Wean slowly –  you get the idea!
  • To get away from antibiotics, consider using treatments with antibacterial properties instead. Try using a silver gel daily; if it burns or stings or is too drying, stop using it. You can also try Hibiclens (a gentle antiseptic liquid) available at the pharmacy. You’ll gradually need less oral antibiotics as your skin gets healthier.
  • Take a probiotic daily (a good quality one is usually refrigerated).
  • If you suddenly have a flare-up, try to identify what caused it. Inadvertently used a commercial soap? Ate a triggering food? Feeling emotional or stressed? Also, consider allergy testing with an allergist and allergy “patch” testing with a dermatologist.
  • If you have a bad flare-up, try to use the steroid cream for only 5-7 days and then start the taper again. The goal is to be off them in 3-4 weeks.
  • Your eczema may be caused by foods. Until your eczema is healed, try to avoid acidic foods like all citrus, including lemons, tomatoes etc. Get a list of acidic foods online. You may need to experiment to determine the specific culprit, but go off everything first for 2 weeks and then slowly add foods back one at a time, about 2 weeks apart.
  • Eat a healthy diet with lots of veggies, whole grains, and clean proteins. Avoid sugar, processed anything, white flour, too much bread, pastry, pasta, alcohol (moderation is fine), too much salt. Skin is an organ, and it can’t be healthy if we aren’t.
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About the Author
Brandith Irwin, MD

Brandith Irwin, MD, is a board certified dermatologist and founder of Madison Skin & Laser Center in Seattle, Washington. She is also Co-Founder of SkinTour.com a website focused on accurate consumer education on nonsurgical, aesthetic procedures and products. Through her books and website, Dr. Irwin is dedicated to educating people about skin care in the context of a global conversation about beauty, self-esteem and inclusiveness.

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