Eczema is an inflammatory skin condition that can affect up to 10% of the adult population in the UK. There is a genetic predisposition to the disease and there is a strong association with asthma and hay fever.
Flare-ups of this extremely itchy, chronic inflammatory condition can occur up to 3 times a month. Immune dysfunction is thought to play a significant role in the disease and eczema is often exacerbated by certain allergens. The immune system is responsible for the cellular responses that occur when the person is exposed to allergens.
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What can Make Eczema Worse?
Flare-ups of eczema can be exacerbated by secondary bacterial infections which are often caused by a bacteria called staphylococcus aureus. This can lead to an inflamed crusting, weeping and painful areas of skin. On rare occasions eczema can be infected by a virus called herpes simplex (the cold sore virus). This is a serious, rapidly worsening skin condition, which will invariably lead to hospital admission.
How to Treat Eczema
Treatment of eczema is first of all the use of regular emollients or moisturisers. After continuous regular use of emollients i.e. up to 4 to 6 times a day then the addition of a steroid cream or ointment should be considered for areas of resistant eczema.
Occasionally it is worth taking a skin swab from areas of stubborn eczema as this may elude to a superadded bacterial infection. In these cases an appropriate oral antibiotic, for example, flucloxacillin or clarithromycin (for those patients allergic to penicillin) can be prescribed for 5 to 7 days. This course of antibiotics is used in conjunction with the emollients and steroid preparations.
Occasionally we may prescribe a cream containing a combination of a steroid and an antibiotic, for example, Fucibet or Fucidin H cream.
In addition to topical applications (creams and ointments) and antibiotics, the itching associated with eczema may be relieved by an antihistamine. Antihistamines are available in tablet, capsule and liquid forms. Antihistamines commonly include chlorphenamine and fexofenadine. Note that antihistamines can cause drowsiness and it is important to consider this, especially if driving or operating machinery, and when the medicine is to be used for a child. When used in children, drowsiness can affect their concentration. Therefore, if antihistamines are needed, general recommendations may be to consider suitable medicines that cause least drowsiness and limit the number of doses during school-time if possible. Trusted Treatments does not offer any remote services for children and we recommend that if a child has eczema that their GP is consulted when flare-ups occur.
Patients that do not improve with regular emollients and the use of steroid creams may require referral to a dermatologist for the consideration of immune modulating drugs.
There can be a number of trigger factors that may be identified that contribute to the development and a continuation of the symptoms of eczema. These triggers might may include certain foodstuffs, for example, milk, eggs, wheat, soya and peanuts. Stress has also been known to cause flare-ups of eczema.
The Fingertip Unit
The quantity of emollient necessary to treat eczema could be in excess of 500g per week and is often required to be used 4 to 6 times per day. When using steroid creams or ointments, we are often told to apply them sparingly. The definition of sparingly was described beautifully by a Professor Finlay of Cardiff University. Professor Finlay stated that one fingertip unit (FTU) of a cream or ointment is the amount squeezed from a tube from the tip of the index finger to the first crease of the same finger. This fingertip unit is the amount of cream or ointment needed to cover an area the size of two hand prints. The fingertip unit (FTU) is usually equivocal to 0.5g of cream or ointment.
- There are a variety of emollients on the market and the best emollient is the one that the patient is more than happy to use
- Aqueous cream is no longer recommended for use as an emollient
- Emollients should be used before and after washing and can be used as a soap substitute
- Using tubes of creams is preferable to pots - this avoids contamination, which can be caused by dipping unclean fingers into pots
When using steroid creams or ointments, we always try to use a step-down approach as the condition improves. That is to say that we move from potent steroids to moderate or mild strength products.
Trusted Treatments is the online clinic that is accessible 24 hours a day. If you would like a clinician to offer you a range of treatment options for eczema, complete an online consultation for eczema today.
This resource has been last edited on 14th June 2021 by: Richard Neilson MPharm MBA MRPharmS MCIM.
This resource has been reviewed by: Pending Review.
If your condition or symptoms require urgent treatment, please call NHS 111 by dialling 111 on your telephone. If you require emergency treatment, for example, if you or someone else has chest pain, has received an injury to the head, or has been involved in a serious accident, call 999 on your telephone immediately. If your condition or symptoms are not something that can be assessed remotely through the Trusted Treatments online doctor service, please make an appointment with your usual GP at the earliest opportunity. If your GP cannot offer an appointment in a timeframe that you feel is appropriate, call 111 on your telephone and seek advice, explaining your concerns. Read more about where to get help..