Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to firstname.lastname@example.org
For this article, I concentrate on the most common type of eczema, atopic eczema. However, the treatment of atopic and non-atopic eczema is similar. The Greek word atopy means “out of place” and describes the group of disorders including eczema, asthma and allergic rhinitis and which are genetically linked. Triggers include specific allergies to foods, overheating, secondary infection, wool next to the skin, cat and dog fur, soaps, detergents, house dust mites and pollen. Extreme hot and cold, humidity, and hormonal changes in women (caused by the menstrual cycle and pregnancy) can also cause flare-ups.
Initial approach to treatment of atopic eczema involves the avoidance of exacerbating factors and hydrating the skin. Exacerbating factors include excessive bathing, low humidity environments, dry skin, exposure to solvents and detergents and emotional stress. A sleeping environment with minimal dust and upholstery reduces house dust mites and can reduce the severity of eczema.
In adults, food allergies do not appear to be a factor in eczema according to studies. In infants, avoidance of certain foods can help. Food triggers include eggs, nuts, peanut butter, chocolate, milk, seafoods, and soya.
Maintaining adequate skin hydration
Skin hydration is a key component of their overall management. Lotions, which have a high water and low oil content, can worsen dry skin via evaporation and trigger a flare up. However, thick creams (eg, Eucerin®, Diprobase®) which have a low water content, or ointments (eg, petroleum jelly, Emulsifying Ointment), which have zero water content will better protect against dry skin.
A study in infants with atopic dermatitis who required topical steroids (see more details next week) found that infants treated with emollients had significantly decreased requirements for topical steroids (prescription only creams and ointments) compared with the group of infants not treated with emollients. Emollients are best applied immediately after bathing when skin is well hydrated. Hydration can be improved by soaking in a bath containing a bath additive such as Oilatum® for 10 to 20 minutes. Bath additives leave the skin and bath very slippy so take particular care when bathing.
Urea is a hydrating agent found in many emollients sold over the counter in pharmacies including Calmurid® and Eucerin® cream. Urea is strongly hygroscopic (water-loving) and draws and retains water within skin cells. Urea softens the skin. Urea can be beneficial in dry skin conditions where scaling and flaking occur. Whelehans Intensive Moisturising Cream was developed by our pharmacist because brands such as Calmurid® Cream, while effective, are very expensive. Our cream contains 10% urea and is over half the price of brands such as Calmurid® Cream.
Efficacy of preparations containing crotamiton (Eurax®) for itch is uncertain so are best avoided in Eczema. Similarly, calamine lotion is best avoided. Oral antihistamines are widely used for itch in patients with atopic eczema. Sedating antihistamines appear to be most affective. Chlorphenamine (Piriton®) is the only sedating antihistamine available over the counter in Ireland. Although not as effective as sedating antihistamines, non-sedating antihistamines such as cetirizine (Zirtek®, Cetrine®) and loratadine (Clarityn®, Lorat®) can be useful where sedation will be an issue. Thry are available over the counter in pharmacies. Tepid baths to hydrate and cool the skin can also temporarily relieve itching.
Free Eczema skincare consultation at our Eczema Clinic
Whelehans Pharmacy offer free Eczema skincare consultations at our Eczema Clinic on Saturday July 16th with skincare expert Trish Wallace. Learn how to reduce redness and irritation and how to reduce frequency of flare-ups. Whelehans offer a range of effective products that give clearer skin in a safe and effective way without the need for stronger and potentially damaging prescription medicines like steroid creams. Book your free appointment; call Whelehans at 04493 34591.