Eczema treatment and prevention tips

In addition to topical steroid creams and moisturisers, the following strategies may be required:

  • Oral steroids: These are often used for severe allergic contact dermatitis and severe flares.

  • Phototherapy, biolgocis (dipulimab) and immune-suppressing medications such as cyclosporine: These are suitable for chronic, persistent and extensive eczema.

  • Antibiotics and antiviral medic​ations: These are suitable if the eczema is complicated by secondary bacterial and viral infections.

  • Oral antihistamines with sedative effect are often prescribed to help sleep at night.

Reducing the recurrence of eczema

Your doctor may prescribe non-steroidal creams called topical calcineurin inhibitors (eg topical tacrolimus / pimecrolimus) to substitute topical steroid creams when the eczema is under control to prevent recurrence of eczema.

“Non-steroidal creams are not more effective than steroid creams but can be useful for the treatment of eczema over areas of thin skin such as around the eyes, where long term topical steroid use is not recommended because of the risk of side effects,” says A/Prof Pang Shiu Ming​, Senior Consultant at the Department of Dermatology at Singapore General Hospital (SGH), a member of the SingHealth​ group.

Your doctor may advise you to apply topical steroid two times / week to resistant patches after improvement to prevent frequent relapse (proactive therapy).

A/Prof Pang advises sponging gently under the arms, in the groin and other areas where cleansing is imperative when you have eczema. “Try not to rub or scratch the rash. When it gets severely itchy, try to relieve it by tapping or applying moisturiser to the skin,” he says.

As for perfume, he says to avoid spraying it directly on your skin if you have bad eczema.

Recurrence is common if you have eczema. To reduce recurrence of rash, you can eliminate the following aggravating factors:

  • Dry skin: Keeping your skin well moisturised is an effective way to avoid an itchy flare-up.

  • Frequent use of soap, hot water and cleansers: These can worsen the breakdown of the natural barrier function of the skin. Use mild unscented soaps/cleansers and shower with lukewarm water instead of hot water.

  • Hot temperatures and sudden changes of temperatures: Stay in a cool environment as far as possible. When travelling to cold dry countries, bring along your own cleanser and moisturisers.

  • Strenuous exercise: It’s best to avoid heavy sweating. Swimming is good exercise if you have eczema.

  • Rough, tight and woollen clothing: Wear light, smooth, soft, non-binding clothing instead.

A/Prof Pang also advises wearing gloves and protective clothing when doing housework to avoid coming into contact with allergens and household skin irritants, such harsh detergents and household cleaning agents.

Special tips for children with eczema

Here are some tips on what to do if your child has rash due to eczema:

  • Avoid bubble baths.

  • Gently pat your child dry with a towel after a bath. Do not rub the skin vigorously.

  • Restore the skin barrier with emollients after shower.

  • Avoid fluffy toys and carpets / rugs in your child’s room to reduce house dust mite in the house.

  • Most children with eczema do not have food allergy. Infants with severe eczema who do not improve with topical steroids and regular emollients should be assessed for food allergy.

Ref: L20