Eczema (Atopic Dermatitis)

Daily Skin Care

(Critical to Prevent or Minimize Flare-ups)

Gentle Bathing

• Bathe skin as little as possible, to prevent stripping the skin of natural oils that protect it.
• Take short, warm (but not hot or cold) showers or baths.
• Use a gentle cleanser to wash the skin, such as Dove, Elta, Cetaphil Gentle Cleanser, Cerave cleanser, or Purpose cleanser. DO NOT use Ivory, Zest, Irish Spring, or Dial.
• Be gentle when drying the skin. Pat the skin with a soft towel to dry.

Aggressive Moisturizing

• Moisturize the skin as much as possible, especially right after a bath or shower.
• Good choices for moisturizers are plain Vaseline, Elta moisturizer (available at the front desk), Cetaphil cream, or CeraVe cream (available at the front desk). Do not use scented moisturizers.
• For especially dry hands or feet, apply Elta moisturizer at bedtime and cover it with cotton gloves or socks to wear while sleeping.

Other Tips

• Launder clothing with a scent-free detergent such as Dreft, All Free, or Cheer Free. Use the extra rinse cycle when possible.
• Cut fingernails short to help minimize scratching.

What to Do When Flaring

Topical Medications

• Prescription treatment may be necessary when eczema flares up, as there is usually more itching, redness, cracking of the skin, and sometimes infection.
• Apply treatment creams provided by your doctor, a small amount on each itchy or red area.
• Steroid creams should not be applied to the face, underarms, or groin area without consulting with your doctor first. If you are unsure where to put the cream or which one to use, call the office.
• For severe outbreaks, your doctor may recommend “wet dressings” (see below).

Oral Medications

• Medicines (such as Atarax/hydroxyzine, doxepin, or Benadryl/diphenhydramine) taken at bedtime can help with itching and sleep. These medicines often cause drowsiness, so it is important not to drive or operate machinery after taking them. If you still feel sleepy in the morning, call your doctor to discuss a different dose or medication.
• Other antihistamines that cause less sleepiness (such as Zyrtec, Allegra, or Claritin) are available over the counter for daytime use, if needed.
• Not all of these medications can be used for children. If you have questions about over-the-counter medications for your child, please call our office.

Infection

• If you are concerned that the skin is infected (fever, warm and tender skin, yellow or white weeping drainage), then call your doctor immediately.
• If antibiotics (such as Keflex/cephalexin, amoxicillin or doxycycline) are prescribed, make sure to take the full course of treatment as directed by your doctor, even if the infection seems to be getting better.
• If your doctor recommends, use bleach baths to control infection recurrence (see below).

Bleach Baths

Bleach baths are an inexpensive and easy way of reducing the amount of bacteria, including Staph Aureus, on the skin. If skin gets too dry from these baths, rinse off more thoroughly after bathing or reduce the amount of bleach added to the tub.

• Fill bathtub to a water level of 1-1/2 feet.
• Add 1 capful Clorox (bleach) to the bath water.
• Soak for 10-20 minutes.
• Rinse skin well in the shower afterward. You may use regular soaps or shampoos, as desired.
• Blot skin dry with a towel, using a fresh towel after each bath. WARNING: Use a white towel or old towel, as the bleach may cause it to lose color.
• Repeat 2-3 times weekly, as directed.

Instructions for Wet Dressings

Wet dressings are an intensive regiment to control severe skin dryness and irritation. This is a short-term solution, and aims to make the patient more comfortable and calm down inflammation to that more traditional, less time-intensive treatments can be used instead. This technique will greatly increase the strength of the topical medication and should only be used as prescribed.

Getting Ready

• Patient may get cold as the dressings evaporate, so treat in a warm environment.
• Materials: 100% cotton recommended for wet wraps (cotton pajamas, T-shirt, socks, gloves) followed by dry warm materials (towels, sweat suits, blanket).
• Solution:   Soak dressings in warm water or diluted vinegar (1/8-½ cup vinegar to 4 cups water)

Applying the Dressings

• Apply prescription medication to the affected areas in a thin, even film.   Be careful to use steroids only on the recommended areas, stronger steroids on the trunk, arms, and legs and mild steroids on the face, groin, and underarms (avoid near eyes).
• Remove dressings from the solution, and gentle squeeze out excess fluid. The material should feel wet, but not dripping.
• Cover the dressing with dry towels, dry clothing, or blanket. Leave in place for at least 20-30 minutes.

Remove the dressings, and reapply a thin coat of steroid cream to all of the affected areas as prescribed.