Skin care for eczema

Photo of a young woman being examined by a dermatologist (PantherMedia / imagepointfr)

People who have eczema have dry, cracked skin. This can cause itching and affect the protective function of the skin. So eczema treatment is based on a special daily skin care routine.

In eczema it's very important to make sure the skin doesn't become too dry. This helps to reduce itching and inflammation, and prevents thickening of the skin (lichenification). Research also suggests that good skin care can reduce the need for steroid products.

In mild eczema, dry skin is the main symptom. A good skin care routine is then often enough to keep the condition at bay. Acute rashes (flare-ups) are treated with additional anti-inflammatory creams, for instance containing steroids. These are called topical corticosteroids.

Lipid-replenishing and moisturizing products (emollients) usually aren't considered to be medications. This means that doctors can't prescribe them and, as a result, statutory health insurers in Germany generally won't pay for them. So patients have to pay for these skin care products themselves – with a few exceptions:  Some products that are only available in pharmacies can be prescribed for children under the age of twelve.

What's the difference between ointments, creams and lotions?

Emollients are mainly made up of lipids (fats) and water. Some have a thicker consistency than others. This is influenced by the amount of lipids compared to other ingredients, and what kinds of lipids are used:

  • Ointments: Ointments create a thick protective film on the skin, preventing it from drying out.
  • Creams: Creams have more water in them than ointments do. So they feel more watery and are easier and more pleasant to apply.
  • Lotions: Lotions contain the most water of all the emollients. The water evaporates quickly, which tends to have a cooling and more dehydrating effect.

Some products also have water-binding substances in them, such as urea. Urea products can sometimes irritate the skin and cause mild burning, particularly in children and infants.

How are emollients applied?

The higher the proportion of fats in a moisturizing product, the better it protects the skin from drying out. So people with eczema are often advised to use products with a high fat content. But ointments are harder to apply, which can end up irritating the skin. They are also less practical to use in everyday life because it takes longer for them to be absorbed. Creams, which have a more liquid consistency, are easier and more pleasant to use. Lotions are very watery, so they're less suitable for very dry skin. Because they have a cooling and dehydrating effect, they are mainly used to treat weeping (wet) areas of skin.

Some people decide which product to use based on the current state of their skin, as well as external factors such as how dry or moist the air is, or how hot or cold it is outside. For instance, they may use a richer product in the winter (with a higher proportion of fats). But a person's choice of skin care products is also a matter of personal preference. There is no scientific proof that certain products are better than others.

It's important to be aware that many of the products contain substances that some people have an allergic reaction to (contact allergens). So it's a good idea to look at the ingredients when choosing a product, to avoid anything known to cause problems. But special (e.g. unscented) products are often more expensive. Trying out different things can help here: If less expensive products don't cause any problems, there's no reason why you shouldn't use them.

Specialists recommend using emollients two to three times a day, making sure you apply enough each time.

Bath or shower: Which is better for your skin?

When you take a bath, a lot of moisture enters your skin, and flaky skin and irritants are removed. So bathing is generally considered to be good for people with eczema. But there hasn't been any research into whether baths or showers are better for children and adults with eczema.

In both cases, it is recommended that people use warm (not too hot) water and get out of the bath or shower after 5 to 10 minutes. If the water is too hot, it may irritate the skin and make the itching worse. The most important thing is to moisturize your skin with an emollient afterwards so that the absorbed moisture doesn't escape.

People are often advised to only use cleansing products that have a low pH, are free of irritants and unscented. Soaps with a high pH can irritate the skin and dry it out. But there's no good-quality research comparing the effects of different cleansing products either.

Special bath additives are available for the treatment of eczema too. These contain oils or other substances that are claimed to protect the skin and keep it supple. But there's no proof that they have any benefits if you moisturize your skin using emollients after bathing or showering anyway. So dermatological societies don't routinely recommend using these bath additives. This is also true for products that are supposed to make the water softer.

During acute inflammations it's best to apply an anti-inflammatory cream (e.g. a steroid cream) immediately after getting out of the bath or shower. The affected areas of skin shouldn't be dried with a towel, or only dried carefully, to avoid further irritation.

Can wet wraps help?

Wet wraps are mainly used in children and adults with moderate to severe eczema. Two pieces of bandage are cut to the right size. A rich moisturizing cream is then applied to the skin. Next, one of the bandages is wet with lukewarm water (excess water is wrung out) and placed on the affected area of skin. The second (dry) bandage is placed on top of the wet bandage, or wrapped around it.

These dressings relieve itching by keeping the skin moist and cool. They also protect the skin from damage caused by scratching. There are no good-quality studies on the benefits and drawbacks of wet wraps. But a lot of people find them pleasant and say they help them sleep better, for instance.

Does special clothing help?

Rough fabrics like wool or coarse linen can irritate your skin. Finely woven clothes made from cotton or silk are usually a better choice for people with sensitive skin. And loose-fitting clothes are often more pleasant to wear than tight clothes.

Special clothing made from certain kinds of silk or silver-coated textiles are available too. The idea is that these will prevent bacteria from growing on your skin. But they haven't been shown to help in studies on people with eczema, so dermatological societies don't tend to recommend wearing them.