Acute eczema can appear de novo as the first attack of inflammatory skin diseases or can occur as an exacerbation of an existing itchy skin rash. It typically presents with oozing, redness and swelling of the affected area. A stinging or burning sensation followed by pain and itching are the main symptoms. The commonest examples of acute eczema presenting as itchy skin rashes are contact dermatitis or an acute exacerbation of atopic eczema in children.
The treatment of acute eczema involves general measures applicable to all types of eczema whatever be the cause and specific measures related to the itchy skin rash.
Acute Eczema Treatment: General Measures
The sudden appearance of eczema can be alarming and distressing for an individual. The intense burning sensation, itching and soreness can deprive the patient of sleep and cause further stress. Hence rest and reassurance are the first steps in the management of acute eczema. The general measures are described in the article titled ‘How to Treat Eczema’.
Acute Eczema Treatment: Specific Measures
All types of acute eczema will benefit from astringent soaks. Lukewarm potassium permanganate solution (1:10000 dilution) or aluminum acetate solution (Burrow’s solution BP) are the best choices for this. This is what you can do at home: Take half a liter of lukewarm water and add two pinches of potassium permanganate powder (the solution turns light brownish pink). Soak a multilayered soft cotton cloth or gauze pad in this solution and keep the eczematous area compressed with the soak for 2-3 minutes. Remove from the skin and repeat till the oozing and the crusted debris are removed. Repeat this wet soak or compresses 2-3 times daily till the eczema dries up.
Aqueous creams, bland emollients: After the soaks, apply homemade eczema cream or natural eczema cream and bland emollients to the eczema to soothe and cool the itchy skin rash.
Topical steroids: Moderate to potent strength topical steroids help to reduce the inflammation and heal the eczema. These should be used sparingly on the face and body folds to avoid the side effects of topical steroids.
Wet wrapping technique. When there is extensive involvement of the body area, wet wrapping or two pajama treatment is used to control the eczema and relieve the itchy skin rash.
Secondary infection. In the presence of secondary bacterial infection, patient may come with pus discharge instead of the usual watery discharge from the eczematous skin accompanied with fever, body pain and lymph node enlargement in the region. In such cases, antibiotics should be given to control infection.
Combined steroid antibiotic creams: If a bacterial infection is suspected in the itchy skin rash caused by eczema, a combination steroid-antibiotic cream will give better results than the steroid alone.
Sedative antihistamines like hydroxyzine, trimeprazine will help to control the itching.
Removal of the cause, systemic steroids in allergic contact dermatitis, antifungal-mild steroid combination on seborrheic dermatitis and desensitization treatment in allergic dermatitis.
Topical Steroid Use in Acute Eczema
Topical corticosteroids are very effective in controlling the acute phase of eczema. The choice of the type of topical corticosteroids depends upon the site and severity of the itchy skin rash. Generally mild to moderate strength creams are preferred over the face and body folds and near the genitals. The application should not be more than two weeks at a stretch.
How to Avoid Side Effects of Topical Steroids in Acute Eczema
Prolonged use of topical steroids can cause topical and systemic side effects. Hence the use of topical steroids should be limited to shorter periods only. Once the acute stage is over, tacrolimus or pimecrolimus can replace steroids. These are free from the common side effects of topical steroids.
How to Treat Childhood Eczema – Emollients
Emollients are often the first form of treatment used to help children suffering from eczema, which are available in several forms, such as bath and shower oils, soap alternatives, creams, lotions and ointments. According to the National Eczema Society, this form of eczema treatment is one that is typically underused, with those suffering from severe forms requiring emollients around five times a day. In Allergies: A Parent’s Guide, Goldman highlights that emollients work by giving the skin surface a protective barrier while moisturising and reducing associated itchiness. Also, emollients which contain antibacterial agents are best avoided, unless the child frequently suffers from or is currently suffering an infection.
In terms of safety aspects associated with using emollients to treat children with eczema, Goldman recommends the following advice:
Avoid aqueous cream (can cause further irritation).
Test new products first on a small patch of skin.
Wait 30-60 minutes in between applying emollient and topical steroid.
Be careful holding children as bath products make skin slippery.
Treatments for Children with Eczema – Topical Steroids
Another form of treatment for children suffering from eczema involves using topical steroids, which are safe when used appropriately, following instructions prescribed by the doctor. However, there is a risk of the skin thinning if these are used for lengthy periods of time and at higher doses. As identified by Goldman, topical steroids come in the form of creams, ointments, lotions and gels, which are used to treat flare-ups and work by reducing the skin inflammation. It is worth discussing with the family doctor any concerns relating to a child suffering from eczema symptoms, especially if emollients have not seemed to be helpful.
It is important that topical steroids, in whichever form one has been prescribed by the doctor, are used in very small amounts. In order to provide the most benefit, such treatment should be started as soon as one has observed a flare-up of eczema. While the word “steroid” can cause some parents to panic, this form of treatment has been officially recognized by the National Eczema Society as being safe and a better option than leaving a child to suffer the pain and irritation associated with eczema.
As highlighted above, eczema is a very common skin condition, triggered by allergies and is treated using emollients and/or topical steroids. The latter are safe to use, as long as one follows the doctor’s instructions.
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