How Severe Eczema Is Treated

Finding the right treatment for the relief of symptoms and the prevention of flare-ups when you have severe eczema is crucial. The skin can become red and swollen, and the itch can be extreme and disruptive. In some cases, eczema can affect over 40% of the body's surface area.

This article will discuss how you can manage severe eczema with home remedies, over-the-counter (OTC) treatments, prescription medication, and phototherapy.

Home Remedies and Lifestyle

Eczema treatment for any severity starts with trigger management and a good skin care routine.

Identifying and Avoiding Triggers

Eczema often has triggers, which are anything that irritates the skin and causes an eczema flare-up (periods when the eczema is worse). Anything can be a trigger, but common ones for eczema include:

• Dry air
• Prolonged exposure to extreme heat or cold
• Certain types of soap, hair products, bodywash, and other cleansers
• Some fabrics, like wool or polyester
• Some laundry detergents and fabric softeners
• Certain foods
• Fragrances, such as scented candles
• Juices from foods like fruit, vegetables, and meats
• Cleaners and disinfectants
• Some metals, especially nickel
• Emotional stress
• Pollen
• Sensitivity to animals or other allergens
• Sweat
• Working with wet materials

If you can identify what triggers your eczema, avoiding or minimizing your exposure to it can help reduce the severity of your symptoms.

Sometimes exposure can't be avoided. In these cases, take measures to protect your skin, such as using a humidifier for dry air or wearing cotton gloves under waterproof gloves during activities for which your hands are in water.

Skin Care

A good skin care routine is the basis for eczema treatment. It is important during flare-ups and in between them. You should adhere to this routine even if you are using other treatments as directed by your healthcare provider.

Start with bathing or showering using warm, not hot, water. This helps hydrate skin and remove crusts, scales, and irritants.

After bathing, pat dry with a soft towel. Apply a good moisturizer within three minutes of getting out of the water. This helps your skin retain the hydration from bathing.

Apply moisturizer frequently throughout the day.

Home Remedies

Your healthcare provider may suggest trying some home treatments to soothe symptoms such as itching, or to prevent infections. You should try these treatments under the guidance of your healthcare provider. Don't try them without consulting with them first.

Wet Wrap Treatment

Wet wrap treatment involves wrapping the affected skin in layers of wet and dry dressings.

To make wet wrap treatments:

1. Bathe or shower and pat dry.
2. Apply topical medications (if applicable) first, then moisturizers.
3. Apply wet (damp, not dripping) gauze or clothing (damp pajamas work well for babies and children).
4. Put a dry layer over the top of the wet layer using elastic bandages, dry gauze, or clothing (such as dry pajamas and gloves or socks for hands and feet).
5. Leave it on for two to six hours (or overnight).

You can do this once or twice daily if necessary or several times a week for maintenance, for a duration of a few days to several weeks. Follow your healthcare provider's instructions.

Diluted Bleach Baths

If your healthcare provider recommends it, diluted bleach baths two to three times per week can help prevent infections, to which eczema-affected skin is prone. At this level of dilution, it is similar to swimming in a chlorinated pool.

To prepare a bleach bath:

1. Fill a full tub with lukewarm bathwater.
2. Add 1/2 cup of plain (not splash-free or scented), regular strength (6%) household bleach (sodium hypochlorite) and mix it in.
3. If filling the tub halfway, use 1/4 cup of bleach.
4. If using an infant tub, add 2 tablespoons of bleach to a full tub.
5. Wait until the bath is full and prepared before getting in, then soak in the bath for five to 15 minutes, or however long your healthcare provider advises (it is safe at this concentration for children to get their face and scalp wet).
6. Rinse off the diluted bleach water and pat dry.

Over-the-Counter (OTC) Therapies

OTC options are a good place to start. Severe eczema may require additional treatment, but OTC products provide a treatment base.

Topical

Topical eczema treatments mean they are applied to the skin.

Using the right moisturizing product is key to eczema treatment. Look for thicker ointments or creams. These have a higher oil content than lotions, which contain too much water. Use products that contain minimal ingredients and are fragrance-free and dye-free.

Some options to try include:

• Petroleum jelly, such as Vaseline
• Mineral oil
• Eucerin cream
• Moisturel cream
• Cetaphil cream

Tips for applying moisturizer:

• Soak the affected area in lukewarm water first if possible, or take a bath or shower.
• If also using a prescription topical medication, apply it as directed first, then use moisturizer.
• If the product comes in a pot or jar, use a clean utensil to remove moisturizer from the container, not your fingers, to prevent contaminating the product.
• Soften moisturizer by rubbing it between your hands.
• Apply using downward strokes, don't rub it in up and down or in circles.
• Let it soak in.
• Apply twice a day or as often as necessary (particularly after washing your hands or being in water).

Mild anti-itch lotions, such as Caladryl or Calamine, may also help soothe dry, scaly patches.

Systemic

Oral antihistamines are sometimes suggested for itchy eczema. They tend not to relieve the itch itself, but they are sedatives and can help make for more restful sleep when taken at bedtime.

Prescriptions

It is common for people with severe eczema to need prescription treatments.

Topical

Some prescription eczema treatments are applied to the skin.

Steroids

Topical steroids may be prescribed for short-term use to help clear affected areas and manage itching and inflammation.

Apply to affected areas only and use as directed by your healthcare provider. Topical steroids are typically not for long-term treatment because they can cause the skin to thin over time.

Calcineurin Inhibitors

Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream are topical non-steroid immunosuppressants that help reduce inflammation. Unlike steroids, they do not cause skin thinning. Anyone over 2 years of age can safely take them.

Common side effects include mild stinging or burning when first applied to the skin.

JAK Inhibitors

The enzymes JAK1 and JAK2 are involved with processes that contribute to skin inflammation, itch, and skin barrier function.

Opzelura (ruxolitinib 1.5%) cream is a topical selective JAK inhibitor that can treat mild to moderate eczema or eczema that is not adequately controlled by other topical prescription medication.

JAK inhibitors are for short-term and non-continuous treatment, and people who have a weakened immune system or are under 12 years of age should not use them.

Systemic

Some prescription eczema treatments are taken orally or by injection.

Steroids and Immunosuppressants

Systemic corticosteroids and immunosuppressants such as cyclosporine, Imuran (azathioprine), and CellCept (mycophenolate mofetil) may be prescribed if topical treatment is ineffective.

Because of side effects and the potential for rebound flares that can arise after you stop taking your medication, these are typically avoided as much as possible and are only used for short-term treatment of acute, severe flares.

People using these medications need monitoring from their healthcare provider.

JAK inhibitors

Cibinqo (abrocitinib) and Rinvoq (upadacitinib) are oral JAK1 inhibitors for moderate to severe eczema that other treatments (including other systemic treatments) cannot adequately control.

Dupixent

Dupixent (dupilumab) is an injectable medication that inhibits the inflammatory response. It can treat adults with moderate to severe eczema that topical therapies cannot control. Side effects may include a reaction at the injection site, cold sores in the mouth or on the lips, and inflammation of the eye or eyelid.

Specialist-Driven Procedures

Phototherapy can treat moderate to severe eczema. This type of light therapy uses certain wavelengths of ultraviolet light to inhibit the inflammatory response in the skin. People sometimes use it with a medication called psoralen, which sensitizes the skin to ultraviolet light. This combination therapy is called psoralen plus ultraviolet A (PUVA).

During a treatment session, you will:

• Apply a moisturizing oil to the skin.
• Get undressed except for underwear and eye protection goggles.
• Stand in a large cabinet during activation of the light-emitting machine (typically seconds to minutes).
• Have your whole body treated or selected areas using specialized lamps.

Treatments are usually two to three times a week for a duration of several weeks. Your healthcare provider may later advise more treatments.

Phototherapy may cause side effects such as skin sensitivity and may increase the risk of skin cancer. Talk to your healthcare provider about the benefits and risks of this treatment.

Summary

Moisturizers and topical medications can also treat eczema. Severe eczema may require more intensive treatments such as systemic immunosuppressants or phototherapy.

If you are experiencing severe or frequent eczema symptoms that are not improving with skin care and moisturizing alone, talk to your healthcare provider about other treatment options. You can also ask for a referral to a board-certified dermatologist who can help you make a plan that offers you relief.