Treatment

There is no simple cure for atopic eczema but the effects can be minimised or prevented and the symptoms treated. Management is aimed at healing the skin, keeping it healthy and treating symptoms when they occur. In allergic contact eczema the sensitisation of the skin is permanent and avoiding contact with any known sensitizers is essential. Also known factors that irritate the skin should also be avoided as far as is possible. Barrier creams which retain moisture in the skin and protect against contamination can be helpful in preventing contact eczema

The main treatment for an acute flare-up is the application of corticosteroid creams or ointments of varying strengths depending on location and severity of the rash. These need to be applied at regular intervals up to four times daily until the rash has subsided.

Prolonged use of these can damage the skin and they must be used with caution. There are many different types of preparation and the patient may need to try several before finding one that is effective. Antibiotic creams or oral antibiotics may also be needed if there is evidence of bacterial infection which can delay recovery.

Antihistamine drugs may also be used to reduce irritation but they do not generally help to reduce the allergic response. Oral corticosteroids may be needed in cases that are resistant to local treatment.

Drugs that modulate the body's immune response which can be used by local application (Tacrolimus ointment and Pimecrolimus cream) have recently become available for treating resistant eczema but these are only recommenced for use under specialist supervision. In rare severe cases the patient may need intensive treatment as a hospital inpatient.

Between flare-ups treatment with emollients (moisturisers) that reduce the loss of water from the surface layer of the skin are essential to reduce dryness and scaling and to maintain the resistance of the skin.