Severe eczema: how to manage it


Ashley Wall has lived with serious people eczema for over 3 decades. He was only 2 years old when the first piece of scaly skin arose next to the body.

“My mother noticed that she was constantly scratching her. And it wasn’t like a small typical rash that children normally receive … it just wouldn’t go away. Nothing worked: no creams, no lotions. She tried it all. That’s when he learned it was something serious, ”says Wall, a 33-year-old man from Livingston, New Jersey.

Wall’s mother took her to a pediatrician. The doctor removed him as a temporary infantile eczema and prescribed him a cream. But it didn’t work. The rash soon spread throughout the body. This time, a trip to the dermatologist’s office confirmed it atopic dermatitis (AD), a chronic form of eczema that exists with allergy symptoms, that Wall would have the rest of his life.

What is severe eczema?

Eczema is a type of inflammation of the skin that causes red, itchy, painful rashes. It affects about 31 million Americans. But it affects each person differently.


For most people with eczema, the symptoms are mild to moderate and can go away in time. But for some, severe dryness, itching, and scratching can become so painful that it can cause bleeding skin, sore wounds or crunchy. With severe eczema, you may have long-lasting outbreaks in various parts of the body at different times. And the skin setbacks can affect your mental well-being and affect your overall quality of life.

Zelma Chiesa Fuxench, MD, an adjunct professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine, says she considers many things before diagnosing a person with severe eczema.

Chiesa Fuxench says she asks herself questions like, “What is the level of itching? What impact does sleep loss have? It is associated with symptoms of depression or anxiety? Can the patient function at work or school? Do they go out and enjoy the things they do? “


One study found that 1 in 2 participants with severe eczema reported it affected their lifestyle. They stayed away from social interaction due to the appearance of their skin and were less able to do daily activities.

For Wall, when she was a teenager, the “painful rashes” made her feel self-conscious.

“He always wore long sleeves and always wore pants. I would never wear dresses or skirts, very aware of that, which again prevented me from enjoying life, ”says Wall.

How to manage eczema triggers

The exact cause of eczema it’s unknown, but experts believe you’re more likely to have it immune system it is activated by a combination of genetic and environmental causes such as climate, irritants or allergens. A defective skin barrier could be the culprit. To get to the root of the problem, you may need to see specialists such as a dermatologist, allergist, or pediatrician if you start at an early age.

No cure for eczema is currently known. But there are things you can do to relieve the itching and even prevent things that can cause an outbreak. Medical treatments are also an option.


Activators to avoid:

Dry skin. If the skin loses too much moisture and becomes dry and scaly, it can cause an eczema outbreak. This can happen especially in the winter months when fresh, dry air sucks moisture from the skin.

“I really emphasize the constant use of a moisturizer on the skin; you want to do it at least once a day, ”says Chiesa Fuxench.

Irritant. The ingredients in the product or certain natural things can cause itching on the skin if you come in contact with them. This may include:

  • Some metals like nickel.
  • Laundry detergent, chemical cleaners and soaps.
  • Some fabrics such as wool and polyester.
  • Cigarette smoke.
  • Perfumes and fragrances.
  • Tattoo inks and inks.

Wall says the ocean salt water feels good against her skin, but spending time in the pool is not an option for her.


“Is it like that [eczema] it just smells completely because the chlorine doesn’t match my skin, ”Wall says.


Sweat and warm up. Sweat contains traces of certain metals such as zinc, iron, nickel and copper. This can irritate the eczema and make it worse in hot spots like the elbow, behind the knees or neck, where sweat usually appears. While it’s impossible to avoid sweating altogether, if you do, try rinsing yourself with fresh water and changing into a clean suit.

Food allergy. Common foods that can make eczema symptoms worse are eggs, milk, and peanuts. About 20% to 40% of children with severe eczema usually have food allergies. If you think certain foods make your skin worse, talk to a doctor.

Asthma or there is fever. Experts know that for some, hay fever or asthma often coexist with or cause atopic dermatitis. Experts do not know why. If you are allergic pollen or animal dandruff, limit exposure. If you’re not sure what causes allergies, talk to one allergy specialist in testing and diagnosis.


Stress. Your eczema can get worse if you feel stressed. Experts do not know exactly why.

Since his diagnosis, Wall says it has been a journey of trial and error to manage the disease. “In the 80s and 90s there wasn’t that much information about it.” But now, at 30, he says he has much more control over skin health.

“I know some of my triggers and sometimes I don’t, because it’s a bit chaotic, but I don’t really go to the dermatologist or the doctor as much … [be]because I feel like I’ve come to a place where I can manage it, ”Wall says.

Chiesa Fuxench says he tries to review his patients’ skin care routines to see “what things they can do [at home] in terms of changing their habits to manage their conditions “.

But if home remedies don’t work and yours symptoms of eczema are not controlled, try:


Topical treatments. Your doctor may prescribe over-the-counter ointments or creams to put directly on your skin, such as corticosteroids. If your eczema is mild to moderate, your doctor may prescribe chrysaborol (Eucrisa). It works by blocking substances that cause the body inflammation.

You should use these medicines exactly as your doctor advised. Excessive use can have side effects and cause the skin to thin. In some cases, your doctor may provide you with stronger creams such as pimecrolimus (Elidel) o tacrolimus (Protopic) to reduce inflammation, itching and the need to use steroids.

Oral prescription drugs. If severe eczema leaves you with open wounds that can cause infection, your doctor may administer it to you orally. antibiotics for a short time to fight bacteria that may enter through the broken skin barrier.

If the inflammation is excessive, you may need to take an oral corticosteroid such as prednisone. It is a very strong drug that cannot be taken for a long time. It can have serious side effects. Take it exactly as your doctor advised.


Phototherapy. If topical treatments do not work for you, your doctor may suggest phototherapy. Your skin is exposed to a controlled amount of sunlight for a certain amount of time. You may also be exposed to other forms of light, such as artificial ultraviolet A (UVA) and narrowband ultraviolet B (UVB). You can do this therapy with or without medication.

Phototherapy increases your chances skin cancer and can cause the skin to age soon. Ask your doctor if this is the right treatment for you.

If none of these treatments work for you, the FDA has approved a new medicine for moderate to severe eczema called dupilumab (Dupixent). Your doctor will need to prescribe it. You take it in the form of a shot that you can give away at home.

If itching and dry, flaky spots affect your sense of your image or mental health, talk to a therapist or counselor. If itching alters sleep or becomes a habit, you can try relaxation or behavior modification techniques.

Break the Itch-Scratch cycle

According to Chiesa Fuxench, there is a saying in the world of dermatology: “We say“ an itch that erupts. ”It basically means that the more you scratch the rash, the more it becomes inflamed and becomes more aggressive, red, swollen, and painful. a “itch-scratch cycle” hard to break.

In some severe cases, itching and intense scratching can irritate the nerve endings of the skin and make it thick and curious. The affected area of ​​the skin may become darker and have different lines from scratches. It is a skin disorder called neurodermatitis. If the itching improves, the skin can heal and improve.

To relieve itching, you can:

  • Hydrate as often as you can.
  • Use creams with ceramides, a type of fat that is usually found on the skin, to strengthen the skin barrier.
  • Use low pH skin cleansers.
  • Apply a cold compress.
  • Pinch and caress the part of the itchy skin.
  • add apple cider vinegar in your bathroom.
  • Soak in a bath with baking soda or oatmeal.
  • Avoid contact with anything that may irritate bare skin. Do not sit on the lawn, plastic chairs or carpeted or rough furniture. Wear soft, breathable clothing made of natural fibers next to the skin.
  • Use a damp wrap around the itchy skin.
  • Try it acupuncture.

If you just can’t control the itching and scratches, develop one skin infection from that, or it costs him to sleep, talk to a dermatologist. They can guide you to treatments that best suit your needs.

How to recover skin after a mishap

At the end of the day, home treatments and remedies are not infallible. Not all of them may work for your severe eczema or you need more than one type of treatment at the same time, according to Chiesa Fuxench.

But when it comes to dealing with the setbacks of eczema, Wall says it’s about knowing what you can control and preparing for as much as you can. “I would say I can’t control the time. But I know that if I travel, I will have what I call the “emergency kit for eczema.”


For Wall, when staying in a hotel or with friends or family, it makes it useful to pack “fragrance-free” products and even bring your own sheets to avoid savings. But even though Wall moves away from most activities that can cause his eczema, he sometimes lets himself be enjoyed despite knowing the consequences.

“It’s a moment and it’s worth it, and you just have to go for it,” Wall says.


“It is really necessary to clearly establish a basic skin care regimen. I usually say basic and simple because we really don’t want to overload patients with treatments, ”Chiesa Fuxench says.

In short, if you live with lifelong eczema, Chiesa Fuxench points out that it is important to understand the idea that, as with other chronic diseases such as diabetes or hypertensionyou will need to keep up to date with your treatments.

“We need to think about how to best treat these patients in terms of a long-term approach,” says Chiesa Fuxench. “The goal is to achieve [them] happy and to be able to lie without thinking that they have to go back and see the dermatologist again ”.

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