Derm Deep Dive: Eczema Treatment

March 2022

All About Eczema and What You Should Know With Dr. Brian M. Connolly, MD, FAAD

Eczema is an extremely common skin condition that affects up to 15 million Americans. Because these itchy, red, irritating bumps are so prevalent and can manifest in many different ways, we wanted to sit down with one of Optima Dermatology’s expert dermatologists, Dr. Brian M. Connolly, to discuss eczema and eczema treatment – and what you should know. 

This conversation with Dr. Connolly is the first in our new Derm Deep Dive series, where we chat with one of our practitioners about a specific dermatological issue so you can learn more about it and your treatment options.

What is Eczema and What Causes It?

Eczema is actually commonly known as “the itch that rashes” because it begins as dry skin that becomes itchy, and as people scratch their dry, itchy skin, it turns into an itchy rash. This type of eczema is the most common and is typically caused by one of two factors: environmental (think skin irritants or dry air), or a genetic defect in the skin’s proteins that help skin cells hold on to moisture.

As far as environmental triggers, for individuals who reside in locations that have dry air, typically from cold weather and from running heaters or furnaces, the skin loses moisture when humidity is removed from the air. Frequent hand washing or bathing can also lead to dry skin. 

Once the skin is dry, it becomes much more sensitive to potential irritants in chemicals found in household cleaning solutions, cosmetics, and other products. 

What Does Eczema Look Like?

The most common signs and symptoms of eczema include red, sometimes scaly, and ill-defined bumps that can grow together into even larger bumps. Eczema is always itchy, which can sometimes lead people to confuse it with poison ivy or an allergic skin rash. 

Eczema tends to flare up in certain areas of the body, which differ based on age. Infant eczema, which is very common, typically appears on the cheeks, around the mouth, and the trunk. 

In adults, eczema manifests most often on the hands, in the folds behind the knees and elbows, on the eyelids, and on the neck. However, it can appear in other places as well, so it is important to consult your dermatologist if you believe you have eczema.

How Can Someone Avoid Common Environmental Triggers for Eczema?

Moisturize, moisturize, moisturize! We can typically tell when our skin is dry, and it’s always best to aggressively moisturize a minimum of three times each day, especially after bathing. 

It’s also helpful to avoid direct skin contact with cleaning products. Always wear gloves to prevent the chemicals in those products from irritating and drying out your skin. If you do have direct contact, wash your hands thoroughly and apply moisturizer. 

Eczema can also be caused by your laundry detergent or sun and sweat exposure, so be sure to evaluate possible triggers based on your lifestyle and when flare-ups tend to occur.

Will Any Moisturizer Do the Trick?

Actually, no. Try to avoid lotions with fragrances as these can cause more irritation and don’t provide much in the way of moisture replenishment. The same goes for cosmetics. Look for fragrance-free moisturizers and creams that are specifically designed to restore moisture to the skin.  

Who is at Risk of Suffering From Eczema?

Eczema can affect anyone at any age, but individuals who live in cold climates with low humidity, who work outside and have a lot of cold or sun exposure, and people who frequently wash their hands for their occupation are more at risk. 

Eczema is also a hereditary condition that can be passed down, so if you have a strong family history of eczema, you are also more at risk. 

This skin condition can manifest at any time, and really at any age, although it is most common in infants and adults. Infants also tend to “grow out” of their eczema at a certain point. 

What Should Parents Look Out for When it Comes to Pediatric Eczema?

While pediatric eczema is very common and typically not a significant concern, it can be difficult to control with an energetic, active child. Parents should primarily look out for any yellow crusting around the eczema sites, as that could be indicative of an infection. Otherwise, there are some good infant eczema creams that can be applied to the irritated areas to manage the symptoms.  

What Do Eczema Treatments Look Like?

The best treatment across the board is moisturizer. A good moisturizer is better than any prescription, but in some cases, we do use medicines to help calm down the skin’s immune system to control eczema. 

Another important treatment is behavioral modification. Whether it’s avoiding the environmental irritants, remembering to moisturize, or keeping yourself from scratching (which makes eczema worse), behavior plays a big role in treating eczema.

When Should a Patient Consider Seeing a Dermatologist?

If at-home, over-the-counter remedies aren’t working, or you feel you need an official diagnosis, extra advice, and support, that is a good time to see a dermatologist. 

I recommend applying a quality moisturizer three times daily for up to two weeks first, and contacting your dermatologist or primary care physician if you still do not see a change.  

How Soon Should a Patient Expect to See Changes or Improvements?

Nothing works immediately, and it may take up to six weeks to notice a significant improvement depending on the severity of the eczema. I always encourage my patients to stick with the treatment – if you don’t feel like the medication is working after a week or two, don’t give up!

When Do You Bring Patients Back in for a Follow-Up Appointment?

It definitely depends on the patient’s specific eczema condition, but I typically recommend a follow-up after three months. 

Can You Provide an Overview of Prescription Treatment Options?

A topical treatment used in conjunction with moisturizers is always advised and is usually the first step when treating moderate or severe eczema. There are many different kinds of topical ointments and creams in varying strengths and formulations, and I work with all of my patients to understand which topical treatment would be best for them.

For more severe or hard-to-treat cases, systemic medications like pills, injections, and special light therapies can be useful. Again, treatment depends on everyone’s unique situation.

Think You Have Eczema? Take Dr. Connolly’s Advice.

We hope this Derm Deep Dive provided some helpful advice about eczema and what to do if you think you have it. 

Your first step after aggressively applying moisturizer should be to contact your dermatologist and discuss treatment options. We have even put together 7 questions you should be sure to ask about eczema at your first appointment. 

At Optima Dermatology, our expert, board-certified dermatologists know the best approach to treating and managing your eczema.

Request an appointment with Dr. Connolly to discuss the best treatment plan for your eczema.