For eczema management, you can broadly view it as treatment of the eczema rashes and maintenance of the condition.
For the treatment of eczema:
- Topical steroids of various strengths are usually used for a short period of time to get the rashes under control. When used under supervision from your dermatologist, you are unlikely to develop serious side effects such as skin thinning etc.
- In cases where there is an overlying infection, antibiotics or antiviral medicines may need to be used. Just using steroids in such cases actually lead to worsening of eczema.
- There are steroid-sparing creams such as Protopic or Elidel ointment that can be useful in certain cases such as young children or sensitive areas such as the face. This allows treatment of eczema without the potential side effects that may be encountered with steroid creams.
- Lastly, there are oral systemic agents that can be used for patients with difficult to control eczema. These may include cyclosporin, mycophenolate mofetil and methotrexate. The newest drug that has just entered the market in the last few months is Dupilimab (dupixent) which is an injection that helps patients with recalcitrant eczema. This is a promising new treatment for severe eczema that appears to be safe with only a few side effects.
For maintenance of eczema:
- Regular use of the correct wash and moisturisers to improve the skin barrier is important. This helps the top layer of the skin keep its structure and has been shown to reduce the number of flares.
- Identification and avoidance of triggers such as dust, heat, sweat or other known allergens can be helpful. Eg. If a patient is allergic to dog dander, their eczema is unlikely to improve unless the dog is removed from the patient's immediate environment.
