Although eczema cannot be cured, there are a number of things that can be done to help manage and control it. The aims of eczema treatment should be to heal the skin, keep it in good condition, and manage the symptoms of an attack or flare-up when they appear.

The following are treatments that your family doctor or dermatologist may recommend. Please be aware that you should not use a combination of these treatments at the same time, unless instructed to do so by your doctor. It is, however, okay to continue to use emollients while receiving any prescribed treatments.

Emollients

Emollients are the most common treatment for eczema and consist of creams, lotions, or ointments that are applied as a protective film to the skin, helping to soothe it and reduce water loss.  They should be used every day, even on those days when your symptoms appear under control.

Regular use of emollients should help to reduce the frequency and severity of eczema flare-ups.  It is not possible to overuse emollients and you should continue to use them, even if your doctor decides that you need a prescription treatment in addition to help manage your condition.  If you have any questions about emollients, including how often you should be using them, please speak to your doctor.

Corticosteroid (or cortisone) creams

Cortisone creams, applied directly to the skin, come in various strengths and are a standard therapy for hand eczema.  They act by reducing inflammation of the skin associated with eczema flare-ups.

Prolonged use of low- or moderate-potency cortisone creams seems to be well tolerated.  Use of high-potency steroids for prolonged periods should be avoided, as they can be associated with thinning of the skin and other side effects.  You should consult your doctor regularly and follow their advice carefully to minimize the risk of these effects.

You should seek advice from your doctor and pharmacist regarding the strength (potency) and length of treatment that is best for you.  Stronger, more potent steroids are only available by prescription.

Topical immunosuppressants

Topical immunosuppressants (eg, tacrolimus, pimecrolimus), sometimes called topical immunomodulators or TIMs, are available as ointments or creams and are applied directly to the skin.  Like cortisone creams, they help to reduce local inflammation of the skin associated with eczema flare-ups.  However, topical immunosuppressants work differently than the cortisone creams and are not associated with skin thinning.  They are reserved for people with moderate to severe eczema and are prescribed only if steroid treatments have not worked, or if someone cannot use other treatments because of side effects.

There are several types of oral medication that may be prescribed for the treatment of hand eczema including antibiotics, antihistamines, immunosuppressants, retinoids, or steroids. These are typically prescribed by dermatologists if topical treatments and lifestyle management are not sufficient to manage the condition.

Antibiotics

If your doctor believes that your eczema has become infected (redness, weeping, or blisters) as a result of bacterial invasion of damaged skin, they may decide to give you a short course of oral antibiotics and/or an antibiotic cream or ointment to clear up the infection. Some topical products may combine a cortisone cream with an antibiotic to reduce inflammation and fight infection at the same time.

Antihistamines

Antihistamine pills may sometimes be prescribed for short periods of time to help reduce the itch of eczema at night and help break patterns of sleeplessness. Antihistamines that have a sedative effect are generally taken just before bedtime and may cause some drowsiness the next day. This should be taken into account when driving or operating machinery. Antihistamine creams are not effective in treating eczema.

Immunosuppressants

Immunosuppressant pills (eg, ciclosporin, azathioprine), like oral steroid pills, dampen down the body’s immune responses. However, they may be used for somewhat longer periods of time than oral steroids, depending on how well they are tolerated. These products are associated with side effects, and patients using them will require regular blood tests and visits to the doctor during treatment.

Retinoids

Retinoid pills (eg, alitretinoin, acitretin) are sometimes prescribed for hand eczema and contain substances chemically related to vitamin A. Alitretinoin is a new treatment recently approved in some countries for patients with severe long-standing eczema of the hands that is unresponsive to treatment with stronger, more potent steroid creams. Retinoid therapy can cause birth defects when used in pregnant women, so special precautions to avoid pregnancy are required when using this class of drugs in women who are of child-bearing potential.

Steroids

Steroid pills (eg, prednisolone) are sometimes used to treat severe eczema when topical treatments are not effective. Steroids calm down the body’s immune response and are only suitable for use over short periods of time because of the potential side effects of such therapy.

Some people with chronic moderate to severe eczema benefit from ultraviolet light treatment (eg, PUVA [Psoralen plus UltraViolet light A]), which is usually given in a specialist hospital unit supervised by a dermatologist. By carefully exposing affected skin to certain wavelengths of light for specified amounts of time, the exaggerated immune response that causes eczema inflammation can be prevented. You may need to attend the clinic between 2 and 5 times per week for up to 6 months. UV light is a contributing cause of skin cancer and premature aging of the skin, and may not be suitable for everyone, especially if your condition is exacerbated by sunlight.

Remember…

Only a healthcare professional can provide information specific to your needs, and diagnose and treat you effectively. Always talk to your family doctor or dermatologist before using any new treatment for your eczema. Be sure to take the treatment according to your doctor’s instructions. If you have any questions about your treatment, ask your doctor or pharmacist to explain.