If you experience the irritating, itchy, red skin symptoms of eczema, you may be aware of the various different preparations that are available, both from your doctor on prescription and from your pharmacist over the counter.
Topical preparations are creams, lotions, gels and ointments that can be applied to the skin to help relieve the symptoms of skin conditions such as eczema.
Here, we discuss these treatment options, what they are, how they work and if there are any side effects associated with them.
Emollient Creams For Eczema
Emollient creams are often recommended for eczema and can be used more freely than steroid creams (see below). They’re usually used to help treat eczema that is causing dry, scaly skin, rather than red or infected eczema.
They’re similar to a normal moisturising cream in that they help to relieve dry skin, but they’re stronger.
Emollients work by covering the skin affected by eczema with a protective film like barrier. This helps to reduce water loss from the skin which helps to keep it hydrated and moisturised.
They can also help with mild inflammation and can reduce the number and frequency of eczema flare ups you experience if you use one regularly.
These types of creams work best on mild cases of eczema and can be bought over the counter from your pharmacist. Your pharmacist can advise which type of emollient is best for you. They’re available as lotions, creams and ointments.
Ointments contain more oil and are therefore generally greasier than creams and lotions. Lotions contain the least amount of oil and are therefore the least greasy, and creams are between the two.
You may benefit from a mixture of lotions, creams and ointments, depending on your activities for any particular day. For example, you may want to use a lotion or a cream on your face, or on your body if you’re going out. Then you may want to use an ointment in the evening or if you’re planning to stay at home for the day.
Emollients are also available as washes, shower gels and liquids that you can add to the bath. These all replace soap which can be very drying on the skin.
There are different emollients available for the skin on the body and the skin on the face. Some contain artificial fragrances and colourings which can be irritating so ask your pharmacist for one without these additives.
Emollient Side Effects
There are some side effects associated with emollients. These include a reaction to an ingredient in the emollient that causes the skin to feel hot or feel like its burning or stinging. They can also block the pores which can cause blockages in the hair follicles which can lead to rashes or boils and make acne on the face become more inflamed.
Some emollients contain paraffin which can be highly flammable, so make sure you stay away from flames and cigarettes when applying a paraffin based emollient. Be mindful of clothing that can be stained with paraffin as this doesn’t was out easily and can still be flammable.
Topical Steroids For Eczema
Among the most common topical treatments for eczema are steroid or corticosteroid creams. Steroid is the name used to describe all types of steroid drugs. The word corticosteroid describes medications and medicated creams that work similarly to cortisone.
Cortisone is a hormone produced by the adrenal glands. It’s released by the body to help control levels of inflammation. If inflammation levels become high, for example due to consuming high levels of sugar, fried food or alcohol, eczema symptoms can become worse.
The body cannot produce enough cortisol on its own to help stop all inflammation so corticosteroid creams help to slow down the inflammatory response that is responsible for so much eczema misery.
Topical corticosteroids are available in creams, ointments and washes. You can buy weaker versions called hydrocortisones over the counter from your pharmacist and you can get stronger ones, if necessary, on prescription from your doctor.
They work by relieving inflammation which in turn helps to relieve the itching caused by eczema. You may need a different corticosteroid cream if you have eczema on your body to if you have eczema on your face.
Corticosteroid creams are generally used to help treat a flare up of eczema, rather than treating the underlying cause of your skin complaint.
Topical Steroid Cream Side Effects
The downsides of corticosteroid creams and ointments is that they can thin the skin and increase the rate of hair growth on areas of the skin where hair growth isn’t welcome, such as on the hands and face. Topical corticosteroids can also cause other skin complaints such as acne spots, stretch marks, darkening of the skin (hyperpigmentation), lightening of the skin (hypopigmentation) and thickening of the skin (lichenification).
Rarer side effects of corticosteroids include eye damage, folliculitis (inflamed, red, infected, pus filled hair follicles) and problems with the immune system becoming weakened.
Usually, doctors recommend only using corticosteroid creams for short periods of time such as one or two weeks. This will help to minimise the risk of these negative side effects.
If you do suffer a side effect from using corticosteroids, talk to your pharmacist or GP. Side effects should start to reduce once you stop using corticosteroids but your eczema symptoms may reappear. Your GP may be able to prescribe a different corticosteroid if you decide that you’d like to persist with one.
Topical Calcineurin Inhibitors
There are another group of medicated creams that help to reduce the inflammation of eczema, that aren’t steroid based. These medications are called topical calcineurin inhibitors and there are two types – tacrolimus ointment and pimecrolimus cream.
They both work by having a dampening effect on the immune system and are called immunomodulating drugs. They block a chemical called calcineurin which is released by the immune system and causes skin inflammation, redness and itching.
By dampening down the immune system, these drugs help to slow down the release of calcineurin. They’re used to help prevent flare ups of eczema and are only available on prescription from your doctor or dermatologist.
Topical Calcineurin Inhibitor Side Effects
Around half of all people using topical calcineurin inhibitors experience burning, itching, tingling or redness of the skin that’s being treated. These side effects usually disappear after about a week of continuing with the treatment as the skin gets used to it.
Unlike corticosteroids, calcineurin inhibitors don’t cause a thinning, lightening or darkening of the skin and therefore may be better suited to you if your eczema is on your face or you cannot tolerate corticosteroid creams and ointments.
Calcineurin inhibitors are also available as an oral drug, but these aren’t used to treat eczema. Instead they’re used for other immune diseases and after organ transplants to stop the immune system rejecting the new organ.
When taken orally to suppress the immune system, these drugs can lead to a higher risk of developing certain blood and skin cancers. There is no evidence to suggest that using them topically to treat eczema has the same risk since lower concentrations of the drugs are used and absorbed into the bloodstream.
Topical Prebiotics For Eczema
There is emerging evidence that topical prebiotics can be useful in the treatment of eczema. The gut naturally contains trillions of good bacteria, fungi and viruses that help to keep the gut healthy, as well as the immune system. They’re called probiotics, which feed off prebiotics.
The skin also has its own natural microbiome, or collection of bacteria that keep it healthy. Products that contain these prebiotics to feed the beneficial bacteria, are now coming onto the market and are available from chemists.
Some contain oatmeal which helps to feed the good bacteria on the skin and others contain thermal waters said to create the right pH for the skin.
Similarly, applying live bacteria in the form of yoghurt or kefir directly to the skin can also help to improve eczema prone skin.
The evidence is sketchy and the products are new, so use them sparingly and with caution to begin with. Stop using them if your eczema becomes worse.
Topical Antibiotics For Eczema
If your eczema is very itchy, causing you to scratch your skin, it can lead to open sores and cuts. These are then susceptible to infections. If your eczema is infected, it may ooze and feel hot to the touch.
In these cases, topical antibiotic creams can be useful to kill the bacteria causing the infection. You shouldn’t use topical antibiotics for eczema for longer than two weeks, unless otherwise directed by your doctor.
Where possible, try not to scratch your eczema, and instead use the tips of your fingers (rather than your nails) to gently rub at your skin to relieve the itch. Wearing gloves in bed will help if you scratch at your skin during the night.
If you do require an antibiotic cream from your doctor, it’s likely that you’ll be prescribed a cream called fusidic acid. Antibiotic creams don’t often cause side effects, but they can cause skin irritation in the areas that they’re applied.
They can also cause hives, also called urticaria, which leads to very itchy, raised bumps on the skin. This will make infected eczema feel worse. So if you’re using a topical antibiotic and your skin starts to feel itchier, stop using it and speak to your GP.
Topical Analgesics For Exzema
An analgesic is otherwise known as a painkiller. A non-steroidal anti-inflammatory painkiller called crisaborole is now available as a skin ointment specifically for treating eczema. This is new and only available on prescription from some doctors.
It works by inhibiting the effects of an enzyme that is known to play a role in the development of certain types of eczema.
Crisaborole can help to reduce the inflammation and calm the itching associated with mild to moderate eczema. On the downside, it can cause a burning sensation, swelling, redness or stinging of the skin along with a faster heartbeat and a swelling of the face, throat or tongue.
Speak to your doctor or dermatologist to see if this ointment is available to you.
Cannabis Topicals For Eczema
The non-psychotic elements of the cannabis plant can also be used to help treat eczema. Cannabinoids, found in CBD oils and creams, won’t make you high, but they do have anti-inflammatory properties that can reduce the itching associated with eczema.
Cannabinoids reduce itching by reducing the histamine released by the skin, which causes the allergic response in some cases of eczema. They’re therefore being touted as a safer alternative to steroids or immunomodulators.
It’s perfectly legal to use CBD products, but if in doubt, speak to your GP about using CBD creams.
Natural Topical Treatments For Eczema
If you’re looking to avoid medicated topical creams and ointments, there are also some more natural topical products for eczema. Some people use apple cider vinegar for their eczema.
It’s thought that it helps to fight the bacteria that can cause eczema to become infected. Apple cider vinegar is highly acidic and should never be applied to the skin neat.
Berberis aquifolium, also known as Mahonia aquifolium, barberry or berberis is a botanical remedy used to help treat eczema and other inflammatory skin conditions. It has a natural anti-inflammatory action and studies have found it to significantly improve the symptoms of eczema with minimal side effects (slight rashes or burning sensations.)
Another natural topical remedy for eczema is liquorice gel. Studies have shown that a compound found within liquorice can help to treat the itching and inflammation associated with eczema.
We think it’s exciting that more natural remedies are emerging for the topical treatment of eczema. We hope that you find solace in an effective treatment or combination of treatments for your eczema, especially if you’re suffering side effects from using medicated treatments.