Eczema is named from the Greek word, ekzeein, which means ‘to boil over’ as in severe eczema the inflamed skin seems to erupt. There are many different types of eczema, but the underlying treatment approach is the same – to reduce irritation, damp down redness and inflammation, soothe itching and to prevent the overgrowth of skin bacteria which can worsen symptoms.
Best eczema treatments
Eczema is considered mild if there are areas of dry skin, with or without small areas of redness, but infrequent itching.
Moderate eczema is characterised by areas of dry skin with frequent itching, and redness with or without scratch marks (excoriation) and localised skin thickening.
Severe eczema is diagnosed when there are widespread areas of dry skin, incessant itching and redness (without without excoriation, extensive skin thickenin, bleeding, oozing, cracking and changes in skin pigmentation).
If eczema is infected (with crusting, pus, fever and feeling unwell) always seek immediate medical advice from your doctor.
Emollient creams and soothing bath additives are the mainstay of eczema treatment. These soften and soothe the skin, helping to reduce itching, dryness and flakiness.
Corticosteroid creams or ointments (eg hydrocortisone, betametasone) are widely prescribed to reduce skin inflammation, but only damp down symptoms and are not a cure. They are used as sparingly as possible to control symptoms, as long-term excessive use can lead to skin thinning. Other natural approaches are important to help reduce skin irritation, soothe inflammation and moisturise the skin in order to minimise the need for corticosteroid creams.
Natural remedies for eczema
Any severity of eczema symptoms can be made worse by the following, which are best avoided:
- Hard water containing high levels of calcium carbonate, chlorine or other irritants
- Soaps, detergents, cleansers, bubble bath, cosmetics and perfumes
- Synthetic or wool fibres
- Allergens to which you are sensitised (eg pollen, pet hair, dust mites, mold)
- Contact with chemicals: acids, alkalis, oxidising or reducing agents, some mineral oils, solvents
- Exposure to cold winds or excess heat.
- Stress and anxiety.
Wear protective gloves for housework, gardening, washing-up and when preparing citrus fruit and raw vegetables to reduce hand eczema.
Ditch your washing powder
One of the first, and most important things to do is to check your washing powder, whose detergent residues in clothes and bedding will irritate skin. If you are not already using a non-biological washing powder, and thoroughly rinsing clothes, this will make a big difference.
Most people with sensitive skin are already doing this however, and the next step to consider is to avoid washing detergent altogether. Instead, use an eco-friendly laundry ball that cleans clothes without detergent, eliminates bacteria, and is hypo-allergenic which is great for sensitive skin.
As a bonus, this approach works out cheaper than detergents and bleach, too. Some are scented, but for sensitive skin it’s best to use a fragrance free version.
Silk clothing for eczema
Clothing is in direct contact with the skin all day and night, so it is important to wear fabrics that do not irritate your skin. Avoid synthetic textiles and wool fibres which irritate eczema.
While cotton is often recommended for eczema, silk may be a better option. Studies show that just wearing antimicrobial silk clothing is as effective in reducing eczema (atopic dermatitis) symptoms as applying a topical corticosteroid cream under cotton clothing. Significant improvements are seen within 7 days.
Silk fabrics help to maintain the body temperature by reducing the excessive sweating and moisture loss that can worsen dryness and irritation.
Silk clothing is available on prescription in some countries, including the UK, but for cost reasons is rarely offered. A recent study involved 300 children with moderate to severe eczema who wore silk garments for 6 months, more often at night than in the day in addition to standard care (ie corticosteroids). Skin infections were reduced, and symptoms improved in those wearing silk clothing but quality of life improvements such as itch reduction or sleep loss were not measured. Even so, the ‘small treatment effect’ was deemed ‘unlikely to be cost-effective using currently accepted thresholds’. As a result, obtaining silk clothing on prescription is increasingly difficult.
Silk clothing acts like a second skin, helps to relieve itching, retains moisture to improve hydration, repels irritants and aids temperature regulation. It is important to select medical grade silk fabrics for clothing, however, in which the silk fibres are treated to remove silk glue (serecin) to make them hypoallergenic. The silk may be bonded to soothing polymers and impregnated with natural, zinc-based antibacterial agents to suppress bacterial growth. Flat seams reduce irritation, and are positioned away from common irritation areas such as under arm and inner elbows.
Silk bedding also helps to reduce irritation at night and discourages dust mites.
Hard water treatments
Swimming pools that contain hard water and chlorine-based disinfectants are known to worsen eczema. Less well known is that showering or bathing at home in hard water (which contains high levels of calcium carbonate and chlorine) can also irritate the skin.
A study involving over 1,300 infants found a strong link between the hardness of water, and its chlorine levels, and the appearance of eczema (atopic dermatitis) symptoms. The researchers suggested that installing a domestic device to decrease calcium carbonate levels around the time of birth might even prevent many cases of infant eczema.
Fitting a shower device, or shower head, that softens the water by removing calcium carbonate, and filters out chlorine can make a big difference to eczema symptoms.
Soothing and antibacterial bath additives for eczema
Bath additives such as Oilatum, can soothe and treat dry skin while you relax. If you are prone to eczema flare-ups, then the addition of an antiseptic ingredient (Oilatum Plus) can help to reduce these.
Eczema flare-ups are linked with a type of skin bacteria, Staphylococcus aureus, which can directly irritate the skin, or stimulate over-activity of immune cells in the skin. S. aureus bacteria are found on normal skin of just 5% of people without eczema, but is present on apparently normal skin in 85% of people with eczema.
These bath additives can also be used with a flannel in the shower (take care as they are slippery).
Best eczema creams
Emollient creams and soothing bath additives are the mainstay of eczema treatment. These soften and soothe the skin, helping to reduce itching, dryness and flakiness. They must be applied liberally and frequently, and are sometimes wrapped in bandaging to help the emollients sink into the skin.
As a GP who has recommended and prescribed thousands of eczema creams and ointment, I’ve learned which ones are the most effective.
Dry skin needs a protective layer to help retain moisture and hydration. One of the best ranges is Epaderm which was developed by dermatologists, and provides a film barrier to soothe the skin. Epaderm cream and ointment can safely be left on skin as an emollient treatment.
Epaderm Ointment only contains 3 ingredients (emulsifying wax, yellow soft paraffin and liquid paraffin) and is free from SLS, fragrance or other additives. It is highly effective for treating very dry or cracked skin, and for applying at night.
You can also use a small amount of Epaderm ointment as a soap substitute, by lathering under warm water. This cleanses the skin and removes bacteria without irritating or disrupting the normal skin barrier. If using in the shower or bath, take care as it will make surfaces slippery.
Epaderm Cream is suitable for skin that is less dry and cracked. It has a non-greasy formulation that is absorbed quickly into the skin to form a lighter barrier for less severely affected areas, and for day-time use.
NB Unlike emollient creams and ointments, so-called aqueous cream is designed for use as a cleansing soap substitute only, not as a moisturiser. Aqueous Cream BP contains sodium lauryl sulphate (SLS) and, if left on the skin, it can irritate and even cause skin thinning. I usually advise against using aqueous cream for this reason.
Allergenics skin range for eczema
The Allergenics range is more than just a barrier, it contains anti-inflammatory natural ingredients that help to reduce the need for prescribed corticosteroid creams.
Allergenics cream is steroid-free, but damps down irritation with plant extracts such as Aloe vera, coconut oil, borage oil, beeswax, sweet almond oil, rose oil and shea butter plus antioxidant vitamin E and antiseptic zinc oxide. Allergenics Emollient cream and Allergenics Intensive Treatment Ointment also contains a licorice root extract that damps down irritation, and hyaluronate which attracts water to boost skin hydration. Allergenics is a great treatment range for mild to moderate eczema to damp down redness and sensitivity.
Avène emollient cream for eczema
Water from the Avène dermatological spa near Montpellier in the South of France is rich in silicates and is widely used by French doctors to treat skin conditions such as eczema. Having visited the Avène hydrotherapy centre, I have seen first-hand how effective the silky soft water is for soothing skin irritation.
The waters are used to make a range of hypoallergenic, emollient skin care products that allow a wider range of people to benefit. The Avène range is ideal for red, itchy, sensitive skin, especially on the face.
Oat extracts for eczema
Oats (Avena sativa) are a traditional treatment to soothe itchy and inflamed skin. Modern research shows they contain silica and other ingredients that reduce skin irritation and inflammation. Clinical trials show that oatmeal extracts have a direct antioxidant effect and anti-inflammatory effect that suppresses the formation of immune chemicals (cytokines) in the skin to improve dry, irritated skin, scaling, roughness, and itch intensity.
Oat extracts are naturally softening, anti-inflammatory and have a soothing action which is ideal for mild eczema that feels dry, sore and itchy.
Omega 3 cream for eczema
Eczema inflammation is linked with a lack of essential fatty acids. I particularly like the rich, hydrating, A-Derma Exomega Cream range, developed by French dermatologists, which supplies essential fatty acids, and also includes rhealba oat seedling extracts to suppress itch. This range is sterile, hypoallergenic, and particularly good if you eat little in the way of nuts or seeds and are likely to have skin that is deficient in essential fatty acids. The barrier cream can be applied before swimming to protect sensitive skin from swimming pool water.
I hope you’ve found this overview of the best eczema treatments to support your medical care. For more information and advice, Talk Eczema offers many resources.
If you have any questions or comments, or product recommendations, please use the comment form below. Thanks.
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