Eczema is a common inflammatory skin condition which leads to redness, dryness and flaking of the skin. The damaged skin may also be prone to infections such as impetigo and herpes. I find it useful to frame the treatment of eczema using 4 principles (just like the four legs of a chair, the combination of all these approaches is needed for a holistic treatment protocol):

1. Moisturisation

Moisturisers are key in the treatment of eczema. Generally, moisturisers need to be applied at least twice daily or more. The types of moisturisers used can be creams or ointments. Moisturisers containing menthol can also help with itch.

2. Anti-inflammatory treatment

Medications used to treat inflammation in eczema range from topical medications (e.g. topical steroids and topical calcineurin inhibitors) to tablets (e.g. oral steroids, azathioprine, methotrexate, ciclosporin, upadacitinib, baricitinib, abrocitinib) and injections (i.e. dupilumab). Ultraviolet light treatment, known as phototherapy, can also be helpful. Patients treated with tablets usually require monitoring and blood tests.

3. Antihistamines

Antihistamines can play a role in helping patients to sleep, particularly with the use of sedating types. However, as there are many causes of itch in eczema, antihistamines are not a “cure-all” to eliminate the itching sensation.

4. Treating infections

Infections affecting skin with eczema include herpes infection, bacterial infections and fungal infections. These should be treated appropriately by a doctor. Herpes infection can present with blisters and small sores while bacterial infections can present with redness and yellow crusts. On the other hand, fungal infections on eczematous skin tend to be more well-defined and can be ring-shaped.