Here’s what to do if eczema is seriously affecting your life.
No case of eczema is a walk in the park, but this condition is considered severe once it starts having a negative impact on a patient’s life. The itching can get so intense that it leads to inflamed rashes, bleeding, and infections. This can make it hard to get quality sleep or focus at work.
Severe eczema can be prevented, and this often starts with taking a good hard look at your skin care regimen. “For some patients, eczema flares because they’re not following a great skin care routine,” says dermatologist Suzanne Friedler, MD, of Mount Sinai Hospital and St. John’s Episcopal Hospital.
Some patients will experience severe eczema despite following a great skin care routine and avoiding these common mistakes that make eczema symptoms worse.
These patients will need more potent treatment options. This might include medical treatments such as immunosuppressive drugs, biologics, or phototherapy.
Immunosuppressive drugs suppress or weaken the immune system, so the body is less likely to experience inflammation, which can break the itch-scratch cycle.
Biologic drugs target more specific parts of the immune system that trigger eczema symptoms, according to the National Eczema Association.
Phototherapy, also called light therapy, uses UVB light (yes, the same one given by the sun) to reduce inflammation, relieve itch, and increase vitamin D production, according to Dr. Friedler.
These can often effectively ease eczema symptoms but can come with a risk of serious side effects (and a hefty price tag). For example, light therapy carries the obvious risk of skin cancer for the patient. That’s why derms only recommend these options for the most severe cases of eczema.
Here’s more information about medical treatments for all types eczema, ranging from mild to the most severe.
Dr. Friedler is a dermatologist and clinical instructor at The Mount Sinai Hospital and St. John's Episcopal Hospital.
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Dermatologists consider eczema severe when
the symptoms are having a negative impact
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on a person's daily quality of life.
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Are they unable to sleep, unable to work?
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Some of these patients are scratching
themselves constantly which causes
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their skin to be thickened and
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Sometimes they get head to toe
coverage with this thick scaly red
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So for some patients eczema flares because
they're not following a great skin
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And research shows that many patients
with atopic dermatitis do not
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follow the treatments that
their doctors recommend.
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Avoiding common eczema triggers is
helpful for preventing acute flares,
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as well as for long-term management.
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These triggers include dry skin,
low humidity environments,
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overheating of the skin,
emotional stress, and
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exposure to irritating substances,
such as harsh chemicals or soaps.
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But even some patients who follow good
skin care for sensitive skin, and
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use first line treatments like steroids,
may see their eczema worsen and
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may need other treatments to
help manage their symptoms.
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If you think of eczema treatments
like a pyramid where at the bottom of
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the pyramid, you have good skin care
advice like taking shorter showers and
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using good moisturizer.
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And in the middle you have
treatments like steroids and
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antihistamines to control more mild
inflammation and itching, patients with
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severe eczema are going to need
the treatments reserved for the very top.
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We still instruct patients with severe
eczema to use normal gentle skin care.
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They're still gonna be using steroids, but
these patients are also going to get more
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potent treatments which include
immunosuppressive drugs, biologics and
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The most severe patients are the ones
who're going to need these therapies in
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addition to everything else.
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Immunosuppressive drugs like methotrexate
or cyclosporine weaken the immune system
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to help break that
itch-scratch cycle of eczema.
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Now is an exciting time for patients
with severe eczema with more treatment
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options being researched than ever before.
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There's been an introduction of newer
medication such as biologics to help
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control some of the most
severe eczema symptoms.
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This can be used in patients who have
not responded to other types of therapy.
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Another helpful option for
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treating severe eczema in addition to
your basic therapies is light therapy.
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Light therapy uses a specific
wavelength of UV light,
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usually in the UVB range,
which can help reduce inflammation,
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relieve itch, and
increase your vitamin D production.
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This usually requires two to three visits
a week in your dermatologist's office.
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Treatment for severe eczema dramatically
improves patients' quality of life.
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If you're able to get their skin better,
you help them get better sleep,
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function better at work and
enjoy their social life.
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Biologics. San Rafael, CA: National Eczema Association. (Accessed December 30, 2020 at https://nationaleczema.org/eczema/treatment/dupixent/.)
Immunosuppressants. San Rafael, CA: National Eczema Association. (Accessed on December 30, 2020 at https://nationaleczema.org/eczema/treatment/immunosuppressants/.)
Phototherapy. San Rafael, CA: National Eczema Association. (Accessed on December 30, 2020 at https://nationaleczema.org/eczema/treatment/phototherapy/.)Understanding biologic drugs. San Rafael, CA: National Eczema Association. (Accessed on December 30, 2020 at https://nationaleczema.org/understanding-biologic-drugs.)