Eczema Creams And Ointments

Eczema creams and ointments are the greasiest of moisturizers. They do not contain water, and provide an occlusive layer that reduces the evaporation of water from the skin surface and traps moisture in the skin. Most eczema creams are made from mineral oils (paraffin, petroleum jelly) but some come from animal or vegetable fats or are synthetic. They are especially helpful in treating very dry skin, but can be unpopular because they make clothes and bedding greasy. Ointments are very resistant to bacterial and fungal contamination because they do not contain water, and they do not usually need antimicrobial preservatives. One of the simplest and most effective emollients is a mixture of equal parts (50:50) liquid paraffin and white soft paraffin. It is truly ‘hypoallergenic’ because it does not contain added chemicals such as fragrances or preservatives, and it is an ideal choice for eczema treatment where contact allergies are a problem. Ointments work best at trapping skin moisture when the skin is well hydrated after soaking in a warm bath.

Types Of Eczema Cream

Eczema Creams

An eczema cream contains a mixture of oil and water in variable proportions – oily creams containing relatively more oil than simple creams. An emulsifier needs to be added to ensure an even mixture because oil and water usually separate from one another. Once applied, the water mostly evaporates, although some may be absorbed by the outer epidermis. The most important effect is the thin film of oil left on the surface which traps moisture in the skin.

Eczema Lotions

Cream For Eczema

Generally, an eczema lotion is a watery preparation that contains the least oil and is of little use treatments for eczema, but they do have a cooling effect – hence their use in conditions like sunburn. Because they are non-greasy, an eczema lotion may be useful for treating hairy areas such as the scalp. Their high water content means that preservative chemicals need to be added to prevent bacterial and fungal growth.

Added ingredients

Some eczema creams and emollients contain added ingredients to improve their effectiveness or to give additional actions:

• Humectants are substances that increase the ability of eczema creams to moisturize the skin. They include natural chemicals such as urea and lactic acid which are found in sweat. They are especially useful for hard, dry skin areas but can cause stinging.
• Anti-itch ingredients (anti-pruritics) occasionally present in topical treatments for eczema include lauromacrogols and menthol.
• Antiseptics reduce the level of bacteria on the skin, which can aggravate eczema and trigger a flare. They include benzalkonium chloride, triclosan and chlorhexidine. These chemicals can sometimes cause irritation.

Topical Steroids As Treatments For Eczema

The steroids used as treatments for eczema and other inflammatory skin diseases are a group of substances called ‘corticosteroids’, which are related to the body’s natural hormone cortisol. They should not be confused with anabolic steroids such as testosterone, which are used illegally by some athletes to build up muscles. Cortisol and other corticosteroids have many anti-inflammatory actions, which is why they are used for a variety of medical problems from asthma to arthritis. These anti-inflammatory actions include reducing skin blood flow and suppressing the influx of fighter white blood cells into the skin. They also slow the rate of growth of epidermal skin cells and dermal collagen fibers.

For most medical problems, steroids are taken internally, but one of the good things about treating skin complaints is that medications can work effectively when applied externally, i.e. topically. There are fewer problems from using steroidal eczema creams topically than when they are taken internally. In the early years of use, before doctors were aware of the side effects, strong steroids were prescribed for long-term treatment of skin complaints on delicate skin areas such as the eyelids, face and skin folds. This led to skin damage in the form of thinning (steroid atrophy), stretch marks (striae), ‘broken veins’ and persistent facial redness. However, it is now over 50 years since topical steroids were first used, and there is a great deal of experience in getting the best out of steroidal eczema creams while minimizing the chances of skin damage.

Unfortunately, the memory of steroid atrophy has lingered and it has created a phobia of steroids among eczema sufferers and their carers. Sometimes this anxiety leads to the eczema sufferer being denied safe effective treatment and relief of symptoms.

Topical steroids are usually very effective at suppressing mild to moderate eczema as well as other inflammatory rashes. This gives the skin a chance to heal and helps break the itch-scratch cycle that worsens eczema. However, it would be a mistake to think of steroids as a cure for eczema and it may come back or relapse when the eczema treatment is stopped. This can cause frustration for eczema sufferers because it makes treatment seem like a game of snakes and ladders.

Eczema Treatment Myth #1

All topical steroids are dangerous and cause skin damage.

The Facts:

Topical steroidal eczema creams come in four different strengths. Skin thinning is only likely when strong or very strong steroids are used long term, especially on delicate areas of skin such as the eyelids and skin folds (flexures) around the armpits and groin.

Milder steroids rarely, if ever, cause this problem when used sensibly. Internal (or systemic) side effects from topical steroids are very uncommon but can occur if stronger preparations are overused. In order to prevent this, the maximum recommended weekly dose is 50 g for very potent steroids and 100g for potent steroids.

Although topical steroids look similar, there is a world of difference between the effectiveness and safety of strong or very strong steroids and mild steroids. In general, the stronger the steroid, the more effective it is, and the more likely it is to cause unwanted effects such as skin atrophy.

For this reason, only mild steroid based eczema creams should be used on delicate areas such as the eyelids. However, these are usually ineffective on the thick skin of the palms and soles, where a stronger steroid is needed. The choice of steroid also depends on how severe and widespread the eczema is. Small stubborn patches of very active eczema such as lichen simplex may need a strong steroid, but a milder steroid would be used to treat a larger body area. Young children (under five years) are usually prescribed mild steroids, although occasionally they may need stronger preparations.

Like moisturizers, topical steroidal treatments for eczema come as ointments, creams and lotions that vary in their greasiness. There are also gels for hairy areas like the scalp. In general, an ointment is best for dry, scaly, cracked eczema while a cream is easier to apply to weepy acute eczema. Ointments are more moisturizing and contain fewer additives such as preservatives.

Some steroids contain additional active ingredients, including the following:

• Antibiotics to treat bacterial infection
• Antifungals to treat yeasts and fungal infections
• Coal tar to calm inflammation and reduce skin scaling
• Salicylic acid to soften thickened skin
• Urea to hydrate the skin.

One of the problems with tubes of steroids is that they do not have any coding to indicate their strength. It is very important that people applying steroidal creams for eczema know exactly which ones to use on different body sites. If you are unsure, ask your doctor to write a simple list of what to use where, and mark the strengths on the tube packets, or speak to your pharmacist.

Eczema Treatment Myth #2

Because they are dangerous, steroids can only be obtained with a prescription.

The Facts

Some mild steroidal eczema creams (0.1,0.5 and 1 per cent hydrocortisone) and a moderate strength topical steroid (clobetasone butyrate) are available from pharmacies without prescription. This is not medically supervised, so purchasers are advised not to use these preparations on the face or genital area, during pregnancy or on young children.

This is a precaution in case the treatment was being used inappropriately, and although it is sensible advice, it can make people feel unnecessarily worried about using topical steroids.

What to do if a steroid doesn’t help

If a topical steroid does not seem to be working in eczema there are several possible reasons, including the following:

• The eczema is too severe and the steroid too mild
• Not enough steroid has been applied, or treatment stopped too soon – often because the eczema sufferer is afraid of side effects
• The person has an allergy to an ingredient in the topical steroid or another treatment being applied to the skin
• The diagnosis is wrong, for example, not eczema but a fungal infection.

On rare instances, steroidal eczema creams can actually cause allergic reactions. This is easily overlooked because they also have anti-inflammatory actions. However, it should be suspected if someone’s eczema gets worse after applying steroidal treatments for eczema. If there is any question of allergy to any topical medicament including steroids, patch tests should be carried out.

Finding A Treatment For Eczema

Tagged as: cream for eczema, creams for eczema, eczema cream, eczema creams, eczema lotion, treatments for eczema