This information has been written to help explain the treatment which has been prescribed and to try and answer questions that you may have. If you require any advice please ask the Eczema Nurse or any member of the Nursing Staff.
What is Eczema?
Eczema is a disorder of the skin causing itching, dryness, redness and inflammation. The skin may weep fluid. There are a number of different causes of eczema. Atopic eczema is the most common and may be associated with a personal or family history of asthma/hayfever.
The tendency to develop atopic eczema is inherited. There is often someone else in the family with eczema, asthma or hayfever but this is not always the case. It appears that individuals inherit a tendency to produce abnormal reactions to common allergens found in the environment (eg house dust mite or cats).
The first part of treatment includes bathing. This helps to clean the skin and prevent infection. Preparations which may be prescribed for use with bathing include Potassium Permanganate. This is an antiseptic solution which is sometimes used to treat eczema that is weeping or that has become infected. A small amount is added to the bath water which turns a light pink colour. It should be added immediately before the child/adult gets into the bath as when it is put into the water it only remains active for approximately 10 minutes. It can stain the skin slightly. The bath should be cleaned immediately to prevent staining.
Moisturisers and Soap Substitutes
Regular application of moisturisers is an important part of eczema treatment. In general, the more greasy moisturisers (e.g. Epaderm or Hydromol, or Emulsifying Ointment) are most effective although they may leave a greasy film on the skin. Some patients may not tolerate this and prefer a less greasy moisturiser (e.g aqueous cream).
Epaderm /Hydromol Emulsifying Ointment
By holding the tub of ointment-under hot running water or a shower head a moisturising bubble bath can be produced. It can also be used as an alternative to soap by gently massaging into the skin then rinsing off (soaps tend to dry eczematous skin out further). Take care when getting out of the bath as the surface may be slippy. When drying the skin, pat gently with a towel. This will leave a thin layer of the emulsifying ointment and provide a barrier. Lastly it can be used directly on the skin as a moisturiser, it is best to mix the ointment with a little water to help application.
Topical Steroids (steroid treatments applied to the skin)
These may be prescribed by your doctor. They should be applied once or twice daily. Topical steroids may be prescribed as an ointment or cream. Nursing staff will demonstrate and supervise the application of these. There are also different strengths of topical steroids from mild to very potent. Examples from the four principal groups are given below. You may be prescribed more than one strength for use, for example, at different sites.
- Low Potency
Example: Hydrocortisone 0.5% and 1 %. Use: Face, limbs, trunk (adult or child).
- Medium Potency
Example: Eumovate, (clobetasone butyrate 0.05%), Betnovate-RD, (betamethasone valerate 0.025%. Use: trunk and limbs: adult or child (short term), face (short term).
- High Potency
Example: Betnovate (betamethasone valerate 0.1%). Use: trunk and limbs: Adult or child, short term treatment.
- Very High Potency
Example: Dermovate (clobetasol propionate 0.05%) Use: trunk and limbs: adult or child, short term treatment.
Topical steroids are able to penetrate from the surface to the deeper layers of the skin and reduce the inflammation that makes the eczematous skin red, itchy and sore. A thin layer should be applied to affected areas as directed.
There are different types of dressings and bandages which may be used.
These are applied to the arms and legs and have a cooling effect when first applied and relieve irritation. They are however quite messy to apply. The arms are usually bandaged from wrist to underarm and legs from toes to the top of the thigh. To apply the medicated bandages, first imagine a centre line running up the forearm. Start at the wrist in the centre line and fold the bandage around until you reach the starting point again. Then pull the bandage out slightly so you now have an excess of free bandage. With this extra part fold it back over the centre line and then back over this to make a 'pleat'. Continue working your way up the arm in this fashion until you reach the top of the arm. The finished bandage should have pleats down the centre. The pleats are there to give maximum mobility and compensate for any shrinkage. An elasticated Tubifast bandage, or Comfiifast is applied to the limbs and a Tubifast or Comfiifast vest to the body which are tied together to secure the medicated bandages in place. These dressings also prevent scratching and are quite comfortable to wear.
It is important for the patient to realise that wet wraps are not a cure for eczema but they can be helpful in controlling the symptoms.
Wet wraps involves the application to the skin of two layers of Tubifast, or Comfiifast bandage. The first layer is applied moist, the second layer is dry. As the water in the bandages evaporates, a cooling effect results.
When wet wraps have been prescribed, the Eczema Nurse or Treatment Room Nurses will demonstrate how to apply the bandages.
Try to avoid pure wool or nylon clothes next to the skin, cotton clothing is preferable.
Remember that wrists and necks are likely to be irritated by pullovers whatever is worn underneath.
Cotton mitts or gloves can be worn by children/adults while sleeping to prevent scratching.
You may not have been prescribed all of these treatments and this information is intended as a general guide only. If you require further information please ask the nursing staff. Leaflets are also provided, please take one.