How to Build a Smart Skin-Care Routine When Managing Eczema

If you’re living with eczema, you know that what you do — or don't — apply to your skin can affect whether red, dry, and itchy skin stays at bay. But sometimes figuring out which products are safe for you takes some trial and error.

“The right skin-care routine can help support skin functioning in eczema, but the wrong one can make matters worse,” says Joshua Zeichner, MD, a dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City.

The most common form of eczema is the itchy skin condition called atopic dermatitis, according to the National Eczema Association (NEA). Unlike contact dermatitis, which can be blamed on a specific irritant or allergen, atopic eczema has no defined cause. It appears to be indirectly related to allergies because it's common in people who have respiratory allergy symptoms such as asthma, according to the American College of Allergy, Asthma & Immunology (ACAAI).

Eczema needs to be managed with the right treatment from the time it first appears, which, for between 80 and 90 percent of those who have it, is in the first five years of life, according to statistics from the NEA and the ACAAI.

If you aren’t among these individuals who outgrow eczema in adolescence or adulthood, you’ll want to follow an eczema skin-care plan that helps prevent flare-ups and soothes them when they do occur. Below, consider these pillars of a healthy skin-care routine for eczema, and then work with your dermatologist to build a specific regimen for your skin.

Tend to Your No. 1 Priority: Controlling the Itch of Eczema

Ultimately, overcoming this itching can help prevent skin damage. According to the American Academy of Dermatology (AAD), skin infections are common in people who have eczema. It’s a challenge to prevent eczema rashes from becoming infected, says Dr. Wu. “Bacteria can enter the skin through scratches and other open areas. I’ve seen increasing numbers of patients with eczema that becomes infected with staph and other bacteria.”

Know Where Eczema Is Most Challenging in Adults

One common frustration about adult eczema is that it’s usually front and center, on the face and neck. (Children can get facial eczema, too.) “The skin on the face is thinner than elsewhere on the body, so it’s more sensitive,” Wu explains. Facial eczema can be triggered by cosmetics or skin-care products, according to the National Eczema Society. In adults, it’s frequently found on the eyelids, where it can cause red, flaky, swollen upper and even lower eyelids, according to the AAD. It can also develop around the mouth. “It’s obviously more visible to others when it occurs on the face, so it’s important to treat it sooner rather than later,” says Wu.

The face is not the only area that can be affected. “Eczema patches on the body can become thick and discolored, especially after weeks to months of scratching, and they can develop scabs. The discoloration can persist even months after the itching goes away,” says Wu. Thickened skin from years of scratching may even itch all the time, the AAD notes.

Because eczema makes your skin fragile, you might be more vulnerable to other types of dermatitis compared with someone without eczema. Hands are particularly at risk for the condition because they are exposed to many allergic and irritant triggers. Handwashing, though important, is one way this happens. Frequent handwashing weakens the skin barrier, causing dry and cracked skin, itchiness, and potential infection, according to the coronavirus-covid19-prevention' target='_blank' rel='noopener noreferrer' >Asthma and Allergy Foundation of America (AAFA). Hand sanitizing can be even more bothersome to eczema-prone skin. To reduce hand dryness, the AAFA suggests washing your hands with soap and water rather than using hand sanitizer, and to follow up with a moisturizer directly afterward. This is something to keep in mind during the COVID-19 pandemic, when keep hands clean is key for preventing the spread of the novel coronavirus, and beyond.

Proper Skin Care for Eczema Focuses on Hydrating and Soothing While Minimizing Irritation

“Hydration” is the operative word when putting together an eczema skin-care routine. “We know that in eczema the skin barrier is not working the way it should be, so it is important to maintain skin hydration,” says Dr. Zeichner.

“Soothing” is the other operative word. “Look for products that are specifically made for sensitive skin,” says Wu. “These are usually free of fragrance and other ingredients known to aggravate eczema, including lanolin.” Skip “unscented” products, which may contain a masked fragrance and could irritate your skin, and opt for a product labeled “dye-free,” notes the American Academy of Dermatology.

Also, avoid retinol, vitamin C, and alpha hydroxy or salicylic acids, as these can aggravate eczema, advises Wu. The National Eczema Association, for example, says that while retinol is beneficial for anti-aging, it can trigger eczema flares. One beneficial ingredient to look for is hyaluronic acid, which holds moisture against your skin without being irritating. Past research shows that a hyaluronic acid–ceramide foam may help improve the symptoms of mild to moderate eczema.

Why You Must Moisturize When Treating Eczema

Speaking of prioritizing products that hydrate and soothe, an eczema-friendly moisturizer can play a vital role in your skin-care routine, not only by helping relieve some of the itch of dry skin but also by helping your skin heal, according to the AAD. The organization also notes that it may even decrease your need for eczema medication and prevent eczema flare-ups from becoming difficult to treat.

An emollient-rich moisturizer can sometimes be effective alone, but when used in conjunction with a corticosteroid cream, the moisturizer makes the cream even more effective and may reduce the amount of time you need to use the steroid. Harvard Health Publishing notes that you should just avoid putting the steroid cream on at the same time as you apply your moisturizer. (You’ll want to wait a few minutes in between, so that each product can do its job.) As for the order of which to apply, it’s up for debate, says Zeichner. “I personally have people moisturize first to prime and hydrate the skin — moisturizers are applied liberally, while steroids more sparingly. So applying the moisturizer over the steroids may also inadvertently spread it to places beyond where it was not originally intended to go,” Zeichner adds.

Too Much Is Not a Good Thing When It Comes to Using Products to Treat Eczema

Wu warns that there is a limit to how many times you should apply over-the- counter cortisone products to relieve itching. Cortisone creams can cause thinning of the skin if used long term, according to the Mayo Clinic. Talk to your dermatologist about how often you should use a corticosteroid. For example, between flare-ups, you may be advised to use it only two days per week while just using moisturizer on the other days, a report from the Institute for Quality and Efficiency in Health Care notes.

Also, you may be frustrated by the scaly flakes of eczema, but resist picking at them. “It’s best to moisturize rather than try to remove them,” says Wu. Scrubbing or peeling off the flakes will likely irritate the skin and cause more itching, according to the National Eczema Society. “Plus, you may end up removing new skin that’s attached to the scaly flakes, causing bleeding and creating an opening that may allow bacteria to enter,” Wu adds.

A Starter Skin-Care Routine to Treat Eczema

No two people have the same exact skin, so schedule an appointment with your dermatologist to develop a personalized routine to treat eczema. For a preview of what your regimen may look like, check out the steps below.

One Last Thing About Taming Eczema Symptoms With a Smart Skin-Care Routine

Remember that eczema symptoms may change as you age, as the AAD notes. Check in regularly with your dermatologist, who can help keep your eczema skin-care routine individualized, introduce you to newer treatment products, and help you sort through cleansers and moisturizers to find the best ones for you.

Additional reporting by Julie Davis Canter.

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