skin care in patients with eczema

Eczema is a varied group of different non-infectious skin diseases which may be caused by irritation, allergies and other endogenous and exogenous factors. It is the most common category of skin diseases. Eczema may manifest with erythema, papules, vesicles, crusts, weeping and oedema in its acute phase and with thickening of the skin, lichenification, and scaling in its chronic phase. Itching is a guiding symptom.

Eczema requires medical / dermatological treatment. Several topical (ointments, creams, lotions etc. with pharmaceutical ingredients) and systemic (pills, tablets) medications are available.

Skin cleansing
Mild pH-neutral or acidic cleansers should be used. The use of bath oils free of fragrances and emulsifying agents is recommended in patients with dry skin.
Soaps and bubble baths should be avoided. The water temperature should be moderately warm, not hot, and bathing or showering should not occur more often than once a day. Bathing time should not exceed 15 to 20 minutes. After the cleansing procedure, the skin should not be rubbed dry, but rather gently wiped dry with a soft towel. Immediately after showering or bathing, a moisturiser should be applied.

Hair wash
A mild, possibly fragrance-free shampoo should be chosen. As shampoos may lead to skin irritation and exacerbation of eczema, it is recommended to wash the hair over the sink or bath to avoid exposing eczematous areas of the body to shampoo. Wearing cotton-lined rubber gloves during the hairwash process protects the hands.

Skin care
Skin lesions in eczema may vary with acuity and clinical type. The choice of emollients depends on the prevailing clinical picture and type of eczema.

Skin care in acute contact dermatitis (with marked reddening, vesiculation or oozing)

• Lotions or creams based on light oil in water-emulsions should be preferred in acute lesions. Often, the treating dermatologist may include pharmaceutical ingredients.
  Fragrance-free products with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.
  
• Skin care products should be cooled, e.g. by storing them in the refrigerator. This enhances their itch-relieving effect.

• Skin care products based on water in oil-emulsions (mixtures with more oil/ lipids than water) are recommended, as they have the following advantages:
  1) their fat/ lipid replenishing effect is greater than that of oil in water-emulsions (mixtures with more water than oil/ lipids)
  2) their hydrating effect on the stratum corneum is better than that of oil in water-emulsions (mixtures with more water than oil/ lipids)
  
• The use of water-free ointments or lipid-enriched water in oil-emulsions should be restricted to very dry skin areas, though, as these skin care products lead to an occlusion and sweat retention with subsequent itching. Thickened and lichenified dry skin areas respond best to ointments and lipid-enriched water in oil-emulsions.
  
• Water in oil-emulsions (mixtures with more oil/ lipids than water) with humectants (water-binding ingredients) such as urea, glycerin or lactic acid are strongly recommended, as they have an even greater hydrating effect on the stratum corneum. If there are erosions, fissures or cracks present, urea-containing emollients should be used with caution, as urea may cause burning or stinging when applied on fissured skin.
  
• Fragrance-free products devoid of preserving agents with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.
  
• Skin care products should be cooled, e.g. by storing them in the refrigerator. This enhances their itch-relieving effect.
  
• Emollients may be used several times a day, whenever the skin feels dry or itches.

• Lotions or creams based on light oil in water-emulsions should be preferred in acute lesions.
  
• Fragrance-free products with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.
  
• Skin care products should be cooled, e.g. by storing them in the refrigerator. This enhances their itch-relieving effect.
  
• If the skin on the back of the hand is desiccated, the use of two different emollients may be necessary: a light oil in water-emulsion for the palm and a water in oil-emulsion for the back of the hand

• Skin care products based on water in oil-emulsions (mixtures with more oil/ lipids than water) are recommended.
  
• The use of water-free ointments or lipid-enriched water in oil-emulsions might be necessary in very dry skin areas.
  
• Water in oil-emulsions (mixtures with more oil/ lipids than water) with humectants (water-binding ingredients) such as urea, glycerin or lactic acid are beneficial, as they have an even greater hydrating effect on the stratum corneum. If there are fissures or cracks present, urea-containing emollients should be used with caution, as urea may cause burning or stinging when applied on fissured skin.
  
• Fragrance-free products devoid of preserving agents with a small number of ingredients minimise the risk of sensitisation (allergy development) to cosmetic products.