ÃÛÌÒAPP
Our Eczema clinic is run by nursing staff who can provide you with information about your condition, and how to manage it.
In particular they will show you how to care for your condition such as how to apply topical treatments (creams).
When you come to our clinic, you will be assessed by a nurse who provide you with treatment as prescribed by a Consultant Dermatologist, or other member of their team.
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.
Sometimes atopic eczema can become infected and may need to be treated. Find out more in our Skin infections in atopic eczema section.
What has caused my eczema?
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. For example, house dust mite or cats.
Treatments
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 (eg. 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 (eg. 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 out eczema affected skin even further).
Take care when getting out of the bath as the surface may be slippery. 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 and 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 skin from the surface to the deeper layers and reduce the inflammation that makes the eczematous skin red, itchy and sore. A thin layer should be applied to affected areas as directed.
Dressings
There are different types of dressings and bandages which may be used.
Medicated Bandages
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.
Wet Wraps
It is important to realise that wet wraps are not a cure for eczema but 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.
Clothing
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 and 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.