Treatments can’t cure eczema but they do help to relieve symptoms. The most important thing is for sufferers to find an appropriate skincare routine.

Emollients
(e.g. Eumobase, Balneum, Cetraben, Dermol 200, E45, Emulsiderm, Diprobase, Eucerin, Hydromol, Oilatum and Unguentum M)

Emollients work by replacing natural moisturisers in the skin. They also form a protective barrier over the skin to help keep it hydrated This helps to prevent further moisture loss and also helps to stop bacteria or irritants getting into the skin and causing a flare up which is commonly associated with eczema.  To have the best effect, emollients should be used regularly, a number of times a day. They come in a range of formulations, including ointments, creams and lotions, which are used in different ways.

Ointments and thick creams are best suited for very dry, thickened or brittle skin or for using at night. When the skin is sore or has weepy blisters, then lotions or lighter creams are used because they are easier to apply.

Note that patients may have their own preferences when it comes to choosing a particular type of emollient. Some may find they are sensitive to particular ingredients, such as lanolin, or to perfumes in some formulations. It may take some time to find which suits them best, but this is important because sufferers are much more likely to use a product if they like it. When trying a product for the first time, it should be tested first on a small patch on the arm and left for 24 hours in case a reaction occurs.

The best time to apply any kind of emollient is after a bath or shower because it helps to ‘lock’ water into the skin.

Adding an emollient oil to bath water is a good way to help hydrate the skin. A fine film of oil is left on the skin and this helps to trap water in, keeping skin soft and supple. Emollient oils can either be added to bath water or be applied directly to wet skin in the shower on a sponge.

Warn patients that these oils make the bath and shower slippery so care is needed and perhaps the use of a non-slip mat maybe helpful.

<PRACTICE POINT>

Look at the range of emollients stocked in your pharmacy, noting the different formulations, active ingredients and usage instructions.

Topical steroids

Emollients are useful when eczema is under control, but during flare-ups a steroid cream might be needed. These help ease itching and reduce inflammation and can be used for most types of eczema. They come in a range of strengths, depending on severity and the part of the body to be treated. The strongest are only available on prescription but milder treatments can be purchased over the counter. In general, it’s best to use the lowest strength steroid that is effective. Two types of steroid sold OTC are:

1. Clobetasone butyrate (e.g. Eumovate Eczema and Dermatitis Cream, which contains 0.05%). It can be used for the short-term treatment and control of patches of eczema and dermatitis. Adults and children aged 12 and over can use the product sparingly for up to seven days
2. Hydrocortisone creams and ointments up to 1% in strength (e.g. Dermacort, Eurax HC, HC45 and Lanacort). These are suitable for adults and children over 10 years.

In the case of both hydrocortisone and clobetasone butyrate, they should be applied thinly and evenly over the affected area. Note that certain restrictions apply as to who can buy these products and to which parts of the body they can be applied.

<PRACTICE POINT 1>

Discuss with your pharmacist:

1. Who can you sell these products to?
2. Which parts of the body can they be recommended to treat?
3. Which customers should be referred to the pharmacist for further advice?

Other treatments

There are other products available which will help to alleviate the itching caused by eczema, called antipruritics.

Crotamiton (e.g. Eurax) will soothe and reduce the itching but it will not deal with the underlying causes of the ecezma.  However crotamiton does come in combination with 0.25% hydrocortisone (e.g. Eurax HC).

Lidocaine (e.g. Dermidex) can also be used to numb the itching sensation but can only be used for short periods of time.

<PRACTICE POINT 2>

What OTC products and advice would you recommend for the following customers?

1. A young lady with an itchy red rash over her body.  She has just used a new shower gel.
2. A car mechanic with sore, itchy hands.
3. A woman with a rash on her earlobes, which appeared after wearing new ear rings.