Jay L. Cohen, M.D.

​

In many people, eczema has two main components, which may exist together or separately.  The first is inflammation, which is characterized by redness, itching, irritation, weeping, and occasionally by the presence of blisters.  The second is dry, thickened skin, which may include flaking and fissures (cracks).  Treatment is tailored to each individual, but usually includes several of the following:

 

Moisturizers

 

Moisturizers are the key to any long-term control of eczema and dry skin.  They have two functions – to put water back into the skin and to lock it in.  Those that are thick and greasy, such as Vaseline, add little water to the skin but are best at locking it in.  A list of moisturizers by water content (from highest to lowest) would look like this:  lotion, cream, ointment, hydrophilic ointment (Aquaphor), Vaseline.  The ideal way to treat dry skin would be to apply lotion or cream first and then cover it with an ointment or Vaseline.

 

For severely dry skin there is no such thing as too much moisturizing.  Carry a small tube or bottle with you, keep some where you work and keep a few bottles around the house.  Use it liberally 4-5 times daily.  For patients with eczema, soaking your hands in whole milk or applying whole milk compresses to the face or body can be very soothing and may speed the healing process.  Follow this with your moisturizer or tar preparation as directed.

 

Water

 

While one might think water is good for the skin, the opposite is frequently true.  When we wash our hands, little water is absorbed.  Water on the skin then evaporates and pulls even more water out of the skin, resulting in a net loss of water and increased dryness.  It is important to minimize contact with water, detergent, and foodstuffs.  When washing dishes or cutting fruits and vegetables wear a pair of thin cotton gloves under rubber or vinyl gloves.   Wearing vinyl or rubber gloves alone might cause the hands to sweat and may worsen dry skin.  Keep a pair of cotton gloves in each room and wear them often.  Most parents greatly prefer to bathe their children with their bare hands. This is quite understandable, but 5 minutes exposure to soapy water can undo an entire day’s efforts at “pampering” your hands.  Make a game of wearing your bright yellow gloves over cotton gloves when bathing your children.

 

Steroid (Cortisone) Creams, Ointments

 

Steroids are produced naturally by the body to regulate numerous aspects of our metabolism.  They have strong anti-inflammatory properties, and so are used on the skin to reduce the redness, itching and blistering associated with conditions such as eczema, psoriasis, and poison ivy.  The strongest preparations are best used for short periods of time to produce rapid relief of symptoms.

Chronic use of steroids, even relatively mild ones, may result in unwanted side effects.  These include thinning of the skin, stretch marks, “broken blood vessels”, and loss of skin pigmentation.  Our goal is to use steroids appropriately when needed and then to change to other types of treatment for long term control.

 

Tar

 

The tar products used in dermatology are extracted from crude coal tar, which itself consists of hundreds of different chemical compounds.  They slow the rapid proliferation of skin cells in psoriasis, heal thickened cracked skin, and reduce the inflammation seen in many skin disorders.

 

If you have been prescribed a tar preparation, it is best to apply it at night, either alone or on top of any other creams you are using.  Covering the area will help the medication to penetrate the skin as well as protect your linens from staining.  Gloves or socks may be worn on the hands and feet and plastic wrap may be used to cover affected areas on the arms and legs.  If large areas of the body are affected, it is best to wear an old pair of pajamas or a Sleep Sauna (a “track suit” specifically designed for this purpose).

 

Gloves

 

As mentioned above, special types of hand and foot gloves will help you get the most benefit from your treatment.  We particularly recommend gloves made by Allerderm.  They may be purchased at local pharmacies, by mail, by phone, or through our office.

 

Suggestions

 

Morning:  If a steroid preparation was prescribed apply it first, and if a moisturizer is needed apply it 15 minutes after the steroid preparation.

 

All Day:  Wear cotton gloves under rubber or vinyl gloves for any housework (including while folding laundry), dishwashing, yardwork, etc.  Moisturize at least 4-5 times, especially after washing your hands.  We suggest brands such as Lubriderm, Neutrogena, Cerave, Cetaphil, or any moisturizer that you find helpful.

 

Night:  Soak your hands in whole milk or warm water for at least 15 minutes or take a long warm bath.  This will help your skin “load up” on water.  After soaking or bathing, gently pat the skin dry; do not rub or allow to air dry.  Immediately apply:

 

1. Your moisturizer.

2. Cover with gloves, socks, plastic wrap, pajamas, “track suit”, etc.

3. Sleep tight!  If you follow this program carefully you should see results in a few days.

4. We strongly recommend using a humidifier during the heating season.