5 Surprising Myths About Eczema Treatment Explained
Explaining several prevailing beliefs about atopic dermatitis
Eczema, also known as atopic dermatitis, is a frustrating and challenging condition to treat. A chronic, itchy, irritated, and scaling rash, eczema leads to poor sleep, frequent scratching, and a lower quality of life. Eczema is challenging enough to treat and it’s important to dispel common myths about eczema:
Myth #1: Eczema Is Contagious
It can be uncomfortable on many levels for a child or adult to have visibly irritated skin. It is even more embarrassing if the people around them think that they have a contagious disease. Eczema is a condition that develops as a result of both genetics and the influence of environment. However, it is not an infection that can be spread from person to person.
Verdict: False. Atopic Dermatitis (eczema) is not a contagious disease.
Myth #2: Topical Steroids Are Unsafe
Topical steroids are used when the eczema is starting to flare and the skin starts to become irritated. It is one of the most effective medications that can reduce inflammation. The notion that steroids are foreign to the body is simply not true. Steroids are naturally made by the body and some examples include sex hormones (progesterone, estrogen, testosterone), cortisol, and aldosterone. The safety of topical steroids depends on how they are used.
The correct way to use steroids is to limit its use to periods when the skin is flaring and to taper its use during maintenance periods. Although steroids are typically used twice daily, lowering the frequency of application to once daily may maintain the steroids’ effects while lowering the side effects.[2,3] During the maintenance phase, the steroids are typically completely stopped. Some providers may elect to use the steroids once or twice weekly to reduce or prevent future mini-flares.
On the other hand, there are several ways to incorrectly use topical steroid and should be avoided:
- Strong topical steroids (Class 1, 2, and 3) are not to be used on the face unless this has been discussed with and approved by a health provider.
- Strong topical steroids should not be used in skin folds (armpits, under the breasts, or in the groin) without discussing this with a health care provider. Strong topical steroids can absorb more quickly in the skin folds and lead to skin thinning and stretch marks in these places.
- If steroids are used for long periods of time, they can lead to skin thinning. This should be discussed with a health care provider. Many providers recommend taking a steroid “holiday” once it has been used for several weeks.
Verdict: It depends. Topical steroids are both safe and effective when used correctly.
Myth #3: The Itching in Eczema Can Be Controlled By Not Scratching
The itching that comes with eczema can be very severe, and it is often not easily avoided. It turns out that people with eczema can trigger their itch simply by seeing other people scratch. Not only is the itching severe and associated with pain and heat, but the itching is constant. People with eczema cannot simply stop itching. The skin gets caught in the itch-scratch cycle: as the skin becomes itchy, the person tends to scratch, and the skin then becomes even itchier as a result of the scratching. In many cases, the scratching occurs at the subconscious level at night which tends to cause poorer sleep quality in people with eczema.[6,7]
In this case, it is not as straightforward as just “stop scratching.” People with eczema need relief from the scratching, especially at night. This can be achieved by a variety of methods:
- Antihistamines: Oral antihistamines may work by directly reducing the itch sensation in the skin, although their ability to reduce itch in eczema seems limited. The benefits of using antihistamines may rely on the drowsiness that they cause at night, so physicians may recommend taking a dose 1-2 hours before bedtime at night. This would allow more deep sleep and diminished itching while reducing medication-related drowsiness in the morning.
- Wet wraps or damp clothes: In children, heat and dryness can lead to worsened itch. One approach is to create a local environment that is moist and allows the skin to retain more water. This can be done in children by having them wear very lightly damp clothing (like pajamas) at night and then placing a warm set of clothes over the top when they go to bed. This can create a more humid environment locally for the skin without being too uncomfortable.
- Apply moisturizer at night: Moisturizers are typically applied after bathing. If the bathing is done at night, then this will be the perfect time for applying a nice coat of moisturizer before bed. If you or your child bathe in the morning, it may be worth applying a second coat of soothing moisturizer before bed to reduce the dryness and sensitivity of the skin that is typically seen in eczema.
Verdict: True, but patients with eczema need help to control their scratching. It’s not just in their head.
Myth #4: Swimming Pools Can Make Eczema Worse
Swimming pools have a bad rap since they are known to cause dry skin. The fear is that the drying effect of swimming pools can worsen eczema too. However, swimming pools can have beneficial effects for those with eczema. Similar to bleach baths, the chlorinated water can help manage and kill excess bacteria on the skin to rebalance the microbiome of the skin. The key to swimming is that the skin should be rinsed with a regular water shower after getting out of the pool, and moisturizers should be applied to the skin immediately afterward.
Swimming may be harmful to the skin in those with eczema if it is daily swimming. However, swimming 1-3 times a week can be beneficial. People should find their personal balance of how much swimming their body and skin can take, but total avoidance of swimming pools is not necessary.
Verdict: False. Swimming pools can be a safe form of fun for those with eczema if the swimming is in moderation.
Myth #5: Eczema Can Be Permanently Cured
Unfortunately, there is no absolute cure for eczema (several experts share their best tips for managing eczema in the Integrative Approaches to Eczema eBooks series). Eczema develops as a mix of both internal and external factors. Internal factors include genetics and your familial chance of getting eczema. External factors including environmental exposure to chemicals, what products you put on your skin, weather, altitude, food, and stress. No matter which medical perspective you use, whether it be Western, Ayurveda, Naturopathy, or Traditional Chinese Medicine, the goal is to achieve good harmony for the skin by modifying habits and gaining control. Long-term control may feel like a cure, but eczema can flare back in the future.
Long-term care involves the use of healthy habits that include daily skin care, avoiding environmental triggers, reducing stress, getting adequate sleep, limiting food triggers, and the use of medications as needed to keep the skin in balance.
Verdict: False. While eczema (atopic dermatitis) does not have a permanent cure, it can be well-managed by practicing good skin care and personal care habits.
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- Basler RS, Basler GC, Palmer AH, et al. Special skin symptoms seen in swimmers. J Am Acad Dermatol.2000;43(2 Pt 1):299-305; PMID: 10906654.