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4 Rs of Successful Eczema Management

Because eczema tends to be chronic, treatment strategies must be practical and sustainable. For affected individuals, acquiring an adequate understanding of their skin disorder and obtaining verbal and written information from healthcare providers on selected treatments and their proper usage are crucial. Remembering the 4 Rs can help to simplify the multi-layered approach for successful management.

1. Recognize

  • Learn to recognize and diagnose the condition promptly in order for treatment to be initiated.
  • Eczema sufferers have a predisposition for developing other atopic conditions, such as asthma and allergic rhinitis (commonly referred to as hay fever).
  • Maintaining a diary to track foods eaten, flares, and the use of medications, moisturizers, and cleansers can help to guide therapeutic decision-making by treating physicians. Bring the diary to scheduled clinic visits for your doctor to review.

2. Remove

  • Avoidance is a central eczema management strategy. Identify and eliminate relevant triggers (e.g., irritants, aeroallergens, and foods) and seek ways to reduce stress.
  • Mild cleanser use can help to remove surface dirt, irritants, and microbes.
  • Allergy testing (patch testing) may be helpful to identify triggers.

3. Restore

  • The regimented use of emollients can partially repair and restore the skin barrier and reduce infections and allergic reactivity.
  • Body washes incorporating nonirritating surfactants, emollients, and humectants can replenish barrier lipids during cleansing to minimize TEWL. Lukewarm baths (5-10 minutes in duration) are recommended over showers.
  • Creams and ointments are more effective for eczematous skin. Apply moisturizers 3-5 minutes after bathing.

4. Regulate

  • When flares occur, interrupt and regulate inflammatory responses with immediate treatment in order to break the itch-scratch cycle and limit lesion severity.
  • Consider increasing the use of emollients to reduce itch intensity.
  • Therapeutic strategies include topical corticosteroids, topical calcineurin inhibitors, antimicrobials, and oral antihistamines, as well as routine skin care.
  • An inadequate response to therapy may require the treating doctor to reassess proper medication use, side-effects, and review moisturizer and cleanser use.

Additional tips for management

  • Apply topical medication as soon as eczema symptoms appear and discontinue treatment once the skin inflammation resolves in order to minimize side-effects from the medicines.
  • The side-effects from topical steroids or calcineurin inhibitors are generally limited to long-term and/or overuse, but short-term or intermittent use are both safe and effective, but must be medically supervised.
  • The importance of routine maintenance with fragrance-free moisturizers and mild cleansers is essential for managing eczema successfully.

Adapted from: Kraft JN, Lynde CB, Lynde CW. Skin Therapy Lett FP 5(2):5-7.

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