Eczema (discoid) - Treating discoid eczema

How to use emollients

Use your emollient all the time, even if you are not experiencing symptoms. You may wish to consider keeping separate supplies of emollients at work or school.

To apply the emollient:

• Use a large amount.
• Smooth the emollient into the skin in the same direction that the hair grows.
• Do not rub the emollient in.
• For very dry skin, apply emollient every two to three hours.
• After a bath or shower, gently dry the skin and then immediately apply emollient, while the skin is still moist.
• Do not share emollients with other people.

Side effects

The most common side effect of using emollients is a rash. If you have discoid eczema, your skin may be very sensitive and can become irritable with certain ingredients in an emollient. If your skin is irritated by the emollient, speak to your GP, who will be able to prescribe an alternative product.

Some emollients contain paraffin and can be a fire hazard. As certain emollient products are highly flammable, do not use them near a naked flame.

Emollients that are added to your bath can make your bath very slippery, so take care getting in and out of the bath. As long as you are aware of these hazards, you should be able to use emollients safely.

Topical corticosteroids

If you have patches of discoid eczema, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.

Corticosteroids are any type of medication that contains steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body. See the Health A-Z topic about Topical corticosteroids.

You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used correctly, corticosteroids are a very safe and highly effective treatment for eczema.

Choice of topical corticosteroid

There are different strengths of topical corticosteroids that can be prescribed depending on the severity of your eczema. Discoid eczema usually needs a stronger type of corticosteroid than those used for other types of eczema.

You may be prescribed:

• a cream to be used on visible areas, such as the face and hands
• an ointment to be used at night or for more severe flare-ups

If you need to use corticosteroids frequently, visit your GP regularly so they can check that the treatment is working.

How to use topical corticosteroids

When using corticosteroids, apply the treatment accurately to the affected areas. Always follow the directions on the patient information leaflet that comes with the corticosteroid, which will provide details about how much you should apply.

Do not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day. To apply the topical corticosteroid, take the following steps:

• Apply your emollient first and wait several minutes before applying the topical corticosteroid, until the emollient has soaked into your skin.
• Apply a small amount of the topical corticosteroid to the affected area see the box above for a guide on the amount to use.
• Use the topical corticosteroid until the inflammation has cleared up, unless otherwise advised by your GP.

Speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.

Side effects

Topical corticosteroids may cause a mild burning or stinging feeling at first. In very rare cases, they may also cause:

• thinning of the skin particularly in the crease of the elbow or knee joint
• telangiectasia (visible blood vessels) particularly on the cheeks
• acne (spots)
• increased hair growth

Generally, using a stronger or larger amount of topical corticosteroid may increase your risk of side effects. For this reason, use the weakest and smallest amount possible to control your symptoms.

Oral corticosteroids

If you have a severe flare-up, your GP may prescribe oral corticosteroids. These contain steroids, as topical corticosteroids do, but are swallowed. See the Health A-Z topic about Corticosteroids for more information.

If oral corticosteroids are taken often or for a long time they can cause side effects, such as:

• affecting the growth rate of children
• high blood pressure (hypertension)
• osteoporosis (brittle bones)

For this reason, your GP is unlikely to prescribe oral corticosteroids more than once a year without referring you to a specialist (see referral, below).

Infected eczema

If your eczema has become infected, you will usually be prescribed an antibiotic.

Oral antibiotics

If you have an extensive area of infected eczema, your GP may prescribe an antibiotic to take orally (by mouth). The antibiotic most commonly prescribed is flucloxacillin, usually taken for one week. If you are allergic to penicillin, you may be prescribed clarithomycin instead.

Topical antibiotics

If you have a small amount of infected eczema, you will normally be prescribed a topical antibiotic, such as fusidic acid or mupirocin. This means that the medicine is applied directly to the affected area of skin, in the form of an ointment or cream.

Topical antibiotics should normally be used for a week, or up to 10 days if necessary.

Preventing infection

You can help prevent your eczema becoming infected by keeping your hands clean and you nails short. Try not to scratch as this can make infection more likely.

If you suspect that your eczema is infected, for example because there are weeping blisters in the patches of eczema, see your GP as soon as possible. The infection can spread quickly, and the use of corticosteroid creams can mask or further spread the infection.

Antihistamines

Antihistamines are a type of medicine that work by stopping the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an allergen. Histamine can cause a wide range of symptoms, including sneezing, watery eyes and itching.

Antihistamines may be prescribed during flare-ups of discoid eczema to cope with the symptom of itching, particularly if it is interfering with your sleep. However, they will not treat the damaged skin.

Antihistamines can have a sedating effect (make you drowsy), or can be non-sedating. If you are taking sedating antihistamines, avoid driving the next day if you still feel drowsy. The sedative effect is likely to be stronger if you drink alcohol.

See the Health A-Z topic about Antihistamines.

Referral

In some severe cases of discoid eczema, your GP may refer you for assessment and treatment by a dermatologist (a skin specialist). For example, your GP may refer you if the prescribed treatments are not successfully controlling your eczema.

Further treatments

Some of the treatments that a dermatologist may be able to offer you are explained below. These types of treatments are not suitable for everyone, and can only be carried out by experienced skin-care specialists.

Possible treatments include:

• phototherapy where your eczema is exposed to ultraviolet (UV) light
• bandaging where medicated dressings or wet wraps are applied to your skin
• immunosuppressant medication a medicine that suppresses your immune system (the body s natural defence system)