patient education : 09146--Dr. Z's 5-10-15 Plan for Eczema

Dr. Z’s 5-10-15 Plan for Eczema

Eczema is not something we can cure. But we can control it.

The key is to:

1. Put out the fire- with 5-10-15 topical medications used safely
2. Prevent the fire from restarting- with good skin care
3. Maintenance therapy- will discuss at follow up

STEP 1 – Put out the fire: 

Days 1-5 (5 days)

Clobetasol or Halobetasol or Augmented Betamethasone Dipropionate ointment everywhere twice a day

• morning
• night after the bath, pat dry, while skin still moist apply the ointment to all involved areas

Days 6-15 (10 days)

Fluocinonide or Mometasone or Triamcinolone 0.5% or Betamethasone diproprionate or Amcinonide ointment everywhere twice a day

• morning
• night after the bath, pat dry, while skin still moist apply the ointment to all involved areas

Days 16-30 (15 days)

Triamcinolone 0.1% ointment everywhere twice a day

• morning
• night after the bath, pat dry, while skin still moist apply the ointment to all involved areas

STEP 2 – Good skin care:

 Every day, 2-3 times a day moisturize the entire body with Vaseline^® or other moisturizer. If you want to use something natural, coconut oil is good for most people unless they have an allergy. Other options are Aquaphor^® or Eucerin^® ointment (if no lanolin allergy) or Vanicream^® or Cerave^® Healing Ointment. Aveeno^® and Cetaphil^® make good eczema ointments as well. (The store or generic version can also be used.)

• You want ointments or cream (ointments are better, but they are greasy).
• You do not want lotions (they have alcohol and can dry the skin out).
• You want something out of a tub or tube, not a pump. If it comes out of a pump it is too liquid and not thick enough.
• Put it on in the morning.
• Put it on after bathing, bathing should occur every night.  Avoid soap on the areas.  Avoid bar soap- Cetaphil, Purpose, Eucerin, Aveeno all make liquid gentle cleansers
• After a bath put on medicines first, and let them have at least 15 minutes to soak in. Then apply your moisturizing “grease” everywhere.

Consider using bleach in the bath, especially if the skin is oozy or if there are skin cracks or open sores. It sounds weird, but it works great. It can be done 2-3 times per week.

• A bath with a small amount of bleach added to the water may help lessen symptoms of chronic eczema (atopic dermatitis).
• Eczema is an itchy skin condition caused by a problem with the skin’s natural barrier. Any place there is eczema on the skin, there is a chance for a bacterial infection which can make the eczema worse. It’s a bad cycle to be in.  A bleach bath kills bad bacteria on the skin which reduces the itching, redness and scaling. This is most effective when combined with other eczema treatments, such as topical medications and moisturizer.
• If properly diluted and used as directed, a bleach bath is safe for children and adults: 
  • Add 1/2 cup (118 milliliters) of bleach to 40 gallons (151 liters) of warm water — that will fill a U.S.-standard-sized bathtub to the overflow drainage holes. Use household bleach, not concentrated bleach. Use 1 capful for a baby bathtub. Use ¼ cup of bleach for a half standard sized bath tub.
  • Soak from the neck down or just the affected areas of skin for about 10 minutes. Do not submerge the head.
  • Rinse off and gently pat dry with a towel.
  • Immediately apply medicines and moisturizer generously. 
  • Take a bleach bath no more than three times a week.

Step 3:  The Steroid Ladder

Face and Folds

• Preventative:   ________________ twice a day every day

• Mild eczema- any pink or red spots, bumps, scratches, or itchy areas:   ______________________  twice a day for up to 15 days, then take a two-day break before restarting

• Getting worse- bumpy, scaly, bright red:   ___________________ twice a day for up to 10 days then take a two day break before restarting

• Hot Spots- bright red, skin opening up and bleeding, thick and scaly: _________________________ twice a day for up to 5 days then take a two day break before restarting

Body

• Preventative: _____________________ twice a day every day

• Mild eczema- any pink or red spots, bumps, scratches, or itchy areas:   _______________________ twice a day for up to 15 days then take two day break before restarting

• Getting worse- bumpy, scaly, bright red: ______________________ twice a day for up to 10 days then take a two day break before restarting

• Hot Spots- bright red, skin opening up and bleeding, thick and scaly:   ________________________  twice a day for up to 5 days then take a two day break before restarting