How Did Emma Subbs Get Rid of Her Eczema

Emma Subbs is 22-year old woman who has come in for stabilization of her asthma following a serious exacerbation of her condition. Although she has had atopic eczema since childhood she has not been troubled by it in the last 5 years. On talking to her, the admitting nurse realizes that she has very little awareness about her treatments. She has a big bag of tubes and tubs, but only the vaguest idea about how to use them. She is very depressed about the state of her skin, particularly as she has just started a new relationship and is accurately aware of how she looks. Initially she seems not to care about doing treatments herself, and it becomes clear that the nurse’s job is going to be one of education and support. 

Having decided that education is a key part of Emma’s care, the nurse decides to wait until Emma is able to breathe more normally before focusing on teaching her about caring for her skin. As Emma becomes more comfortable with her breathing it is possible to plan her skin care with her. Although Emma is now capable of self-caring, most of her deficits lie in the act that her knowledge is confused and limited. The nurse decides to find out what is normal for Emma and help her to develop a treatment regime around this, and the following advice is given:

Bathing 

Emma usually showers in the evening before going to bed, so advising her to continue doing this but to use an emollient shower gel, such as Oilatum shower gel, allows her to stick to her routine. She is very keen to rub herself vigorously afterwards to stop the itching, so an explanation about his might actually damage the skin and make it itchier is important. 

Moisturizing 

Emma hates the feel of very greasy ointments on her skin, but she is willing to try anything anew. In this situation Epaderm is a good choice, as although it is very greasy it sinks in well. Emma will need to apply it liberally in a downward motion all over her body. Because it is relatively greasy it is best to use it at night before going to bed, and then to wear old nightclothes and/or cover her limbs with tubifast. The latter has the advantage, as it makes harder to scratch the skin. A lighter moisturizer, e.g. Cetraben, might be used during the day. She should take this to work with her and apply it as often as she can. Emma is worried about her boyfriend’s reactions to her going to bed with greasy skin. It is important to reassure her that although the greasy emollients are best, the important thing is that she applies some moisturizer. If it is not always the greasy one, this is not a major problem. 

Steroids

Emma is frightened about using topical steroids, as she has heard that they can thin your skin and cause stretch mark. Clear guidance and support about the basic rules of it is best if they can be written down:

Occlusion. – Although Emma tries hard not to, she cannot help scratching. She does keep her nails short and takes antipruritics before going to bed, although she complains they make her drowsy the following morning. Using occlusion (i.e. wrapping the affected areas to stop her from scratching and to enhance the action of the topical therapies) is useful possible solution. Occlusion can be something simple such as tubifast on limbs, or can be more complex paste bandaging. This involves applying bandages impregnated with medicaments (e.g. coal tar, zinc paste or itchamol) next to the skin. The bandages need to be applied carefully and not just wound round the limb; instead they need to be pleated in a backwards and forwards motion. It is important to apply them in this way because when they dry they contract, and if they are just wound around the limb they will act as a tourniquet. They act to soothe the skin, and make it very difficult to scratch.

At home

Once Emma gets home it is advisable for her to continue with the regime as taught to her. Once the acute attack has subsided she can stop using the steroids, but she will need to continue to use the moisturizers. You advise her to try and keep house dust to a minimum by regular vacuuming and damp dusting and by minimizing the number of soft furnishings in the house. She should try to keep cool and should wear cotton garments wherever possible. Avoiding very perfumed things such as cosmetics or fabrics softeners is also advisable. 

How did she get rid of her eczema

The treatment outlines for Emma above is the standard treatment of eczema. Emollients and steroids remain the mainstays. Education and support are also important, as it can be very confusing trying to understand which of the many topical applications have to be applied to the various parts of the skin. As with psoriasis, in serious cases, systemic drugs may be used – most common cyclosporine, an immunosuppressant. It is not uncommon for patient with eczema to be on oral antibiotics; these can often have a dramatic effect on clearing up the skin, thus indicating the significant role that bacterial infection has in exacerbating eczema.