If eczema is worsening (spreading, increasing redness, painful, hot) despite multiple daily applications of steroid cream over several days, call your heath care provider
If you are so uncomfortable that your sleep, work, or other daily activities are disrupted, you need a more effective treatment and should see your health care provider.
Generally eczema is not an emergency and should not be handled in a hospital emergency department. Exceptions include the following:
A. When the skin becomes so irritated that it breaks down and becomes infected; if the rash has become red, hot, and painful; if red streaks are coming from the rash; or if you have a fever, an emergency department visit may be necessary if you cannot see your regular health care provider within 24 hours.
B. Any person with a weakened immune system or certain medical conditions (such as diabetes, on chemotherapy, alcoholism, AIDS, older than 70 years) and symptoms of infection should go immediately to a hospital emergency department.
Removing whatever is causing the allergic reaction is the easiest and most effective treatment. This may be as simple as changing your laundry detergent or as difficult as moving to a new climate or changing jobs.
Prevent dry skin by taking warm (not hot) showers rather than baths. Use a mild soap or body cleanser. Dry yourself very carefully and apply moisturizing skin lotions all over your body. Avoid lotions with fragrances or other irritating substances.
Avoid wearing tight-fitting, rough, or scratchy clothing.
Avoid scratching the rash. If you can't stop yourself from scratching, cover the area with a dressing. Wear gloves at night to minimize skin damage from scratching.
Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare.
If the chronic disease-causing agent cannot be removed or identified, the next step is to lessen the allergic inflammatory response.
i. Apply an nonprescription steroid cream (hydrocortisone) along with anti-itching lotion (menthol/camphor, such as calamine). The cream must be applied as often as possible without skipping days until the rash is gone.
ii. Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution - this medication may make you too drowsy to drive a car or operate machinery safely.
iii. Clean the area with a hypoallergenic soap every day. Apply lubricating cream or lotion after washing.
iv. Avoid physical and mental stress. Eating right, light activity, and adequate sleep will help you stay healthy, which can help prevent flares.
v. Do not expect a quick response. Eczema is easier to control than cure.
Avoid, when possible, whatever triggers your allergic reaction.
An allergist may use skin patch testing to find out what is triggering your reactions.
If you know the trigger, you may be able to avoid it.
In many cases, it is impossible to determine exactly what the trigger is.
See Self-care at home for other ideas on preventing eczema flares.