Eczema Management

Download our fact sheet on the basics of eczema skincare.

Bathing and Moisturizing

People with eczema tend to have very dry skin in general. This is because the disease causes defects in the stratum corneum, or the skin barrier. The skin barrier is the outermost layer of the skin that serves a dual purpose: it protects irritants, bacteria, viruses and allergens from getting into our bodies and it keeps moisture from getting out. Genes, skin trauma — such as from scratching or rubbing — and inflammation caused by the immune system can all contribute to this defective or “leaky” skin barrier in people with eczema.

The most effective way to treat dry itchy skin is to give it the moisture it needs and help it to retain it. Proper bathing and moisturizing are important for this reason — especially if you have eczema. The best way to replace and retain moisture in the skin is to moisturize immediately after taking a bath or shower.

Tips for bathing and moisturizing with eczema

Although there have not been comparative studies to pinpoint the best frequency or duration of bathing, the “Soak and Seal” method of treating eczema is recommended by many healthcare providers to combat dry skin and reduce flares.  

To get the full therapeutic benefit of Soak and Seal, follow these steps in order:

• Bathe or shower in lukewarm (not hot) water for a short period of time (about 5-10 minutes) at least once per day.
• Avoid scrubbing your skin with a washcloth or loofah.
• Use a gentle cleanser (not soap) that is unscented, fragrance-free and dye-free.
• Lightly pat dry with a towel leaving the skin damp. Do not rub the skin.  
• Apply prescription topical medication to the affected areas of skin as directed.
• Liberally apply a high-oil content moisturizer all over the body to seal in moisture. Try to do this within 3 minutes to limit the amount of moisture lost from the skin.  

Let the moisturizer absorb into the skin for a few minutes before dressing or applying wet wraps. Wear cotton gloves over your hands while you sleep to help lock in the moisturizer and prevent scratching. Visit our Product Directory for a list of cleansers and moisturizers that fulfill the requirements of NEA’s Seal of Acceptance program.

Bathing treatments

Not only will soaking in a tub of warm (not hot) water help your skin better absorb moisture, bathing can also relax your body and mind and help ease stress. There are also specific bath treatments that can relieve eczema symptoms, including the following. 

Bath Oil: Using gentle oils in your bathwater can help keep you moisturized. Be sure to use oils that do not contain fragrances.

Baking Soda: Adding a quarter-cup of baking soda to your bath, or applying it to the skin directly in the form of a paste, is a common treatment used to help relieve itching.

Bleach: Data suggests mild bleach and water solution can decrease inflammation, itching and potentially the amount of Staphylococcus aureus bacteria on the skin, which can lead to skin infections in eczema. Use a half-cup of household bleach for a full tub of water, one-quarter cup for a half tub. Soak up to 10 minutes, then rinse off. Some healthcare providers suggest doing these two to three times per week. People with bleach sensitivities or allergic asthma that might be aggravated by chlorine fumes should consult with their healthcare provider before starting bleach bath therapy. Download our bleach bath instruction sheet.

Oatmeal: Adding colloidal oatmeal to your bath, or applying it to the skin directly in the form of a paste, is also a common treatment used to help relieve itching.  

Salt: If you’re experiencing a severe flare, bathing may cause your skin to sting. Adding one cup of table salt to your bath water can help ease this symptom.

Apple Cider Vinegar: Add between one cup and one pint of vinegar to the bath. This also can be used as a wet dressing, as the vinegar is believed to have antimicrobial effects. Get the Facts on apple cider vinegar for eczema.

Learn more about bathing therapy for eczema.

Moisturizing

If you use a prescription topical medication, apply it as directed before you moisturize. Apply a thick layer of moisturizer all over your skin within three minutes of bathing or showering to lock in moisture and protect the skin barrier. Moisturize your skin at least twice a day. Soften moisturizer by rubbing it between your hands and then apply it to your body using the palm of your hand. If the moisturizer feels tacky on your skin, don’t remove the excess. It will be absorbed within a few minutes. Moisturize your hands every time you wash them or when they come into contact with water.

Finding the right moisturizer

Finding a moisturizer that works can be a challenge. What works for one person may not work for another and as the condition of your skin changes, so can the effectiveness of a product. A manufacturer may also change the formulation of a product periodically as well. Start with the National Eczema Association Seal of Acceptance™ to find moisturizers free of fragrance, dyes and other common allergens. Products on this list are recognized by NEA as suitable for care of eczema or sensitive skin. Moisturizers are classified as ointments, creams, lotions or skin barrier repair creams based on the amount of oil and water they contain. The more oil in a moisturizer, the better it usually is at treating eczema.

Ointments

Ointments such as petroleum jelly and mineral oil are usually the first choice for eczema treatment as they have the highest oil content and are very good at sealing in moisture. If you don’t like how ointments feel on your skin, the next best alternative is a cream.

Creams

Creams are second to ointments in the amount of oil they contain and are also very good at sealing in moisture. Because they contain less oil, they are also less greasy to the touch. Be sure to read labels carefully — creams sometimes contain stabilizers or preservatives that can irritate your skin.

Lotions

Lotions contain the least amount of oil. Because they are primarily made of water, lotions evaporate quickly and may contain preservatives that burn when applied to skin that’s scratched or broken. If your skin stings or burns after you apply a lotion, switching to a cream or ointment may help.

Skin barrier repair creams

Skin barrier repair creams are available by prescription and over the counter. They are infused with lipids and ceramides, which are naturally occurring substances found in healthy skin barriers that skin with eczema may lack. The lipids and ceramides found in skin barrier moisturizers form a protective layer on the skin to help lock in moisture while keeping out irritants. This allows eczema skin to heal and become more resistant to symptoms, including burning, dryness and itch.

Learn more about moisturizing skin with eczema.

Wet wrap therapy

During particularly intense eczema flares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. While wet wrap therapy can be done at home, wet wraps specifically applied to the face use gauze and surgical netting and should be applied by medical professionals trained in this treatment.

Wet wraps are best done after bathing, moisturizing and applying medication. Use clean, preferably white, cotton clothing or gauze from a roll for the wet layer, and pajamas or a sweat suit on top as a dry layer. If the eczema is on the feet and/or hands, you can use cotton gloves or socks for the wet layer with vinyl gloves or food-grade plastic wrap as the dry layer.

To do wet wrap therapy, first moisten the clothing or gauze in warm water until they are slightly damp. Next, wrap the moist dressing around the affected area. Then gently wrap the dry layer over the wet one. Lastly, carefully put on loose-fitting clothing so as not to disturb the dressing. Leave wet wraps on for several hours or overnight, taking care not to let them dry out. Consult with a healthcare provider before starting wet wrap therapy. Download our wet wrap therapy instruction sheet and learn more about wet wraps.

Complementary and alternative treatments

Many people with eczema use skincare products and practices that are outside Western or conventional medical advice to help manage their symptoms. If you use these natural therapies or home remedies with doctor-prescribed medications, you are using a “complementary” method to manage your eczema. If you are using natural therapies in place of conventional medicine, you are using an “alternative” method of self-care for your eczema treatment.

Before you consider any kind of treatment, it’s important to understand what triggers your eczema. Learning about the skin irritants in your everyday surroundings can help you better manage the condition whether you use traditional medications, alternative therapies or both. The following complementary and alternative therapies have been studied and found to benefit certain symptoms of eczema in adults. Check with your healthcare provider if you are interested in trying alternative therapies on your child’s eczema.

Plant-based and other topicals

Coconut oil

Studies show that applying coconut oil topically reduces the amount of staph bacteria on the skin, which reduces the chance of infection. Apply coconut oil once or twice a day to damp skin. Be sure to choose coconut oils that are “virgin” or “cold pressed.” This method of oil extraction does not use chemicals, which could  further irritate skin. Get the facts on coconut oil.

Sunflower oil

Sunflower oil boosts the skin’s barrier function, helping it to retain moisture. It also has anti-inflammatory properties. Apply sunflower oil to adult skin twice a day, with one of those times being shortly after bathing while skin is still wet. Avoid using sunflower oil, if you have a known allergy to sunflower seeds.

Topical vitamin B12

Topical vitamin B12 has been shown to be effective on eczema symptoms in both adults and children. However, there is no commercial product as of this writing, and so it must be compounded. Dr. Peter Lio, a dermatologist at Chicago Integrative Eczema Center and member of the NEA Board of Directors and Scientific & Medical Advisory Council, shares this recipe for a B12 compound that was formally studied.

Topical B12 Cream:

• 0.07 g cyanocobalamin (vitamin B12);
• 46 g persea gratissima Oil (avocado oil);
• 45.42 g water;
• 8 g TEGO® Care PS or methyl glucose stearate (an emulsifier);
• 0.26 g potassium sorbate (a preservative);
• 0.25 g citric acid.

Some have simply mixed vitamin B12 powder into a moisturizer base so that the final concentration is 0.07%.

Vitamins and supplements

Individuals who are living with eczema or caring for loved ones with the disease sometimes turn to vitamins and nutritional supplements to try to help lower inflammation, boost the immune system or get a good night’s sleep. Here are some common vitamins and supplements people use to manage their eczema:

• Vitamin D
• Fish Oil
• Zinc
• Selenium
• Prebiotics and Probiotics
• Melatonin
• Turmeric
• Primrose oil
• CBD

It’s important to understand that there are few clinical studies proving the efficacy of vitamins and supplements for eczema and what works for some people might not work for others. Certain vitamins and supplements may be harmful when taken together or with prescribed medication. Always check with your healthcare provider before trying a new vitamin or supplement, and make sure they’re aware of everything you’re taking or administering to a loved one with eczema.

Ancient wellness systems

Integrative medicine is gaining traction in the healthcare field, specifically the idea of balancing conventional “Western” treatments with complementary “Eastern” therapies for a whole-body approach to treating eczema. Certain cultures have been practicing intricate systems of holistic healing – like Traditional Chinese Medicine (TCM) and Indian Ayurvedic Medicine – for thousands of years. However despite this longevity, published data with use in eczema is currently limited.

Traditional Chinese Medicine 

Traditional Chinese Medicine (TCM) is the ancient wellness practice of bringing all aspects of human health into balance. Practitioners believe in a vital life force called Qi that surges through the body, and when Qi becomes imbalanced, it can lead to illness or disease.

TCM incorporates several treatment modalities that are customized to an individual’s needs. These might include acupuncture or the practice of inserting fine needles into strategic points on the body; massage techniques like acupressure, cupping and Gua Sha; mind-body practices; and traditional Chinese herbs. TCM’s herbal arsenal includes more than 10,000 herbs, which are mainly found in the leaves, stems and roots of certain plants and can take the form of powders, liquids or topicals.

Ayurveda

Ayurveda, which translates from Sanskrit as “knowledge of life,” is a system of medicine that began in India more than 5,000 years ago. Similar to TCM, Ayurvedic medicine seeks to bring the body into balance using a tailored set of tools that include herbs, oils, dietary changes, massage and mind-body practices like yoga and meditation.

In the Ayurvedic system, people have life forces called “doshas” that help determine what kind of mind-body imbalances they may be prone to. Ayurvedic practitioners use these doshas to describe how the body functions and how it might react to different factors, such as what you eat or what you put on your skin.

Mind-body practices

Stress is a known trigger for eczema flares. Though the exact relationship between stress and eczema is unknown, experts believe that when you experience a stressful situation, your body produces inflammation. And inflammation is an underlying cause of eczema. Techniques may include hypnosis or biofeedback, a technique you can use to learn to control some of your body’s functions, such as your heart rate.

Mindfulness meditation

Mindfulness meditation is a mental exercise that involves a person concentrating on a particular object, thought or activity in order to “train their brain” to stay focused on the present moment, with no judgment, in order to achieve mental clarity and a state of emotional calmness. Learn more about the benefits of meditation on eczema.

Yoga, qigong and tai Chi

Yoga, qigong and tai chi are all examples of ancient mind-body practices that combine breathing with body movement and meditation to attain focus, clarity and relaxation. Some individuals with eczema believe these gentle exercises have helped them reduce stress, lower inflammation and distract from itch.

Tai chi and qigong are martial art forms that combine graceful movements with diaphragmatic breathing to help circulate vital energy called Qi in order to achieve balance between the body and mind. Yoga is rooted in Ayurveda and based on a Hindu philosophy that combines deep, slow breathing (pranayama) with a series of poses (asanas) to help achieve balance, focus and inner peace.

Acupressure and massage

Acupressure is similar to acupuncture but with physical pressure applied to certain points on the body, rather than needles, to unblock “life energy.” Limited studies show that acupressure can help relieve the symptoms of itch and lichenification, which is thick, leathery skin.

It is well known that massage helps relieve stress, which may then help reduce eczema flares. It’s important to go to a massage therapist who is accredited and experienced with working with people with non-contagious skin conditions. Prior to your appointment, check with your massage therapist to be sure the oils and lotions used will not trigger your eczema or make it worse. Bring your own if you are unsure.