From the Guidelines
For a woman with flaky skin on her forehead, eyelids, and hairline who has a history of childhood eczema, I strongly recommend avoiding harsh soaps and detergents, and instead using a dispersible cream as a soap substitute to cleanse the skin, as suggested by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. This approach is crucial in managing atopic eczema, as it helps to prevent the removal of natural lipid from the skin's surface, which is already compromised in individuals with a history of eczema. Key considerations for her treatment include:
- Avoiding extremes of temperature
- Keeping nails short to prevent scratching and further irritation
- Wearing comfortable, non-irritant clothing such as cotton next to the skin, rather than woollens 1
- Using topical corticosteroids judiciously, with the principle of using the least potent preparation required to keep the eczema under control, and stopping them for short periods when possible, as outlined in the management guidelines for atopic eczema 1. Given the sensitive areas involved, such as the eyelids, it's essential to use only mild steroids and for limited durations to avoid skin thinning, and to consider non-steroidal alternatives for longer-term management. Regular moisturizing with a hypoallergenic, non-comedogenic moisturizer is also vital in maintaining skin health and preventing flare-ups. By following these guidelines and adapting them to the specific needs of the patient, it's possible to effectively manage her condition, reduce symptoms, and improve her quality of life.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily Purpose Anti-itch
For a woman with flaky skin on her forehead, eyelids, and hairline, who has a history of eczema (atopic dermatitis) as a child, hydrocortisone cream or ointment may be used to relieve itching and irritation.
- Apply hydrocortisone to the affected area not more than 3 to 4 times daily 2.
- It is recommended for adults and children 2 years of age and older 2. Key words:
- Hydrocortisone
- Itching
- Irritation
- Eczema
- Atopic dermatitis Note: If the symptoms persist or worsen, it is recommended to consult a doctor for further guidance 2.
From the Research
Treatment Options for Flaky Skin
The woman's history of eczema as a child and current symptoms of flaky skin on her forehead, eyelids, and hairline may be related to either atopic dermatitis or seborrheic dermatitis.
- For atopic dermatitis, treatment options include:
- Topical corticosteroids as the first-line treatment for flare-ups 3
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, which can be used in conjunction with topical corticosteroids 3
- Ultraviolet phototherapy for moderate to severe cases 3
- Emollients and daily bathing with soap-free cleansers for maintenance therapy 3
- For seborrheic dermatitis, treatment options include:
Considerations for Treatment
It is essential to consider the woman's history of eczema and the potential for skin infections, which are common in atopic dermatitis patients 5.
- Bacterial colonization, particularly Staphylococcus aureus, can contribute to eczematous flares and overt infection 6
- Local antiseptic measures, such as bleach baths, and topical antimicrobial therapies can be considered in patients with high bacterial colonization 6
Additional Therapies
Other therapies that may be considered include:
- Phototherapy, which is a safe and effective treatment for moderate to severe atopic dermatitis 3
- Systemic antibiotics for infected lesions 6
- Newer medications, such as crisaborole and dupilumab, which have been approved by the U.S. Food and Drug Administration for the treatment of atopic dermatitis, but may be cost-prohibitive for most patients 3