What to do when skin peels during eczema healing?

Managing Skin Peeling During Eczema Healing

Regular application of emollients is the cornerstone of managing skin peeling during the eczema healing process. 1, 2 Peeling skin is a normal part of the healing process as damaged skin cells are replaced with new ones.

First-Line Management for Peeling Skin

• Apply emollients multiple times daily:

  • Use ointments rather than creams for dry, irritable rashes as they provide better hydration by improving the skin's lipid barrier 3
  • Water-based creams may further dry the skin, while very greasy emollients could increase folliculitis risk 3
  • Apply at least once daily to the entire body, more frequently on affected areas 3

• Choose appropriate emollients:

  • For isolated areas: Creams are preferred
  • For multiple areas: Lotions may be more practical 3
  • Avoid alcohol-containing products which can worsen dryness 3

For Moderate to Severe Peeling

• Consider topical corticosteroids for inflammatory areas:

  • Low potency (e.g., hydrocortisone 1%) for sensitive areas like face and neck 1
  • Medium potency for body areas 1
  • Apply once daily rather than twice daily for similar efficacy 4

• For eczematous areas with peeling:

  • Prednicarbate cream 0.02% may help with erythema and desquamation 3
  • Short-term use only to avoid skin thinning

For Excessive Dryness with Peeling

• Urea-containing moisturizers are particularly effective for dry skin:

  • More effective than placebo in improving skin condition (RR 1.28,95% CI 1.06 to 1.53) 2
  • Particularly helpful for chronic, thickened areas

• Glycerol-containing moisturizers show benefit:

  • Participants noticed more skin improvement compared to vehicle (RR 1.22,95% CI 1.01 to 1.48) 2

For Fissures (Cracked Skin)

• Treat fissures with:
  • Propylene glycol 50% in water for 30 minutes under plastic occlusion nightly 3
  • Follow with hydrocolloid dressing
  • Antiseptic baths with potassium permanganate (1:10,000) may help accelerate wound closure 3

Maintenance Therapy

• After healing:
  • Continue twice-weekly application of medium potency topical corticosteroids to previously affected areas 1
  • Maintain daily emollient use even after resolution to prevent recurrence 1

Important Cautions

• Avoid common pitfalls:

  • Hot showers and excessive soap use can worsen dryness 3
  • Alcohol-containing lotions or gels should be avoided 3
  • Don't stop moisturizing once skin appears healed - continue maintenance therapy 1

• Watch for signs of infection:

  • Secondary infection may occur with impetiginization (usually Staphylococcus aureus) 3
  • If suspected, take bacterial swabs and consider appropriate antibiotics 3

Moisturizers have been shown to produce better results when used alongside active treatments, prolonging time between flares and reducing the amount of topical corticosteroids needed to achieve similar reductions in eczema severity 2. Regular and consistent application is key to managing the peeling skin during the healing process.