What lotion is recommended for managing eczema?

Management of Eczema with Emollients

For managing eczema, fragrance-free emollients should be applied liberally and frequently (3-8 times daily), even when skin appears normal, and immediately after bathing to trap moisture. 1

First-Line Treatment: Emollients

Emollients are the foundation of eczema treatment and provide several benefits:

• Decrease symptoms of eczema
• Reduce the need for topical steroids
• Preserve and restore moisture to the skin
• Improve skin barrier function

Types of Emollients

Recent evidence from a 2023 randomized clinical trial comparing lotions, creams, gels, and ointments found that all four emollient types were equally effective in managing childhood eczema 2. However, satisfaction levels varied among users, with lotions and gels receiving highest satisfaction ratings.

The choice between emollient types should consider:

• Lotions: Lighter, less greasy, may be preferred for daytime use
• Creams: Balance between moisture and greasiness
• Gels: Non-greasy, often preferred for ease of application
• Ointments: Most occlusive, best for very dry skin but can be greasy

Application Recommendations

• Apply emollients 3-8 times daily 1
• Use liberally - research suggests prescribing 130g/m²/week meets the requirements of 95.8% of patients 3
• Apply immediately after bathing when skin is still damp 1
• Continue using even when skin appears normal 1
• Use proper application technique to avoid contamination (latex-free gloves, single-use packets) 4

Bathing Recommendations

• Daily bathing is advisable before emollient application 4
• Use a dispersible cream as a soap substitute 1
• Consider adding bleach baths with 0.005% sodium hypochlorite twice weekly to help prevent infections 1
• Avoid hot water which can worsen dryness

Additional Treatments for Flares

When eczema flares occur despite regular emollient use:

Topical Corticosteroids

• Hydrocortisone is FDA-approved for temporarily relieving itching associated with eczema 5
• Should be used for short periods (2-4 weeks) to avoid side effects such as skin atrophy 1
• Potency should match severity:
  • Low-potency for mild cases
  • Medium-potency for longer treatments
  • High-potency for acute flares 1

Topical Calcineurin Inhibitors

• Can be used for short-term management of flares on limited areas 4
• Monitor for systemic absorption, especially with tacrolimus ointment 4

Managing Infections

• Regular monitoring for signs of infection is necessary 4
• Consider antiseptic washes with aqueous chlorhexidine 0.05% for erosive lesions 4, 1
• Antifungal creams may be used on areas of macerated skin 4
• Prophylactic antibiotics are not recommended 4

Common Pitfalls to Avoid

1. Insufficient emollient use: Many patients under-apply emollients. Liberal and frequent application is essential.

2. Stopping emollients when skin improves: Emollients should be continued even when skin appears normal to maintain the skin barrier.

3. Using fragranced products: Fragrance-free products are recommended to avoid irritation.

4. Inappropriate application: Applying emollients on dry skin rather than damp skin after bathing reduces effectiveness.

5. Using products with potential irritants: Avoid emollients containing urea, salicylic acid, or silver sulfadiazine in infants due to risk of percutaneous absorption 4.

6. Relying solely on emollients during severe flares: While emollients are the foundation of treatment, they should be combined with appropriate anti-inflammatory treatments during flares for better outcomes 6.