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Counseling patients with eczema

You can recommend lifestyle changes, OTC medications, and review the proper use and safety of prescription drugs
By | Nov. 7, 2024

Key takeaways

  • Eczema is a chronic condition characterized by inflammation, redness, and irritation of the skin.

  • Pharmacists can support patients in managing their eczema by discussing helpful lifestyle changes, recommending OTC medications, and reviewing the proper use and safety of prescription drugs.

In this article:

According to the National Eczema Association, 1 in 10 people will develop eczema in their lifetime, with most cases peaking during early childhood. Eczema—also referred to as atopic dermatitis—is a skin condition that causes itchiness, dry skin, rashes, scaly patches, and blisters. While there is no cure for eczema, there are ways to help relieve symptoms or prevent flare-ups.

Eczema treatment includes lifestyle changes, over-the-counter (OTC) drugs, and prescription medications. Pharmacists can help patients manage their condition by discussing helpful lifestyle changes, recommending suitable OTC products, and educating patients on proper medication use.

Read on to learn more about how pharmacists can support patients with eczema.

What is eczema?

Eczema is a disease characterized by skin inflammation, redness, and irritation. It can cause extreme itchiness, and when the skin is scratched, it can lead to redness, swelling, cracking, and scaling. The cause of eczema is unclear, but according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, genes, the immune system, and the environment are thought to be involved.

While eczema usually develops in early childhood, it can occur at any age. In many cases, eczema is a chronic (long-term) condition that causes flare-ups throughout life. At this time, there is no cure for eczema, and treatment is focused on relieving symptoms and preventing flare-ups.

Nonpharmacologic management of eczema

Regardless of the severity of eczema, pharmacists can recommend lifestyle changes to assist patients in managing their condition. These include identifying eczema triggers and implementing an effective moisturizing and bathing routine.

Avoiding eczema triggers

Eczema symptoms start or flare up due to an environmental trigger. Pharmacists can help patients identify these triggers and develop strategies to avoid them.

According to the National Eczema Society, there is minimal evidence confirming which triggers produce flares. However, there are several possible culprits. Some of the most common eczema triggers in adults include:

  • Dry skin: When the skin is dry, it becomes brittle, scaly, and tight. This can lead to an eczema flare-up. Due to this risk, it’s important to encourage patients to keep their skin moisturized, as moisturizers and lotions protect the top layer of the skin and reduce the risk of flare-ups. 
  • Irritants: Household products and natural substances can irritate the skin and cause burning, itchiness, dryness, and redness. These irritants may be included in products applied to the body or used in the home. Examples include shampoo, body wash, perfume, surface cleaners, laundry detergent, and hand soap.
  • Stress: Stress is one of the biggest triggers of eczema flare-ups as it contributes to inflammation and interferes with the skin’s ability to repair. As a pharmacist, you can discuss stress management techniques with patients, such as exercise, deep breathing, meditation, yoga, and adequate sleep.

Eczema is common in young children and babies as well. According to the National Eczema Association, eczema typically occurs in this age group because the child’s sensitive skin comes in contact with an irritant. Examples include:

  • Certain ointments or baby lotions
  • Food allergies
  • Dry air
  • Certain soaps or shampoos
  • Products with fragrances

Moisturizing and bathing routine

Maintaining moisture in the skin is a crucial part of eczema care. As a pharmacist, you can help patients understand how and when to moisturize and which moisturizers are best to use.

According to the Annals of Allergy, Asthma & Immunology, fragrance-free, over-the-counter moisturizers are preferred over prescription moisturizers. Liberal, daily application is an essential part of preventing eczema flare-ups. Some other counseling points regarding moisturizers include advising patients to:

  • Apply any prescription topical medications as directed before applying moisturizer
  • Apply a thick layer of moisturizer all over the skin within three minutes of bathing
  • Use fragrance-free and dye-free moisturizers because they are the safest and the least irritating
  • Moisturize their hands every time they are washed or after they come in contact with water

You can help patients choose a moisturizer with ingredients that help eczema-prone skin. According to the National Eczema Association, these include moisturizers with:

  • Oat or shea butter
  • Aloe
  • Glycerin
  • Hyaluronic acid
  • Petrolatum
  • Vitamin E
  • Humectants
  • Niacinamide

According to the American Family Physician, pharmacists should encourage once-daily bathing for 5 to 10 minutes with lukewarm water. Cleansers should be soap-free, dye-free, fragrance-free, and hyporeactive.

Common OTC eczema treatments

Many OTC eczema treatments are available, including oral and topical options. Some OTC drugs can help with symptoms such as itchiness, redness, irritation, and rash. Others help prevent flare-ups or are used as sleep aids when eczema symptoms disrupt nighttime sleep. If one of the following options is recommended, pharmacists can explain its purpose, directions for use, and potential risks.

Antihistamines

Many people with eczema experience extreme itchiness. Oral antihistamines may provide relief through sedative effects. In severe cases where itchiness is causing trouble sleeping, a sedating antihistamine may be useful. A few examples of OTC oral antihistamines include:

Although antihistamines are usually well tolerated, side effects may still occur. These include:

  • Drowsiness
  • Dizziness
  • Dry mouth
  • Headache
  • Blurry vision

While oral antihistamines can provide eczema relief, topical antihistamines aren’t recommended because there is a lack of evidence supporting their effectiveness.

Pain relievers

Eczema symptoms may also include burning, pain, and inflammation. In these cases, pharmacists may recommend an OTC pain reliever, such as a nonsteroidal anti-inflammatory drug (NSAID) or Tylenol (acetaminophen). Keep in mind that each of these medications comes with its own risks. For example, Tylenol can cause serious liver damage. Therefore, adult patients should be advised not to take more than 4,000 mg of Tylenol per day.

Hydrocortisone

Topical hydrocortisone is a corticosteroid used for skin inflammation, irritation, and itchiness. It’s commonly used for eczema and is considered a lower-potency treatment option. Pharmacists may recommend OTC versions of hydrocortisone for mild cases of eczema. The drug may be applied to the affected area one to four times per day, depending on the particular product used. Patients should be advised to follow the instructions on the label carefully, and the product should not be used for longer than recommended on the drug facts label or by the patient’s healthcare provider. Children younger than 2 should consult a medical professional before use.

Common prescription treatments for eczema

In some cases, OTC drugs may not be able to manage eczema symptoms. Fortunately, an unprecedented number of prescription medications, including topicals, biologics, and oral medications, are available for the treatment of eczema.

Topical drugs

The most common types of prescription topical drugs include corticosteroids, janus kinase (JAK) inhibitors, calcineurin inhibitors, and PDE-4 inhibitors. Each of these may work differently to relieve eczema, have slightly different application instructions, and come with their risks. For example, topical steroids are typically used for 7 to 14 days, and they may only need to be applied once a day. However, topical JAK inhibitors, such as Opzelura (ruxolitinib), are typically used twice per day.

Below are common examples of topical prescription drugs used for eczema:

Biologics

Biologic drugs are genetically manufactured medications derived from natural sources, including humans, animals, or microorganisms. Biologics work to treat eczema by blocking part of the immune system response. This helps improve inflammation. Some common examples include:

While biologics are effective treatment options for people with eczema that’s not well managed by topical treatments, they may require more intensive counseling from a pharmacist because they are administered by injection. Therefore, pharmacists must help patients learn how to administer the medication and troubleshoot any administration issues properly.

Oral medications

For those who aren’t finding relief with topical therapies, oral prescription medications are another option. According to the National Eczema Association, these include immunosuppressants, JAK inhibitors, and corticosteroids. Common oral drugs include:

According to the National Eczema Association, immunosuppressants, such as azathioprine and cyclosporine, are usually only prescribed for short periods, and topical medications are preferred for long-term management.

The bottom line

Eczema is a chronic condition characterized by inflammation, redness, and irritation of the skin. There is no cure for the disease, and treatment is focused on relieving symptoms and preventing flare-ups. Pharmacists can support patients in managing their eczema by discussing impactful lifestyle changes, recommending OTC medications, and reviewing the proper use and safety of prescription drugs.

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