Benefits and Drawbacks of Eczema Topicals

If you suffer from eczema then you know what a struggle it can be to find the right topical support for relief. I  say “support” instead of “remedy” because when we’re treating our skin topically, it’s going to be supportive rather than curative, which remedy implies.

So, where do you even begin??

With the enormous amount of treatments out there, it can be daunting to find the one that’s right for you. You almost have to treat it like a process of elimination to see what works with your particular brand of eczema.

For the most part, I’m a middle of the road person when it comes to medications, natural remedies, and OTC’s. I don’t believe there’s one best way or best system. If you’ve got asthma, you’re probably going to need an inhaler until you actually get the underlying inflammatory process under control.

There’s nothing worse than when you’re in the middle of an eczema flare. Your skin is an itchy oozy mess, you feel horrible, and all you need is something to help calm it down.

So let’s talk about what you can put on your skin to help tame the flame and itch!

Prescription Medications

Steroids.Topical steroids are very common when it comes to treating an eczema flare. They work by reducing inflammation which calms the itch and gives your skin a chance to heal. Like over-the-counter (OTC) cortisone, prescription steroids work similarly to the anti-inflammatory hormone cortisol made in your body, but they’re much stronger.

As a general rule of thumb, it’s best to start with a lower potency in short bursts and then stop once the flare settles.

While I think steroids can be helpful in the short-term, I’m not in favor of long-term use. They can have detrimental effects such as thinning of the skin, acne or stretch marks. It basically decreases the integrity of the skin which is the exact opposite of what we’re trying to achieve when treating with eczema.

In some rare cases, steroids can induce other skin conditions like rosacea. The last thing we want to do is add another inflammatory skin issue to the one we’re already dealing with.

In addition to these side effects, there’s also a skin condition associated with excessive topical steroid use called Topical Steroid Withdrawal (TSW). The symptoms are actually similar to eczema– dry, itchy, red, burning skin in mild cases and oozing, bleeding skin in the its more severe form.

Eucrisa. Similar to steroids, Eucrisa alters the body’s natural inflammatory process that triggers eczema symptoms. The main ingredient, crisaborole, is combined with an emollient-rich ointment that helps keep the skin moisturized.

But like most prescription medications, you run into possible side effects. The more common ones include burning or stinging when the medicine is applied.

Here’s the thing with prescription medications– they’re often designed to shut down biochemical pathways by blocking enzymes, so they basically turn off your natural processes. This alters your biochemistry causing shifts in the inflammatory processes and the immune system.

In the case of Eucrisa, it blocks the enzyme PDE4 (phosphodiesterase-4) which shuts off certain inflammatory signals, effectively decreasing or stopping the process.

The goal is to give the skin more support and heal it, rather than shut off biochemical pathways. Not to mentioned the many underlying causes that aren’t addressed when the inflammatory process (read: body’s danger signal) is artificially blocked.

Like I said, I’m a middle-of-the-roader when it comes to prescription topicals. I think they have their place, but not when it comes to finding a long-term solution. It’s important to get to the root cause of why you have certain things going on in your body.

OTC Medications

Most practitioners can’t speak with insider knowledge of the over-the-counter lotions and potions- but I can because one of my first jobs out of undergrad was in the formulation department for a very well-known personal care and paper products company (yes, it was a long and winding road for me to get here!!).

My job was on the microbiology and chemistry side, so I got to experience firsthand what types of chemicals were used and the effects they can have. This was one of the many things that actually drove me to wanting to go more natural!

Even though I’ve seen the negative side of OTC’s, I do think they have their place when it comes to finding immediate relief.

Hydrocortisone cream. Cortisone creams relieve eczema bouts the same way most prescription topicals do. Synthetic cortisone mimics the actions of cortisol, your main anti-inflammatory hormone, but is more pronounced. It works by suppressing the inflammatory signals that get triggered and block the symptoms caused by inflammation.

Helpful in the short term? Possibly, yes.

Long term solution? NO.

Benadryl cream. Antihistamines such as Benadryl (diphenhydramine) cream are very common when it comes to soothing the itch that comes with eczema. They’re generally used to treat allergies by blocking the effects of histamine– an immune system protein and signaling chemical. The body can mistake things like pollen as a harmful substance in the body and then releases histamine to fight it off. This is what causes the itchy eyes and runny nose. Even though eczema isn’t an allergy, antihistamines do have a sedating and anti-inflammatory response that helps relieve itching.

The downside to OTC medications is that they just work as a band-aid instead of solving the actual problem. They’re very accessible and inexpensive so it’s easy to become reliant on them rather than find a solution to the root cause.

Conventional Topicals

Eucerin. This is a well known brand that creates creams and lotions specifically for dry skin and eczema. Eucerin contains emollients which promote moisture and increases the skin’s capacity to hold onto water. Keeping the skin moisturized can provide some itching relief and give it a chance to heal.

Cetaphil. Cetaphil is another brand that has a line of lotions made primarily to help treat eczema. Their eczema specific moisturizer has an active ingredient called filaggrin which is an essential protein for skin hydration and barrier function. Many people with eczema have mutations in the filaggrin gene which is why they are prone to eczema, rashes and general skin irritation.

Petroleum jelly/Vaseline. Petroleum jelly is a topical that dermatologists recommend frequently because people with sensitive skin can generally tolerate it. It locks in moisture and protects against outside allergens. It’s a highly process petrochemical that many sensitive people react to, not to mention the environmental impact.

Most conventional topicals are going to provide some support and dampening of the inflammatory feeling on the skin. The downside is that most of them contain synthetic ingredients like sodium dodecyl sulfate (SLS), isopropyl palmitate, parabens, and preservatives to name a few. These chemicals are known toxins or irritants so it’s important to remember that anything you put on the skin will get absorbed into the body.

Some of these chemicals are also endocrine disruptors which is something you don’t want to mess with. They are stored in fat cells and alter normal hormone biochemistry, especially estrogens and estrogen hormone pathways.

Natural Topicals

The last area I wanted to touch on are the natural remedies. And as always, you have to find what works for you.

I’ve tried so many over the years I’ve lost count. We hear the same thing from our patients as well.

I always kid around when we have the, “what have you tried?” conversation because most of us have a lotions and potions graveyard. You know… the drawer where all of your partially used topicals go to die!!

Herbal Treatments. Moon Valley Organics has EczaCalm and Herbal Heal. I use both of these depending upon my needs. I’ve been using Herbal Heal over EczaCalm because lately I feel like that’s been working really well for me. Both of these have about 12 different ingredients made with organic carrier and essential oils, as well as many herbs that are anti-inflammatory.

They both contain calendula which is known in the herbal world to be very nourishing to the skin. It’s a pretty awesome ingredient because there are no known side effects, it’s incredibly healing, and it can be used across all age ranges. You’ll see it in some of the more natural baby diaper creams— Bottom Balms, for example. It really can be used in a wide array of applications.

You can also make up your own. I talk about it more in this post.

Essential Oils. Lavender, frankincense, myrrh (we’re getting a little Christmas-y)—and tea tree oil are all very soothing for eczema.

The beauty of using EO’s is that they have multiple avenues of how they’re helping. Some of the most common mechanisms of action are antimicrobial, anti-inflammatory, calming, analgesic (pain eliminating), and skin supporting. You’re going to get a little more bang for your buck with the cross-functional types of support they provide.

Frankincense, also known as boswellia, is my FAVORITE! It’s a potent anti-inflammatory that has lots of research behind it. It’s also a great immune booster, stress reducer, and healing to the skin. It’s steroid-like structure is thought to be one of the reasons it’s so effective. I use it topically, aerosolized in a diffuser, and internally for treating all types of inflammatory conditions, not just eczema. Frankincense is literally the Swiss Army knife of the anti-inflammatory world!

Lavender is calming, sedating, and has some inflammation relieving properties. It’s also well tolerated by most people, including children and babies. A little at bath time (for kids and adults) helps soothe the skin and the mind.

Myrrh is another cross-functional heavy hitter like Frankincense. It has all of the “anti’s”… antioxidant, anti-inflammatory, and antimicrobial to bacteria, parasites, and fungi (like Candida). A bonus is that it has anti-cancer properties as well. Historically it has been used to heal wounds and cracked/chapped skin.

Tea tree oil, like Frankincense and Myrrh, has many beneficial properties, but it’s broad spectrum antimicrobial actions are what make it famous. It’s active against a wide array of microorganisms (bacteria, yeast, other fungi, parasites, and viruses) making it a very useful tool. Staphylococcus aureus and yeast based infections such as Candida, jock itch or ringworm (yes, it’s a fungus- not a worm) are sometimes implicated in eczema, and research shows tea tree oil to be effective against them.

Please note that sometimes, especially when used in excess, essential oils can be irritating to the skin. I always tell people to be very careful when they’re first starting to work with them. If you’re making a batch of something yourself or adding them to a bath, start off with just a couple of drops to see how your skin responds.

Organic Healing Balm. Dr. Bronner’s has an Baby Unscented Organic Magic Balm. I use this on my kids for everything. I sometimes use it on my eczema- it just depends on the severity of the itch.

A lot of people with eczema like Bronner’s, but some people find it a little bit irritating. I’d say stay away from the peppermint one and stick with the unscented balm.

All Good’s Goop is another good option. It has lots of herbs, olive oil, and coconut oil to soothe the skin.

Cleansing Oil. Another company that I really like is FatCo. I use their products myself and have heard from a lot of my clients that they love their facial cleansing oil. I’m an advocate of using oils because they don’t strip the skin like detergents found in other products.

They also have this myrrhaculous face cream. It has myrrh and tallow which are the main components in their lotions and creams. It’s highly supportive and nutritive to the skin. Speaking subjectively from my own experience (and the experience of a lot of the people that I work with that have used this), it’s just really supporting and nourishing to the skin.

Sea Salt Spray. This is something you can easily make yourself with some water and some sea salt at home. A lot of people who have eczema benefit from going into the ocean and salt water. Dead sea salt works really well because it’s packed with minerals that help balance the pH in your skin.

Kamedis. Kamedis has a complete eczema line from washes to lotions. I learned about this from patients that raved about it. They have created plant-based treatments for eczema that combine botanical extracts with OTC ingredients.

Theramu. Theramu is another one of my favorites. They’re also all-natural and use a combination of CBD  and emu oil which provides bioavailability so it works where your skin needs it most. Both the CBD oil and emu oil are soothing so it’s one of the go-to’s in our clinic as a first line therapy to try out.

Summary

With a condition that is so highly individualized, you have to play around and find what works for you. Some topicals will work better than others and some will work for a short period of time.

While that can be frustrating, the great news is that true healing can be accomplished and you can banish the topicals forever!

The goal is to always get to the root cause of what’s going on, but if you’re in a really bad state, topicals can be the way to go to find immediate relief. And that’s okay! You can always transition and switch off of them as you work on your underlying causes.

Which topicals have worked for you? We’d love to hear!