Features of severe Eczema
Attacks of eczema may be mild, moderate or severe. If you have a mild attack of eczema, you may have one or two patches of eczema on your skin with some itching.
If these symptoms are more pronounced, this is referred to as moderate eczema.
However, sometimes the attacks of eczema are severe. In a severe attack of eczema, the rashes of eczema are spread over a very wide area of your skin.
You may also have very significant itching which may interfere with your sleep and your daily activities, making you feel irritable during the day.
During severe eczema, you may scratch your skin excessively. This may lead to bleeding and scratch marks on your skin.
Eventually, there may be scars over a wide area of your skin, as well as thickening of your skin, with permanent colour changes.
Sometimes in severe eczema, the scratching of your skin can result in a bacterial invasion of the skin. When bacteria infect your eczema lesions, there may be a copious discharge from the skin, with the formation of crusts. There may also be many blisters present on your skin.
If your skin is invaded by viruses like the herpes virus, these blisters may spread all over your body and you may develop a fever, and feel sick. If this disease is not treated, it can lead to other health problems as the virus affects other parts of the body, and ultimately if neglected, it may result in death.
Management Of Severe Eczema
If you have severe eczema, you will need to see a doctor in a hospital.
The doctor will ask you some questions about your disease.
He may ask you about the time you first noticed eczema. He will also want to know about anything in your environment that worsens the attacks of eczema.
He may ask you if anyone in your family has eczema. He may also ask about the presence of asthma, allergic rhinitis, food allergies, and any other allergic conditions.
The next thing the doctor will do will be to examine your body. He will inspect eczema, and check how it has spread over your body. Then he may decide to use cotton wool to dab some of the areas of your body.
This is a swab, which he will send to the lab to see if any bacteria will grow on it. He might end the examination by checking your other organs like your liver, spleen, kidneys and lymph nodes. He may also send you for a urine test.
When your doctor has finished doing all these things, he will now reach a conclusion about the nature of your disease, and he will make a plan on how to go about curing your disease, and the drugs to use.
Drugs Used in the Management of severe Eczema
Steroids are drugs which can reduce inflammation. When steroid ointments are applied over your eczema, they will reduce the symptoms of itching, redness and rashes.
There are a number of steroid ointment preparations available in the market, and they have different strengths depending on the amount of the active steroid drug they contain.
Your doctor will prescribe a steroid ointment for you, with instructions on how to apply it.
If the drug does not succeed in reducing your symptoms, he may prescribe another one with a higher steroid content. Steroids have side effects, so it is very important to follow the instructions of your doctor closely.
2. Immunosuppressant ointments
If the steroid ointments do not give you much help, your doctor may decide to prescribe other immunosuppressant ointments for you. One of these is a class of drugs known as calcineurin inhibitors.
These drugs are strong immunosuppressants and include medications such as pimecrolimus and tacrolimus. Your doctor may prescribe these drugs for you with instructions on how to apply them. It is important that you follow instructions closely because these medications have side effects.
3. Oral steroids
If the ointments do not control the symptoms effectively, your doctor may decide to prescribe oral tablets like oral steroids. These steroid drugs will suppress the immune system, and help to reduce the symptoms.
They are usually used only for a short period of time because of the side effects of steroids which include high blood glucose, raised blood pressure, fat redistribution, etc.
4. Other drugs that reduce immunity
There are some other drugs which may also be considered.
These include drugs like cyclosporin and azathioprine.
They are used for short periods under very close medical supervision.
5. Ultraviolet light.
Some skin doctors may decide to try shining ultraviolet light on your eczema. This has been noted to give relief in some cases. This treatment is known as phototherapy.
These include drugs such as chlorpheniramine ( piriton), loratadine, etc.
They may be prescribed by your doctor to help reduce the itching and to make it easier for you to get to sleep at night.
7. Antimicrobial drugs
Your doctor may prescribe antibiotics if he believes that some bacteria have infected your eczema. He will often know the correct antibiotic to use from the result of the swab which he took while examining your eczema. If your eczema has been invaded by viruses such as the herpes virus, your doctor may choose to prescribe an antiviral drug.
Self Care Practices to help you manage severe Eczema
In addition to the drug treatment, you will need to take some other steps to help in the cure of your disease.
You will need to avoid allergens in your environment which trigger off attacks of eczema, or which can worsen the attacks. You will need to avoid things such as dust, pollen, hay, animal fur, etc.
Eczema occurs more frequently in dry skins. You can help reduce symptoms by making frequent use of a moisturizer such as plain petroleum jelly to keep your skin moist.
- Nicole Yi Zhen Chiang, Julian Verbov. Dermatology, a handbook for medical students and junior doctors. 2nd edition. London, UK: British Association of Dermatologists; 2014.
- Australasian society of clinical immunology and allergy. Eczema ( atopic dermatitis). www.allergy.org.au. Accessed 4th January 2019.