Treatment

There's no simple cure for discoid eczema, but medicines can help to ease the symptoms.

Treatments include:

• emollients – to use all the time
• soap substitutes – to replace irritating soaps and cleaning products
• topical corticosteroids – for flare-ups
• antibiotics – for infected eczema
• antihistamines – for severe itching

There are many different preparations for each type of medicine and it's worth taking time with a pharmacist or GP to find the best one for you.

A range of emollient products, soap substitutes and some topical corticosteroids can be bought from pharmacies without a prescription. Some of them are cheaper to buy this way than with a prescription.

Ask a pharmacist for advice on the different products and how to use them. See a GP if your eczema does not improve after using an over-the-counter product.

Self-help tips

There are also some things you can do yourself that may help to control symptoms of discoid eczema, such as:

• avoiding soaps and detergents, including liquid soaps, bubble bath, shower gels and wet wipes – even if these do not obviously irritate your skin; use an emollient soap substitute instead
• protecting your skin from minor cuts (for example, by wearing gloves), as cuts may trigger discoid eczema
• taking daily lukewarm baths or showers – using an emollient when washing may reduce your symptoms, and remember to apply skin treatments soon afterwards
• not scratching the patches of eczema – keeping your hands clean and your fingernails short may help reduce the risk of skin damage or infection from unintentional scratching
• making sure you use and apply your treatments as instructed by a GP or pharmacist

See a GP if you think your skin is infected. For example, if there's excessive weeping or tenderness in the patches of eczema.

Infection can spread quickly, and the use of topical corticosteroid creams can mask or further spread the infection.

Emollients

Emollients are moisturising treatments you apply directly to your skin to reduce water loss and cover it with a protective film. They're often used to help manage dry or scaly skin conditions such as eczema.

Choice of emollient

Several different emollients are available. You may need to try a few to find 1 that works for you. You may also be advised to use a combination of emollients, such as:

• an ointment for very dry skin
• a cream or lotion for less dry skin
• an emollient instead of soap
• 1 emollient to use on your face and hands, and a different 1 to use on your body

The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so they can be quite greasy, but are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so are not greasy, but can be less effective. Creams are somewhere in between.

Creams and lotions tend to be more suitable for swollen (inflamed) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.

If you've been using a particular emollient for some time, it may become less effective or may start to irritate your skin. If this is the case, a GP will be able to prescribe a different product.

How to use emollients

Use your emollient all the time, even if you're not experiencing symptoms, as it can help prevent the return of discoid eczema. Many people find it helpful to keep separate supplies of emollients at work or school.

To apply the emollient:

• use a large amount
• do not rub it in – smooth it into the skin in the same direction that the hair grows
• for very dry skin, apply the emollient every 2 to 3 hours, or more often if necessary
• after a bath or shower, gently dry your skin and then immediately apply the emollient while the skin is still moist

If you're exposed to irritants at work, make sure you apply emollients regularly during and after work.

Do not share emollients with other people.

Side effects

Occasionally, some emollients can irritate the skin. If you have discoid eczema, your skin will be sensitive and can react to certain ingredients in over-the-counter emollients.

If your skin reacts to an emollient, stop using it and speak to a GP or pharmacist who can recommend an alternative product.

Be aware that some emollients can be a fire hazard, so should not be used near a naked flame.

Emollients added to bath water can make your bath very slippery, so take care getting in and out of the bath.

Topical corticosteroids

To treat the patches of discoid eczema, a GP may prescribe a topical corticosteroid, which you apply directly to your skin, to reduce inflammation.

Choice of topical corticosteroid

There are different strengths of topical corticosteroids that can be prescribed depending on the severity of the eczema. Discoid eczema usually needs a stronger type of corticosteroid than other types of eczema.

You might be prescribed a cream to be used on visible areas, such as your face and hands, and an ointment to be used at night or for more severe flare-ups.

How to use topical corticosteroids

When using corticosteroids, apply the treatment accurately to the affected areas. Unless instructed otherwise by a doctor, follow the patient information leaflet that comes with the medicine.

Do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day.

To apply the topical corticosteroid, take the following steps:

1. Apply your emollient first and ideally wait around 30 minutes, until the emollient has soaked into your skin, before applying the topical corticosteroid.
2. Apply enough of the topical corticosteroid to cover the affected area, but try to use the smallest amount possible to control your symptoms.
3. Use the topical corticosteroid until the inflammation has cleared, unless otherwise advised by a GP.

Speak to your prescriber if you've been using a topical corticosteroid and your symptoms have not improved.

Side effects

Topical corticosteroids may cause a mild and short-lived burning or stinging sensation as you apply them. In rare cases, they may also cause:

• thinning of the skin
• changes in skin colour
• spots (acne)
• increased hair growth

Most of these side effects will improve once treatment stops.

Generally, using a stronger topical corticosteroid, or using a large amount, will increase your risk of getting side effects. You should use the weakest strength and the smallest amount possible to control your symptoms and never use more than the amount recommended by your doctor.

Sometimes people may also develop skin symptoms after they stop using a steroid cream, such as intense redness and swelling of the skin. If this happens to you then call 111 for advice immediately or visit 111 online.

Antibiotics

If your eczema becomes infected, you may also be prescribed an antibiotic.

Oral antibiotics

If you have an extensive area of infected eczema, you may be prescribed an antibiotic to take by mouth. This is most commonly flucloxacillin, which is usually taken for 1 week.

If you're allergic to penicillin, you might be given an alternative such as clarithromycin.

Topical antibiotics

If you have a small amount of infected eczema, you'll usually be prescribed a topical antibiotic, such as fusidic acid. These medicines come as a cream or ointment you apply directly to the affected area of skin.

Some topical antibiotics also contain topical corticosteroids.

Topical antibiotics should usually be used for up to 2 weeks as necessary.

Antihistamines

Antihistamines are a type of medicine that stop the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an irritant. Histamine can cause a wide range of symptoms, including sneezing, watery eyes and itching.

Antihistamines may be prescribed during flare-ups of discoid eczema to cope with the symptom of itching, particularly if it's interfering with your sleep. However, they will not treat the damaged skin.

Many older types of antihistamines can make you feel sleepy (drowsy), which can be useful if your symptoms affect the quality of your sleep. Otherwise, ask a pharmacist or GP to recommend a "non-sedating" antihistamine.

Complementary therapies

Some people may find complementary therapies, such as herbal remedies, helpful in treating eczema, but there's little evidence to show these remedies are effective.

If you're thinking about using a complementary therapy, speak to a GP first to ensure the therapy is safe for you to use. Make sure you continue to use other treatments a GP has prescribed.

Further treatments

If the treatments prescribed by a GP are not successfully controlling your symptoms, they may refer you for assessment and treatment by a doctor who specialises in skin conditions (dermatologist).

Further treatments that may be available from a dermatologist include:

• phototherapy – where the affected area of skin is exposed to ultraviolet (UV) light to help reduce inflammation
• bandaging – where medicated dressings are applied to your skin
• immunosuppressant therapy – medicines that reduce inflammation by suppressing your immune system