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Discoid eczema - Treating discoid eczema

NHS Choices Medical Reference

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There is no simple cure for discoid eczema. However, there are treatments that can ease symptoms during an eczema flare-up.

Medication used to treat discoid eczema includes:

There are many different preparations for each type of treatment. It is often a matter of practicality and personal preference to find the best preparation for you, and this may take time.

There are also some self-help tips which may help to control symptoms of discoid eczema. This includes:

  • avoiding soaps and detergents, including liquid soaps, bubble bath, shower gels and wet wipes - even if these do not obviously irritate your skin you should use an emollient instead of soap
  • protecting your skin from minor cuts (for example, by wearing gloves) as they often trigger discoid eczema
  • taking daily lukewarm baths or showers - using an emollient when washing may reduce your itching and remember to apply your treatments after your bath or shower
  • keeping your fingernails short to reduce skin damage from scratching
  • making sure you use and apply your treatments as instructed by your GP or pharmacist - treatment failure is often due to people not using enough of the prescibed medication 

Over-the-counter medicines

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

Ask your pharmacist for advice on the different products and how to use them. If your eczema does not improve after one week of using an over-the-counter preparation, see your GP.

Emollients

Emollients are substances that help soften and smooth your skin to keep it supple and moist. They are one of the most important forms of treatment for all types of eczema.

As discoid eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent it from becoming further irritated. Emollients prevent water being lost from the outer layer of the skin, and add water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.

Choice of emollient

There are a variety of emollients available. Your GP will be able to recommend a suitable product if you have discoid eczema.

You may need to try a few different emollients to find one that works for you. You may also be prescribed a mix of emollients, for example:

  • an ointment for very dry skin
  • a cream or lotion for less dry skin
  • an emollient to use on your face and hands
  • a different emollient to use on your body  
  • an emollient to use instead of soap 
  • an emollient to add to bath water or use in the shower

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

Some people find emollients can irritate their skin. If this happens, speak to your pharmacist or GP so an alternative emollient can be prescribed instead.

How to use emollients

Use your emollient all the time, even if you are not experiencing symptoms. Many people find it helpful to keep separate supplies of emollients at work or school.

To apply the emollient:

  • use a large amount
  • smooth the emollient into the skin in the same direction that the hair grows 
  • do not rub the emollient in
  • for very dry skin, apply emollient every three to four hours
  • after a bath or shower, gently dry the skin and then immediately apply emollient, while the skin is still moist
  • do not share emollients with other people

Side effects

Occasionally some emollients can irritate the skin. If you have contact dermatitis, your skin will be sensitive and can sometimes react to certain ingredients such as perfume in over-the-counter emollients. If your skin reacts to the emollient, stop using it and speak to your GP, who will be able to recommend an alternative product.

If you are using an emollient for the first time, you may want to apply a small amount for a day or two before applying it to a widespread area. This will allow you to check whether your skin reacts to it or not.

Some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, they should not be used near a naked flame.

Emollients that are added to your bath can make your bath very slippery, so take care getting in and out. As long as you are aware of these hazards, you should be able to use emollients safely.

Topical corticosteroids

If you have patches of discoid eczema, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.

Corticosteroids are any type of medication that contains steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body.

You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used as instructed by your pharmacist or doctor, corticosteroids are one of the safest and most effective treatments for discoid dermatitis.

Choice of topical corticosteroid

There are different strengths of topical corticosteroids that can be prescribed depending on the severity of your 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 face and hands
  • an ointment to be used at night or for more severe flare-ups

If you need to use corticosteroids frequently, visit your GP regularly so they can check the treatment is working. 

How to use topical corticosteroids

When using corticosteroids, apply the treatment accurately to the affected areas. Unless instructed otherwise by your dermatologist, you should follow directions on the patient information leaflet that comes with the corticosteroid. Do not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day. 

To apply the topical corticosteroid, take the following steps:

  • apply your emollient first and wait several minutes before applying the topical corticosteroid, until the emollient has soaked into your skin
  • apply a good amount of the topical corticosteroid to the affected area  
  • use the topical corticosteroid until the inflammation has cleared up, unless otherwise advised by your GP

Speak to your prescriber if you have been using a topical corticosteroid and your symptoms have not improved after three to four weeks.

Side effects

Topical corticosteroids may cause a mild burning or stinging feeling at first.  If used for long periods of time they may also cause: 

  • thinning of the skin - particularly in the crease of the elbow or knee joint
  • telangiectasia (visible blood vessels) - particularly on the cheeks 
  • acne (spots) 
  • increased hair growth

These side effects are rare.

Generally, using a stronger or larger amount of topical corticosteroid may increase your risk of side effects. For this reason, use the weakest and smallest amount possible to control your symptoms.

Corticosteroid tablets

If you have a severe flare-up, your dermatologist may prescribe oral corticosteroids. These contain steroids, as topical corticosteroids do, but are tablets that you swallow.

If oral corticosteroids are taken often or for a long time they can also cause side effects, such as:

For this reason, your GP is unlikely to prescribe repeat courses of oral corticosteroids without referring you to a specialist.

Infected eczema

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

Oral antibiotics

If you have an extensive area of infected eczema, your GP may prescribe an antibiotic to take by mouth. The antibiotic most commonly prescribed is flucloxacillin, usually taken for one week. If you are allergic to penicillin, you might be given an alternative such as clarithomycin instead.

Topical antibiotics

If you have a small amount of infected eczema, you will normally be prescribed a topical antibiotic, such as fusidic acid. This means the medicine is applied directly to the affected area of skin, in the form of an ointment or cream.

Topical antibiotics should normally be used for 7-10 days as necessary.

Preventing infection

You can help prevent your eczema becoming infected by keeping your hands clean and your nails short. Try not to scratch as this can make infection more likely.

If you suspect your eczema is infected, for example because there is excessive weeping or soreness in the patches of eczema, see your GP. Infection can spread quickly, and the use of corticosteroid creams can mask or further spread the infection.

Antihistamines

Antihistamines are a type of medicine that work by stopping the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an allergen. 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 is interfering with your sleep. However, they will not treat the damaged skin.

Many older types of antihistamines can make you drowsy. Ask your pharmacist or GP to recommend one of the more modern "non-sedating" antihistamines. These are safer and less likely to make you drowsy.

Referral

In some severe cases of discoid eczema, your GP may refer you for assessment and treatment by a dermatologist (a skin specialist).

Further treatments

Some treatments a dermatologist may offer are explained below. These types of treatments are not suitable for everyone, and can only be carried out by experienced skin-care specialists.

Possible treatments include:

  • phototherapy - where your eczema is exposed to ultraviolet (UV) light
  • bandaging - where medicated dressings are applied to your skin
  • immunosuppressant medication - a medicine that suppresses your immune system (the body's natural defence system)
Medical Review: October 16, 2012
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