The following principles are used in the local “management” of eczema:

a.     The more serious the inflammation, the blander the application.

b.     The vehicle of an application is as important as the medicine it carries.

c.     The appearance of eczema (and not its cause) determines its “management.”

Acutely inflamed eczema is to be medicated with wet dressings of normal saline or Burrow’s solution (1:20), which provide moisture, a disinfectant, and an astringent effect. Dressings may be applied open to allow water to evaporate and cause cooling and soothing or closed with a cellophane cover to stop evaporation and maintain heat and moisture on the eczema for some time. A wet dressing can be made by placing a solution in a porcelain, enamel, or plastic container, but not in a copper or aluminum- one, then soaking a cloth (such as a clean old shirt or bed sheeting) in the solution, wringing out the cloth tightly, folding it in six or eight layers, placing it on the affected area, and securing it with a safety pin. As the compress dries out, it is to be removed, rewet, and reapplied, about six times daily for ten minutes each time, using a fresh solution for each application. After the application, the area should be patted dry. If the eczema is on the hands or feet, these should be soaked directly in a pan containing the solution.

Infected eczema must be treated with antibiotics as well as wet dressings. The medicines that may be added to skin applications to achieve protective, softening, anti-infective, or anti-itch effects are antibiotics, hydrocortisone, coal tar, boric acid, zinc oxide, and salicylic acid. Shake lotions, liniments, ointments, and creams are all skin applications which may contain the above ingredients.

Shake lotions are powders suspended in water to be used on scaly patches of skin. Upon evaporation of the water, a thin layer of powder remains on the skin. Liniments are lotions containing an oil; they form the transition between shake lotions and ointments. Ointments are fats containing a medication to soften thick and horny skin and a medication to heal its inner layers. Creams contain water along with fat and medication.

All ointments and lotions are to be used sparingly, as a little dab is just as effective as a larger amount. Each medicated area must be bathed with warm water and an alkali-free soap before every new application.

Medicated cortisone tape, such as Cordran, presents the following advantages over lotions, creams, or ointments. Its application is easy; its penetration is enhanced by an occlusive action which hydrates and softens the skin; it is not bulky (fitting easily under shoes or socks); it is not messy; it protects against scratching; it permits a clean, uniform, and permanent application of medication to a localized area of eczema. There is also no irritation or pain when the tape is peeled off and replaced every twelve hours.

The skin is prepared before the application of the tape by cleaning off scales, crusts, dried exudates, or any previously used ointments or creams with a saline solution. No soap is to be used, and there is no need to remove hair. If an irritation or an infection should occur, the use of the tape should be discontinued.

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For those who cannot afford this sort of treatment, but have plenty of time to spare, co-counselling may represent a viable alternative. After a period of training, co-counsellors are paired off, and thereafter act as both counsellor and client to each other. The idea may sound strange at first, but it often works very well, and the co-counselling movement has many enthusiastic adherents.

For some people it can be enormously helpful just to write things down on paper. The process of recording how you feel sets up an internal dialogue that can offer new insights into old difficulties. Yoga or meditation may also be helpful in learning to relax. For the less spiritually inclined, biofeedback offers a ‘scientific’ route to relaxation.

There is one ailment where learning to relax is of special importance, and that is asthma. The fear of suffocation that accompanies an asthmatic attack is understandable, but the anxiety itself can make the attack worse – or even bring one on unaided. Asthmatics should learn a relaxation technique and practise it every day so that it can be ‘turned on’ at will, whenever an attack seems imminent. Hypnotherapy is often used to teach this sort of instant relaxation, and is particularly effective with children. They learn to feel that they are able to control the asthma, which reduces their feeling of helplessness and panic. In the case of children, it is very important for the parents and other adults to stay calm as well – anxiety is infectious. For children who are too young to learn a relaxation technique, a reassuring presence and a warm drink can often stave off an attack.

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