What's the best treatment for eczema?

A fellow caregiver asked...

My husband is being afflicted with eczema on his foot and now it is spreading to his hand. Would you kindly be able to teach us how to treat it besides the cortisone creams that he is being given b his regular PC?

Expert Answer

Jessica J. Krant, MD, MPH, is a board-certified dermatologist specializing in medical, cosmetic, and surgical dermatology, including Mohs micrographic skin cancer surgery. In addition to her work in private practice, Krant is assistant clinical professor of dermatology at SUNY Downstate Medical Center.

Treating eczema is sometimes ineffective, if the rash you are treating is not truly eczema.

The term "eczema" is used often to describe any scaly, dry-looking rash. But eczema is a specific term that should only be used in cases where severely dry skin has caused damage to the natural skin barrier, and the skin is unable to heal itself, leading to itching, flakiness, inflammation, and redness. There are different ways true eczema can look and act. The best approach to treating it, is to minimize water contact (water actually dries skin out, contrary to what you might think), minimize contact with harsh soaps, do a lot of moisturizing with thick creams or petroleum jelly, and allow the skin barrier to heal itself over time. True eczema will respond to this.

A scaly rash on one foot, spreading to a single hand, is potentially not just plain eczema. I would see if the primary doctor can culture the rash for a fungal infection which is formally called tinea, and on the feet is known as "athlete's foot". In dermatology, rashes on the feet and a single hand, or two hands and one foot, are known to be suspicious for fungal involvement. If cortisone creams have been applied over time to a fungal infection.... it could have led to "tinea incognito", a "hidden fungal infection" which has been obscured by the cortisones. This is identifiable with good testing, and NOT dangerous. However, it should be identified.

If the PC is not able to do a good test for this, it is reasonable to get a referral to a dermatologist in this case, since a specialist may be able to ferret out the culprit and get you to a cure faster.

Either way, do not be worried. Both conditions are curable with topical creams and the right regimen.