How do you treat eczema in the elderly?

According to the National Eczema Association, older adults face unique challenges with skin health due to natural aging processes that weaken the skin barrier. This makes it crucial to understand exactly how do you treat eczema in the elderly, where standard treatments may need careful modification for safety and effectiveness.

Quick Summary

Treating eczema in older adults requires a multi-pronged approach, focusing on gentle, frequent moisturizing, identifying and avoiding triggers, and using appropriate topical and oral medications as prescribed by a healthcare provider. Lifestyle adjustments, like using a humidifier and taking lukewarm baths, are also essential for managing sensitive, aging skin.

Key Points

• Daily Moisturization: Apply thick, fragrance-free creams or ointments twice daily, especially after a lukewarm bath or shower, to hydrate the skin and restore its barrier.

• Gentle Cleansing: Use mild, hypoallergenic, and non-alkaline cleansers with lukewarm water during short bathing sessions to avoid stripping the skin of natural oils.

• Trigger Avoidance: Identify and minimize exposure to environmental triggers like harsh soaps, fragranced products, and irritating fabrics such as wool.

• Manage Itching and Scratching: Keep nails short, use cool compresses, and consider a mild oral antihistamine (with a doctor's approval) for severe itching, particularly at night.

• Consider Medical Treatments: For persistent or severe eczema, a doctor may recommend topical steroids, calcineurin inhibitors, or in more serious cases, oral medications, biologics, or phototherapy.

• Monitor for Infection: Be vigilant for signs of secondary infection, such as increased redness, swelling, pus, or warmth, and seek prompt medical attention if these symptoms appear.

Understanding Eczema in the Elderly

Eczema, or atopic dermatitis, can present differently in older adults than in younger individuals. The aging process naturally reduces the skin's moisture and elasticity, thinning the protective barrier and making it more susceptible to irritation and flare-ups. This condition can lead to persistent and intense itching, which can significantly impact a senior’s quality of life, sleep, and mental well-being. Furthermore, older adults may be dealing with other health conditions and taking multiple medications, which can complicate treatment plans and require a cautious approach.

Why Eczema Worsens with Age

Several factors contribute to the increased prevalence and severity of eczema in the elderly:

• Reduced Sebum Production: As people age, their sebaceous glands produce less oil, leading to chronic dryness, or xerosis, which is a major contributor to eczema.
• Compromised Skin Barrier: The skin's outer layer becomes thinner and less effective at retaining moisture and fending off irritants and bacteria.
• Slower Healing: Older skin takes longer to heal from scratches and inflammation, increasing the risk of secondary infections.
• Systemic Conditions: Diseases like diabetes and circulatory problems can also affect skin health, making eczema management more difficult.

Basic Treatment Strategies: The Foundation of Care

Effective management starts with gentle, consistent daily care. These foundational steps can provide significant relief and prevent future flare-ups.

Moisturizing is Non-Negotiable

This is the single most important step in managing senior eczema. The goal is to hydrate the skin and lock in that moisture to repair the skin's barrier function.

• Choose the Right Products: Opt for thick creams and ointments over lotions, as they are more effective at sealing in moisture. Look for products that are fragrance-free and hypoallergenic. Ingredients like ceramides, hyaluronic acid, and petroleum jelly are excellent choices.
• Moisturize Strategically: Apply moisturizer at least twice a day, especially immediately after bathing while the skin is still damp. This traps the water in the skin, maximizing hydration.

Gentle Bathing Practices

Hot, long baths can strip the skin of its natural oils and worsen dryness. Simple changes can make a big difference.

• Use Lukewarm Water: Keep showers and baths short, around 5 to 10 minutes, using lukewarm water instead of hot.
• Use a Mild Cleanser: Ditch harsh, scented soaps. Use a gentle, fragrance-free, and non-alkaline cleanser.
• Pat, Don't Rub: After bathing, gently pat the skin dry with a soft towel rather than rubbing vigorously. This prevents unnecessary irritation.

Medical Treatments for Moderate to Severe Cases

When basic care is not enough, a healthcare provider can recommend stronger medical interventions. It is crucial to consult a doctor before starting any new medication.

Topical Treatments

These are often the first line of defense for controlling inflammation and itching.

• Topical Steroids: Corticosteroid creams and ointments reduce inflammation. For older adults, low-to-medium potency steroids are generally preferred, especially for long-term use, to minimize side effects like skin thinning.
• Topical Calcineurin Inhibitors (TCIs): Non-steroidal creams like tacrolimus and pimecrolimus can be used on sensitive areas like the face and neck. They work by suppressing the immune system's response that causes inflammation.

Oral Medications and Advanced Therapies

For more widespread or severe eczema, systemic treatments may be necessary.

• Antihistamines: Oral antihistamines, particularly those with a sedating effect like diphenhydramine, can help relieve severe nighttime itching and improve sleep. Non-sedating antihistamines are also an option for daytime relief.
• Oral Corticosteroids: In very severe, short-term flare-ups, a doctor may prescribe oral steroids. However, due to significant side effects like high blood pressure and bone thinning, long-term use is not recommended for seniors.
• Biologics: For refractory, moderate-to-severe eczema, injectable biologics like dupilumab may be considered. These newer medications target specific parts of the immune system and can be highly effective, with close monitoring.
• Phototherapy: Controlled exposure to specific ultraviolet (UV) light can help reduce inflammation and itch. This is typically done under medical supervision in a clinical setting.

Lifestyle Adjustments and Environmental Controls

Mitigating triggers in the living environment is a powerful, non-invasive way to manage eczema.

Avoiding Irritants and Allergens

• Use Hypoallergenic Products: Switch to fragrance-free detergents, fabric softeners, and other household cleaners.
• Wear Breathable Fabrics: Choose soft, breathable fabrics like 100% cotton over synthetic materials or wool, which can cause irritation.
• Control Temperature and Humidity: Use a humidifier to add moisture to dry indoor air, especially during winter. Keep the home at a stable, comfortable temperature, and avoid getting overheated.

Scratching Prevention

Itching can lead to scratching, which further damages the skin barrier and creates a vicious cycle. Try these methods to break the habit:

• Keep nails trimmed short.
• Use a cool compress on itchy areas.
• Wear soft gloves or socks at night to prevent unconscious scratching.

Stress Management

Stress can trigger or worsen eczema flare-ups. Techniques that promote relaxation are beneficial.

• Meditation and Deep Breathing: Simple breathing exercises can help reduce anxiety and calm the nervous system.
• Engaging Hobbies: Occupy the mind with enjoyable activities to reduce the focus on itching.

Comparison of Eczema Treatment Options for Seniors

Treatment Method	Pros	Cons	Best For
Daily Moisturizing	Safe, no side effects, improves skin barrier, accessible.	Requires consistent, multiple daily applications.	All eczema patients, especially for maintenance.
Topical Steroids	Highly effective for flare-ups, fast-acting.	Can cause skin thinning with long-term, high-potency use; risk of side effects.	Mild to moderate flare-ups; supervised, short-term use.
Topical Calcineurin Inhibitors	Non-steroidal, safe for sensitive areas, no risk of skin thinning.	Can cause initial stinging or burning; potential black box warning risk.	Sensitive skin areas like face and neck.
Oral Antihistamines	Good for nighttime itching, helps with sleep disruption.	Can cause drowsiness, confusion, and urinary issues in seniors.	Short-term relief of severe itching.
Oral Corticosteroids	Very powerful, rapidly controls severe flares.	Major side effects, not for long-term use.	Severe, widespread, and resistant eczema for a brief period.
Biologics (e.g., Dupixent)	Highly effective for moderate-to-severe cases; minimal systemic side effects.	High cost, administration via injection, potential for conjunctivitis.	Moderate-to-severe cases unresponsive to other treatments.

Seeking Professional Guidance

While a strong daily care routine is vital, it’s important to know when to seek medical advice. If an elderly person's eczema is worsening, not responding to basic treatments, or showing signs of infection (increased redness, swelling, pus), a healthcare provider should be consulted. A dermatologist can help create a personalized plan, manage potential medication interactions, and consider advanced therapies. For more in-depth, general information, the National Eczema Society offers comprehensive guidance.

Conclusion

Treating eczema in the elderly requires a thoughtful, multi-faceted approach. By combining diligent skin hydration, gentle cleansing, and trigger avoidance with the right medical treatments under a doctor's supervision, seniors can find significant relief. The unique vulnerabilities of aging skin mean that what works for younger individuals may need adjustment. Empowering seniors and their caregivers with knowledge and consistent practices can help manage this challenging condition effectively, leading to improved comfort and quality of life.

Frequently Asked Questions

Why is eczema different for older people?

Aging skin naturally loses moisture, thins, and has a weaker protective barrier. These changes make elderly skin more prone to dryness and irritation, which can trigger or worsen eczema. Health changes and medication use also play a role.

What is the best type of moisturizer for treating elderly eczema?

Thick, hydrating creams and ointments are most effective. Look for fragrance-free, hypoallergenic products containing ingredients like ceramides, hyaluronic acid, or petroleum jelly, which help lock in moisture and repair the skin barrier.

Are topical steroids safe for seniors with eczema?

Topical steroids can be safe and effective, but seniors are more susceptible to side effects like skin thinning. A doctor will typically prescribe low-to-medium potency steroids for short-term use, monitoring closely for any adverse reactions.

How can an older person stop scratching their eczema?

To prevent scratching, keep nails trimmed, use cool, damp compresses on itchy areas, and wear soft, breathable gloves at night. A doctor might also suggest a sedating oral antihistamine for severe nighttime itch.

Can diet affect eczema in the elderly?

While not a primary cause, diet can influence inflammation. Some people find anti-inflammatory foods beneficial. It is best to consult a doctor or dermatologist before making significant dietary changes.

When should an elderly person see a doctor for eczema?

See a doctor if symptoms worsen, don't improve with self-care, interfere with sleep or daily activities, or show signs of infection like pus, increased swelling, or warmth. A dermatologist can provide personalized treatment plans.

Can eczema in the elderly be a sign of another condition?

Sometimes. Chronic dry, itchy skin can be associated with other health issues common in seniors, such as circulatory problems or certain systemic illnesses. A dermatologist can properly diagnose the cause.