Are we making eczema worse? Rethinking the role of skin creams

Eczema is on the rise, particularly in developed nations like the United States. Studies show that global prevalence has increased by approximately 1% per decade in children over the past 30 years. The situation is even worse in the U.S., where 15.1% of children are affected, compared to the global average of 15%-to-20%.But the reasons for this rise remain unclear. Potential contributing factors include urbanization, pollution and changes in immune system development. However, one factor that is often overlooked is the overuse of emollient creams. If eczema consists of micro-cuts in the skin, could it be that constant application of creams is interfering with the body’s natural ability to heal?Are skin creams part of the problem? The first instinct when faced with dry, irritated skin is to apply a moisturizer. But what if this approach is flawed? A study from the University of Bath found that some emollient creams can weaken the skin’s natural barrier, leading to further irritation and worsening symptoms.This raises an important question: What if eczema is not a problem of dryness, but a problem of constant skin damage and delayed healing?When a person has a rash, their skin often contains micro-cuts—tiny breaks in the barrier. If you had an open wound, would you put lotion inside it? Of course not. Surgeons know that when treating any open wound, the only solution allowed inside the wound is isotonic saline (0.9% sodium chloride). Anything else would be considered malpractice.No lotions, no creams, no antiseptics, not even plain water.Only saline—because it maintains the correct balance without damaging tissue. This is why applying cream after cream to eczema-affected skin could be doing more harm than good. If a rash is actually a form of chronic, unhealed micro-trauma, then the key to treatment should be allowing the skin to heal itself rather than constantly interfering with products.A new approach: Trying two weeks without emollientsIf you have chronic eczema, why not try going without emollients for two weeks? Skin takes about 14 days to heal, which is enough time to determine whether the creams are actually helping or if they are making things worse.What to do instead? 1. Gentle cleansing with salineClean the affected area with isotonic saline (0.9% sodium chloride) instead of soaps or antiseptics.Avoid anything that could irritate or disrupt the skin further.2. Avoid any mechanical abrasionScratching keeps micro-cuts open and prevents healing.If itching is severe, apply a cold compress (ice pack wrapped in a cloth) to reduce inflammation naturally.3. Use barrier protection in select areasIf the rash is in a place that is exposed to dirt, consider covering it with a transparent wound dressing (e.g., Tegaderm).This prevents contamination while still allowing the skin to repair itself.Less is more: Let the skin heal naturallyRather than adding more and more creams, sometimes the best treatment is to do less. If you’ve been using emollients for years with no improvement, why not see what happens when you stop?If after two weeks your skin begins to heal, it means your body was capable of repairing itself all along—without interference from unnecessary creams.This simple shift in approach—cleaning, protecting, and avoiding further damage—might be the key to finally breaking the cycle of chronic eczema.Dr. Carlos Yu is an assistant professor in the Queen’s University, Department of Family and Community Medicine and an assistant professor in the McMaster University, Department of Family and Community Medicine, as well as a lecturer at the University of Toronto's Department of Family and Community Medicine.

Are we making eczema worse? Rethinking the role of skin creams

Register for free access or login.

Related Topics

Business Topic