What lifestyle and environmental modifications should I recommend to patients with atopic eczema?

Patients with atopic eczema should be advised on several lifestyle and environmental modifications to help manage their condition and reduce flares ¹.

• Emollient Use:
  • Encourage the frequent and liberal use of emollients, even when the skin is clear, as they are the basis of management ¹,².
  • Explain that emollients should be used in larger amounts and more often than other treatments, applied to the whole body ².
  • Demonstrate how to smooth emollients onto the skin rather than rubbing them in ².
  • Advise patients that if they are using emollients and other topical products at the same time, they should apply one product at a time and wait several minutes before applying the next ².
  • Be aware of the Medicines and Healthcare products Regulatory Agency (MHRA) warnings about fire hazards associated with emollient residue on clothing and bedding ².
• Avoiding Trigger Factors:
  • Advise patients to avoid known trigger factors that can exacerbate eczema ¹.
  • Recommend avoiding synthetic fibres in clothing ¹.
  • Suggest using emollient substitutes instead of soaps or detergents ¹.
  • Advise keeping rooms cool to avoid heat as a trigger ¹.
  • If animals, irritants, temperature, humidity, or stress are known to worsen eczema, they should be avoided where possible ¹.
• Managing Itch and Scratching:
  • Advise patients to avoid scratching the eczema if possible, and instead rub the area with their fingers to alleviate itch ¹.
  • Recommend keeping nails short ¹.
  • For babies with eczema, suggest using anti-scratch mittens ¹.
• Dietary Modifications:
  • Patients should be advised not to alter their diet unless under specialist advice ¹.
  • There is no evidence of benefit from milk and egg-free exclusion diets in people without a known allergy ¹.
  • Any dietary exclusion or elimination diets should be implemented and monitored by a specialist ¹.
  • Mothers of breastfed infants with suspected allergy causing moderate or severe eczema may require referral for dietary advice ¹.
• Complementary Therapies:
  • Complementary therapies, such as homeopathy, herbal medicine, massage, and food supplements, are not recommended for the management of atopic eczema due to insufficient evidence ¹.
  • If patients insist on using complementary therapies, they should continue to use emollients frequently and liberally ¹.
  • Inform patients that "natural" or "herbal" products are not necessarily safe and can have adverse effects or interact with other medicines ¹.
• House-Dust Mite Avoidance:
  • House-dust mite avoidance strategies are generally not recommended as they are time-consuming and of limited benefit ¹.
• Patient Education and Support:
  • Provide patient information leaflets and details of eczema support groups, such as the British Association of Dermatologists or the National Eczema Society ¹.
  • Address any concerns patients may have regarding adverse effects of topical corticosteroids to improve adherence ¹.
  • Explain how to recognise flares of atopic eczema and provide clear instructions on how to manage them ².