Digital dermatitis...non-compliant patient (adult)

[Beebopwasthebest]

The non-compliance is a separate issue which I don't want to go into but would value advice on the following please:

Really bad dermatitis on hands, bad self trauma from scratching in their sleep.
No recent allergy triggers but a manual job and gets worse when stressed/lack of sleep.

Months ago I supplied good hand creams/barrier lotions (ignored).
Some intermittent use of hydrocortisone cream.

Managed to get them to stop scratching tonight with some cool compresses on and Eurax cream applied today..however the skin is open and bleeding so I don't think it is sensible to continue this?

I have supplied white cotton gloves...a work in progress.

Fucidin?
Anti-histamine tablets?

I will of course continue my efforts to convince them to see a GP or pharmacist but in the meantime time I don't want to be advising things that make it worse. So any advice would be welcome.

Thank you

Can you keep their finger nails trimmed as low as possible to minimise damage?

Anti-histamines might help although less so if it’s stress rather than an allergy. Can they take ibuprofen? It might take the edge off the feeling as well as take down inflammation.

Ideally something like Vaseline to create a barrier then wear the gloves - but they need to want to keep the gloves on.

When I get on a spell of sleep scratching, I take very heavy presciption anti-histamines before bed.

For prevention I am also on a biologic, avoid my allergens, take 2 regular antihistamines daily, and use steroid creams as needed.

but every once in a while if my skin flares up I will scratch it in my sleep. I don’t do it intentionally. Gloves don’t work, I take them off on my sleep. Nails being trimmed doesn’t really help because the skin is so sensitive and fragile that it tears really easily. I manage to scratch spots on my back that I can’t really even reach when conscious. The anti-histamines stop the whole vicious cycle and mean I don’t end up with skin infections.

If the skin is already cracked I would stay as far away from emollients as possible unless you know they are well tolerated.

When my excema is in that state, only high strength steroid cream works, plus Aveeno basic moisturiser.

Epaderm cream and it's fellow emollients make things ten times worse.

When I was little, I found relief from very hot running water (scratched the itch when I couldn't) and pressure, so I'd lie on my hands. The hot water probably makes things worse but the pressure might help.

Vaseline for some people with skin conditions is like rocket fuel, I woild avoid that unless you know the person can cope with it.

It brings me out in heat lumps and the excema is on fire.

Thanks everyone. I'll suggest anti-histamines

Aveeno does that to me!

Everyone is so different, it must drive dermatologists up the wall.