Eczema medical therapy: Difference between revisions
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*[[Immunosuppressants]] | *[[Immunosuppressants]] | ||
**These work by dampening the [[immune system]] to improve [[eczema]]. | **These work by dampening the [[immune system]] to improve [[eczema]]. | ||
** Commonly used [[immunosuppressants]] for [[eczema]] include [[ciclosporin]], [[azathioprine]] and [[methotrexate]]. | ** Commonly used [[immunosuppressants]] for [[eczema]] include [[ciclosporin]], [[azathioprine]], and [[methotrexate]]. | ||
**Laboratory workup such as a complete [[blood test]] must be done by the [[patient]] since [[drug]] side effects may develop. | **Laboratory workup such as a complete [[blood test]] must be done by the [[patient]] since [[drug]] side effects may develop. | ||
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===2014 Clinical Practice Guidelines for the Management of [[Eczema]] by American Academy of Dermatology <ref name="pmid24813302">{{cite journal| author=Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K | display-authors=etal| title=Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. | journal=J Am Acad Dermatol | year= 2014 | volume= 71 | issue= 1 | pages= 116-32 | pmid=24813302 | doi=10.1016/j.jaad.2014.03.023 | pmc=4326095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24813302 }} </ref> === | ===2014 Clinical Practice Guidelines for the Management of [[Eczema]] by American Academy of Dermatology <ref name="pmid24813302">{{cite journal| author=Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K | display-authors=etal| title=Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. | journal=J Am Acad Dermatol | year= 2014 | volume= 71 | issue= 1 | pages= 116-32 | pmid=24813302 | doi=10.1016/j.jaad.2014.03.023 | pmc=4326095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24813302 }} </ref> === | ||
{|class="wikitable" style="width: | {|class="wikitable" style="width:80%" | ||
|- | |- | ||
|colspan="1" style="text-align:center; background:LightCyan"| [[AAD guidelines classification scheme#Strength of Recommendation|Class A]] | |colspan="1" style="text-align:center; background:LightCyan"| [[AAD guidelines classification scheme#Strength of Recommendation|Class A]] | ||
|- | |- | ||
| bgcolor=" | | bgcolor="Beige"|<nowiki>"</nowiki>'''1.'''Use of [[moisturizers]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | | bgcolor="Beige"|<nowiki>"</nowiki>'''2.'''Use of [[topical corticosteroids]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | ||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''2a.'''Need for consideration of side effects with use. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3.'''Use of [[topical calcineurin inhibitors]] ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3a.'''Use as [[steroid]] sparing agents. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3b.'''Off-label use of [[topical calcineurin inhibitors]] in those age less than 2 years. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3c.'''Proactive use of [[topical calcineurin inhibitors]] for maintenance. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3d.'''Routine monitoring of [[topical calcineurin inhibitors]] blood levels not needed. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''4.'''Against routine use of [[topical]] anti-''[[Staphylococcal]]'' [[treatment]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" style="width:80%" | |||
|- | |||
|colspan="1" style="text-align:center; background:LightCyan"| [[AAD guidelines classification scheme#Strength of Recommendation|Class B]] | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''1.'''Application of [[moisturizers]] after bathing. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''2.'''Wet-wrap [[therapy]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3.'''Frequency of application of [[topical corticosteroids]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3a.'''Proactive use of [[topical corticosteroids]] for maintenance. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3b.'''Need for monitoring for [[cutaneous]] side effects with potent [[topical corticosteroids]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3c.'''Addressing fears with use. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''4.'''Counseling on local reactions with [[topical calcineurin inhibitors]] and the preceding use of [[topical corticosteroids]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''4a.'''Concomitant [[topical corticosteroids]] and [[topical calcineurin inhibitors]] use.''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''5.'''Bleach baths and [[intranasal]] [[mupirocin]] for those with moderate to severe [[AD]] and [[clinical infection]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: I]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''6.'''Against use of [[topical antihistamines]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|} | |} | ||
{|class="wikitable" style="width:80%" | |||
|- | |||
|colspan="1" style="text-align:center; background:LightCyan"| [[AAD guidelines classification scheme#Strength of Recommendation|Class C]] | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''1.'''Bathing and bathing practices ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''2.'''Limited use of nonsoap cleansers. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''3.'''Against use of bath additives, acidic spring water. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''4.'''Consideration of a variety of factors in [[topical corticosteroids]] selection. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: II]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''4a.'''Specific routine monitoring for [[systemic]] [[side effects]] with [[topical corticosteroids]] not needed. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''5.'''Informing [[patients]] regarding theoretical risk of [[cutaneous]] [[viral infections]] with use. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Beige"|<nowiki>"</nowiki>'''6.'''Awareness of black-box warning of [[topical calcineurin inhibitors]]. ''([[AAD guidelines classification scheme#Strength of Recommendation|Level of Evidence: III]])'' <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[category:Up to Date]] | |||
Latest revision as of 18:32, 14 July 2022
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Eczema Microchapters |
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American Roentgen Ray Society Images of Eczema |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.
Overview
Topical corticosteroids are the mainline treatment for eczema. Different potencies of steroids are rendered specifically for the severity of eczema. Other drug treatments often used for eczema include topical calcineurin inhibitors, crisaborole, antimicrobials, and antifungals.
Medical Therapy
Pharmacotherapy
- Moisturizers
- Eczema can be exacerbated by dryness of the skin.
- Moisture content is the main factor that determines the occurrence of eczema.
- European emollients such asOilatum, Balneum, Medi Oil, Diprobase, Sebexol, Epaderm ointment, Eucerin lotion, bath oils and aqueous cream can relieve eczema itchiness.
- Topical application of sulfur gains popularity as an alternative treatment to steroids. However, no evidence-based publications are available yet on this matter. [1]
- Corticosteroids
- Mild to moderate eczema - a weak steroid may be used (e.g. hydrocortisone or desonide).
- Severe eczema - high potency [steroid]] (e.g. clobetasol propionate). [2]
- Possible side effects such as atrophy of the skin may occur if overused.[3]
- Use a low potency steroid for face and other thin skin- lined areas. [4]
- Immunomodulators
- These include pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic).
- However, adverse drug reactions of these drugs include flushing, and photosensitivity. [5]
- Antibiotics
- Dry and cracked skin allows entry of bacteria.
- Skin infection may arise and could irritate the skin.
- Antibiotics should be prescribed to cover the microorganism.
- Immunosuppressants
- These work by dampening the immune system to improve eczema.
- Commonly used immunosuppressants for eczema include ciclosporin, azathioprine, and methotrexate.
- Laboratory workup such as a complete blood test must be done by the patient since drug side effects may develop.
Light therapy
- When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen.
- PUVA (Psoralen + UVA) combination therapy also known as photo-chemotherapy can increase the sensitivity to UV light, which can lead to skin cancer.[6]
Herbal Medicine
Some of these topical remedies include:
- Potentilla chinensis
- Aebia clematidis
- Clematis armandii
- Rehmannia glutinosa
- Paeonia lactiflora (Chinese Peony)
- Schizonepeta tenuifolia (Neem)
- Schizonepeta tennuifolia
- Lophatherum gracile
- Calamine
- Oatmeal
- Glycyrrhiza uralensis
- Glycyrrhiza glabra (Licorice)
- Burdock
- Rooibos
- Dictamnus dasycarpus
- Tribulus terrestris
- Azadirachta indica
- Evening primrose oil
- Tea tree oil
- Linseed oil
- Cod liver oil
- Neem oil
- Aloe propolis cream
- Raw goat's milk
- Grapefruit seed extract (GSE)
- Hemp cream
- Guto Kola
2014 Clinical Practice Guidelines for the Management of Eczema by American Academy of Dermatology [7]
| Class A |
| "1.Use of moisturizers. (Level of Evidence: I) " |
| "2.Use of topical corticosteroids. (Level of Evidence: I) " |
| "2a.Need for consideration of side effects with use. (Level of Evidence: I) " |
| "3.Use of topical calcineurin inhibitors (Level of Evidence: I) " |
| "3a.Use as steroid sparing agents. (Level of Evidence: I) " |
| "3b.Off-label use of topical calcineurin inhibitors in those age less than 2 years. (Level of Evidence: I) " |
| "3c.Proactive use of topical calcineurin inhibitors for maintenance. (Level of Evidence: I) " |
| "3d.Routine monitoring of topical calcineurin inhibitors blood levels not needed. (Level of Evidence: I) " |
| "4.Against routine use of topical anti-Staphylococcal treatment. (Level of Evidence: I) " |
| Class B |
| "1.Application of moisturizers after bathing. (Level of Evidence: II) " |
| "2.Wet-wrap therapy. (Level of Evidence: II) " |
| "3.Frequency of application of topical corticosteroids. (Level of Evidence: II) " |
| "3a.Proactive use of topical corticosteroids for maintenance. (Level of Evidence: II) " |
| "3b.Need for monitoring for cutaneous side effects with potent topical corticosteroids. (Level of Evidence: III) " |
| "3c.Addressing fears with use. (Level of Evidence: III) " |
| "4.Counseling on local reactions with topical calcineurin inhibitors and the preceding use of topical corticosteroids. (Level of Evidence: II) " |
| "4a.Concomitant topical corticosteroids and topical calcineurin inhibitors use.(Level of Evidence: II) " |
| "5.Bleach baths and intranasal mupirocin for those with moderate to severe AD and clinical infection. (Level of Evidence: I) " |
| "6.Against use of topical antihistamines. (Level of Evidence: II) " |
| Class C |
| "1.Bathing and bathing practices (Level of Evidence: III) " |
| "2.Limited use of nonsoap cleansers. (Level of Evidence: III) " |
| "3.Against use of bath additives, acidic spring water. (Level of Evidence: III) " |
| "4.Consideration of a variety of factors in topical corticosteroids selection. (Level of Evidence: II) " |
| "4a.Specific routine monitoring for systemic side effects with topical corticosteroids not needed. (Level of Evidence: III) " |
| "5.Informing patients regarding theoretical risk of cutaneous viral infections with use. (Level of Evidence: III) " |
| "6.Awareness of black-box warning of topical calcineurin inhibitors. (Level of Evidence: III) " |
References
- ↑ "Sulfur". University of Maryland Medical Center. 4/1/2002. Retrieved 2007-10-15. Check date values in:
|date=(help) - ↑ Hoare C, Li Wan Po A, Williams H (2000). "Systematic review of treatments for atopic eczema". Health technology assessment (Winchester, England). 4 (37): 1–191. PMID 11134919.
- ↑ Atherton DJ (2003). "Topical corticosteroids in atopic dermatitis". BMJ. 327 (7421): 942–3. doi:10.1136/bmj.327.7421.942. PMID 14576221.
- ↑ Lee NP, Arriola ER (1999). "Topical corticosteroids: back to basics" ("Scanned & PDF"). West. J. Med. 171 (5–6): 351–3. PMID 10639873.
- ↑ Martins GA, Arruda L (2004). "Systemic treatment of psoriasis - Part I: methotrexate and acitretin". An. Bras. Dermatol (in English translation). 79 (3): 263–278. Unknown parameter
|month=ignored (help) - ↑ Stern RS (2001). "The risk of melanoma in association with long-term exposure to PUVA". J. Am. Acad. Dermatol. 44 (5): 755–61. doi:10.1067/mjd.2001.114576. PMID 11312420.
- ↑ Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K; et al. (2014). "Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies". J Am Acad Dermatol. 71 (1): 116–32. doi:10.1016/j.jaad.2014.03.023. PMC 4326095. PMID 24813302.