Eczema medical therapy

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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.
  • Thicker moisturizing ointments have a better effect on a dry, flaky skin.
  • 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.

• 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).
  • Possible side effects such as atrophy of the skin may occur if overused.
  • Use a low potency steroid for face and other thin skin- lined areas.

• Immunomodulators
  • These include pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic).
• However, adverse drug reactions of these drugs include flushing, and photosensitivity.

• Antibiotics
  • Dry and cracked skin allows entry of bacteria.
  • Skin infection could develop, which can further irritate the skin.
  • An appropriate antibiotic regimen should be given.

• Immunosuppressants
  • These work by dampening the immune system to improve eczema.
  • Commonly-used immunosuppressants for eczema include ciclosporin, azathioprine and methotrexate.
  • Patients should undergo regular complete blood tests as side effects may develop.

Light therapy

• UVA is mostly used, but UVB and Narrow Band UVB are also used.
• 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.

Herbal Medicine

Some of these topical remedies lnclude

• Potentilla chinensis
• Aebia clematidis
• Clematis armandii
• Rehmannia glutinosa
• Paeonia lactiflora (Chinese Peony)
• Lophatherum gracile
• Dictamnus dasycarpus
• Tribulus terrestris
• Glycyrrhiza uralensis
• Glycyrrhiza glabra (Licorice)
• Schizonepeta tenuifolia (Neem)
• Schizonepeta tennuifolia
• Azadirachta indica
• Evening primrose oil
• Tea tree oil
• Burdock
• Rooibos
• Linseed oil
• Calamine
• Oatmeal
• Cod liver oil
• Neem oil
• Aloe propolis cream
• Raw goat's milk
• Grapefruit seed extract (GSE)
• Hemp cream
• Guto Kola