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

Light therapy using ultraviolet light can help control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Ultraviolet light exposure carries its own risks, particularly eventual skin cancer from exposure.

When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen. This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer.

Diet and nutrition

Recent studies provide hints that food allergy may trigger atopic dermatitis. For these people, identifying the allergens could lead to an avoidance diet to help minimize symptoms, although this approach is still in an experimental stage.

Dietary elements that have been reported to trigger eczema include dairy products and coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies may vary from person to person.

Alternative therapies

Non-conventional medical approaches include traditional herbal medicine and others. Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes. Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema. Sulfur has been used for many years as a treatment in the alleviation of eczema, although this could be suppressive. Many patients find that swimming in the ocean will relieve symptoms and clear up the red patchy scales. Oatmeal is a common kitchen remedy to relieve itching, and can be applied topically as a cream or, as a colloid, in the bath. Add 2tbl to a square of muslin and fasten securely with elastic band. Submerge in the bath and when the organic porridge oats are saturated, squeeze. The bath water becomes opaque with a soothing scent of oats.

Pseudoceramides

On August 27, 2007, scientists led by Jeung-Hoon Lee created in the laboratory synthetic lipids called pseudoceramides which are involved in skin cell growth and could be used in treating skin diseases such as atopic dermatitis, a form of eczema characterized by red, flaky and very itchy skin; psoriasis, a disease that causes red scaly patches on the skin; and glucocorticoid-induced epidermal atrophy, in which the skin shrinks due to skin cell loss.

Herbal Medicine

Historical sources - notably traditional Chinese medicine and Western herbalism - suggest a wide variety of treatments, each of which may vary from individual to individual as to efficacy or harm. Toxicity may be present in some. Some of these remedies are for topical use.

• 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

Behavioural approach

In the 1980's, a Swedish dermatologist (Dr Peter Noren) developed a behavioural approach to the treatment of long term atopic eczema. This approach has been further developed by a dermatologist (Dr Richard Staughton) and psychiatrist (Christopher Bridgett) at the Chelsea and Westminster Hospital in London.

Patients undergo a 6 week monitored programme involving scratch habit reversal and self awareness of scratching levels. For long term eczema sufferers, scratching can become habitual. Sometimes scratching becomes a reflex (scratching without conscious awareness), and not always from the feeling of itchiness itself. The habit reversal programme is done in conjunction with the standard applied emollient/corticosteroid treatments so that the skin can heal. It also reduces future scratching, as well as reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema.