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24 November, 2009

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Eczema treatments

Eczema is a type of inflammatory skin condition with symptoms including dry, itching and reddened skin patches. Sometimes, the affected areas of skin can split and ooze clear fluid. There can be different causes for eczema. Occasionally it can be an allergic reaction to some type of chemical or other substance. The cause for the most common form (atopic eczema or atopic dermatitis) is unknown.

Some researchers believe that allergens, like house dust mites, are significant triggers; others believe that genetic predisposition to eczema is a more important contributing factor, as most people with eczema have a family history of the condition. Eczema can’t be cured, but it can be managed.

A range of contributing factors
The exact cause of atopic eczema is unknown, but risk factors can include:

A family history of eczema
A family history of allergies or atopic conditions, including hay fever and asthma
Contact with irritants in the environment
Heat, which can aggravate itch and make affected people more likely to scratch
Occasionally, allergic reaction to particular foods – this is rare. Food allergy appears as redness and swelling around the lips within minutes of eating the offending food.

Treatment options
Treatment options for eczema include:

Emollients
Oral antihistamines
Corticosteroids
Pimecrolimus cream
Coal tar
Dietary adjustments
Evening primrose oil
Ultraviolet radiation therapy (phototherapy)
Cyclosporin oral medication.

Emollients (moisturisers)
Emollient creams add moisture to the skin. Apply moisturisers each day to clean, dry skin. It is especially important to moisturise after showering and bathing, and when living or working in an air-conditioned or heated environment. You may need to try several different brands until you find the emollient that works best for you. See your doctor, dermatologist or pharmacist for advice.

Oral antihistamines
Histamine, a chemical produced by the body, is responsible for many of the symptoms of inflammation, particularly itching. Antihistamines block the action of histamine and help to reduce eczema symptoms. Generally, oral antihistamines are best taken around half an hour before bed to help guarantee a good night’s sleep, uninterrupted by the urge to scratch.

Antihistamines are available from pharmacists without prescription, but remember that some types may cause drowsiness. Antihistamine creams should be avoided, as they can trigger an allergic skin reaction. See your pharmacist for information and advice. Antihistamines should not be used in children under 12 months because of concerns about sudden infant death syndrome (SIDS).

Corticosteroids
Eczema responds well to anti-inflammatory creams. Topical steroids (corticosteroids) come in various strengths and are available by prescription from your doctor. Generally, it is better to use the lowest strength that works adequately. Using high strength topical steroids for extended periods of time, especially on delicate areas like the face, can cause side effects including thinning of the skin. It is best to apply the cream to the reddened areas after bathing, but make sure the skin is thoroughly dry.

In severe cases of eczema, a short course of oral corticosteroids may be necessary. This must be done under careful medical supervision because symptoms may become worse once the tablets are stopped.

Pimecrolimus cream
Pimecrolimus cream is a non-steroid anti-inflammatory cream that can help reduce flares of eczema if applied at the first signs of eczema.

Coal tar
Applying coal tar to affected areas is another way to reduce the itch associated with eczema. Coal tar has a strong smell and tends to stain any fabric it touches. It can also irritate some people’s skin. Only use it under supervision of a doctor who is experienced in managing eczema.

Dietary adjustments
While diet is thought to play no part in eczema, occasionally a person’s symptoms are aggravated by eating certain foods, such as dairy products. Seek professional advice from your doctor or dietitian and have proper allergy tests. Self-diagnosis and self-imposed dietary restrictions can lead to unnecessary nutritional deficiencies.

Evening primrose oil
Evening primrose oil (or star flower oil) contains gamma linolenic acid, which is thought to play an important role in maintaining healthy skin. Some studies have suggested that it is lacking in some people with eczema. If evening primrose oil is effective in controlling symptoms in those people, it may reduce the need for medicated creams such as topical steroids. Evening primrose oil is applied directly to the skin or can be taken orally in capsules.

Ultraviolet radiation therapy (phototherapy)
Exposure to ultraviolet radiation can help reduce the symptoms of chronic eczema. Exposure under medical supervision can be carefully monitored with the use of specially designed ‘cabinets’ – the patient stands naked within the cabinet and fluorescent tubes lining the device emit ultraviolet radiation, in a similar fashion to a solarium. The risks of unsupervised ultraviolet radiation therapy can be the same as for sunbathing – accelerated ageing of the skin and increased risk of skin cancer. A person with stubborn eczema may need up to 30 sessions.

Cyclopsorin oral medication
Cyclosporin helps to manage the symptoms of severe eczema by preventing the immune system from sending special cells called lymphocytes into the affected areas of skin. Reduced immune system activity reduces inflammation. However, the side effects of this drug can include high blood pressure, kidney problems, increased susceptibility to all types of infections, and a possible increased risk of skin cancer. Because of the risk of significant side effects, and the need for close and regular monitoring, oral cyclosporin is only considered in severe cases of eczema that are difficult to control with other therapies.

Other skin infections are more likely
An intact skin surface is the best defence against skin infections. This is why a person with eczema is prone to bacterial and viral infections, including:

Staphylococcus aureus – which causes impetigo, thrives on skin affected by eczema. The infection is characterised by inflamed blisters that pop, weep and form crusts. Treatment options include antiseptic creams and antibiotic tablets.
Herpes simplex virus – or cold sores can easily spread over wide areas. See your doctor for prompt treatment.
Warts – these small, raised lumps are caused by viral infections. Warts often clear up by themselves, but this can take up to 12 months in some cases.

Where to get help

Your doctor
Dermatologist
Eczema Association of Australasia Tel. 1300 300 182 or (07) 3821 3297

Things to remember

Eczema is a type of inflammatory skin condition with symptoms including dry, itching and reddened skin patches.
Treatment options for eczema include moisturisers, oral antihistamines, corticosteroids, pimecrolimus cream, evening primrose oil, coal tar, dietary adjustments, ultraviolet radiation therapy (phototherapy) and cyclosporin oral medication.

You might also be interested in:
Eczema - coping tips.
Eczema (atopic dermatitis).
Skin explained.

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