Tuesday, October 18, 2005

Eczema Treatment Will Not Cure Eczema

There is essentially no cure for eczema. It involves a sensitivity of the skin that you are likely to have to some degree from now on. There are, however, a number of approaches which help to minimise your symptoms.
The mainstay of treatment is moisturising the skin. For this we use creams, ointments and shower and bath oils which help to replenish the skin's natural protective oils.
You should discuss these with your doctor, nurse or pharmacist. Washing tends to dry out the skin and make eczema worse. It helps to use an emollient cream as a substitute for soap, and you can apply it liberally at other times during the day. The special bath oils and shower gels also leave a coating of oils on the skin. Some of the creams and oils contain an antiseptic, as it has been found that eczema often flares up as a result of a germ infecting the skin.
Your doctor may prescribe a cream or ointment containing a steroid (topical steroid). These are very effective at reducing inflammation and itch. Your doctor will want you to use this sparingly, and only while the eczema is bad. There are different strengths of steroid applications, and the tendency is to use the lowest strength that the skin requires at the time, in order to minimise the risk of possible side effects of using steroids.
In moderate to severe atopic eczema, where topical steroid treatment has not worked, your doctor may prescribe a new type of treatment to be applied to the skin (topical treatment). The preparations are made from a type of drug known as immunomodulators (calcineurin inhibitors, eg tacrolimus and pimecrolimus) that are used, when taken internally, for such things as preventing rejection of transplanted organs. They are strong drugs, but given as an ointment they do not affect your general immunity, and the main possible side effect is a burning sensation. They are certainly effective on atopic eczema and, used under the supervision of your doctor, may make a difference where the previous treatments were not doing enough. In England and Wales there are guidelines on their usage from the National Institute of Clinical Excellence.
Antihistamines taken by mouth may be helpful in reducing the itch. Your doctor will advise.
If the skin becomes obviously infected, which is more likely as its normal protective surface has been damaged, your doctor will prescribe antibiotics.
There are a number of older fashioned remedies which are still effective and may be suggested by your doctor or specialist. For example tars, menthol.
Evening primrose oil supplements are used for eczema, and are a safe treatment, but have not consistently proved to be effective in research trials. It would appear that the evidence may not support them being any more effective than capsules or medicine containing no active ingredient (placebo).
If the skin is not responding well, your doctor will probably ask a skin specialist (dermatologist) to see you. There are a number of options that the specialist may use. These may include:
Bandages and wet wraps.
Drugs to suppress the immune system of the body as a whole. These are only used in severe cases, and include Cyclosporin, a drug otherwise mainly used to stop rejection in patients receiving transplants.
Phototherapy. Ultra-violet light treatment (UVB and PUVA) can be used in the treatment of atopic eczema. Ultra-violet therapy potentially increases the risks of skin cancer, so it is only used in severe cases.
Naturally, if your eczema is a result of a specific allergy or sensitivity, then it is wise to avoid the thing which causes it if you can.