Diagnosing Eczema

Effective treatment requires a correct diagnosis; however, it is not always easy to distinguish one type of eczema from another or from similar skin conditions. Dermatologists have the medical training and experience needed to determine if eczema is present — and if present, which type. To diagnose eczema, dermatologists examine the skin and ask about:
When the skin condition first appeared
Signs and symptoms, such as long-term pruritus (itching) or recurring dermatitis (inflammation of the skin)
Certain circumstances that may aggravate the condition, such as excessively dry air or emotional stress
Family medical history, including questions about close blood relatives who have asthma, hay fever, or eczema
Personal medical history

Disagreement Over Eczema Treatment's Black Box Warnings

The American Academy of Dermatology (Academy) has issued a statement in response to the U.S. Food and Drug Administration's (FDA) announcement that a black box warning will be added to the labeling and a medication guide will be distributed for the topical calcineurin inhibitors (TCIs), pimecrolimus and tacrolimus.
These topical medications effectively reduce the inflammation and other symptoms associated with the skin disease eczema.
"The American Academy of Dermatology disagrees with this action taken by the FDA. We believe that the data does not prove that the proper topical use of pimecrolimus and tacrolimus is dangerous," said dermatologist Clay J. Cockerell, M.D., president of the American Academy of Dermatology. "Because these medications are applied to the skin, virtually none of it gets inside the body. It's not the same as taking a pill. These are valuable medications, and if used properly, they allow millions of our patients with eczema to live normal lives."
This past summer, the Academy held a conference to discuss the scientific, regulatory, clinical, and public concerns raised by this potential FDA action. The dermatologists, patients, pharmacists and immunologists participating in the conference reviewed the current literature and safety data for these medications. It was determined that the addition of a black box warning and medication guide was unwarranted and could limit access to TCIs, or limit treatment options if qualified patients decide not to use these medications based on fear of a malignancy risk.
"The health, safety and welfare of our patients being treated with these topical medications are of paramount importance to dermatologists," said Dr. Cockerell. "We are concerned that this warning will confuse and unnecessarily worry our patients. We urge patients to get the facts on how to appropriately manage their eczema from their dermatologist."

Eczema Drugs Receive Black Box Warnings

The labels on two prescription creams to treat eczema will have to bear "black box" warnings of possible cancer risks.
The Food and Drug Administration's action Thursday follows an agency advisory committee recommendation last February that Elidel cream and Protopic ointment carry the label warnings.
The new labeling also will clarify that the two drugs are recommended for use only after other prescription topical medicines have been tried by patients, the FDA said. The agency is also issuing a guide updating patients of its concerns.
A black box warning is the most serious type of warning in prescription drug labeling. The warning will be located lower on the labels of the two drugs than is typical, although a statement higher on the labels will refer to the risk.
"This is something that is a possible risk, is a long-term possibility and is something that still needs to be researched," FDA spokeswoman Susan Cruzan said.
As of October, the FDA has received reports of 78 cases of cancers, including skin and lymphoma, in patients treated with the two drugs, said Dr. Stanka Kukich, the acting director of the FDA's dermatologic and dental drug products division.
Novartis Pharmaceuticals, which makes Elidel, said in a statement Thursday that it remained confident in the safety and efficacy of Elidel.
"While Novartis believes this action is not substantiated by scientific or clinical evidence, Novartis has agreed to make the requested changes," the company said.
Astellas Pharma Inc., formed through the merger of Protopic maker Fujisawa Healthcare Inc. and Yamanouchi Pharmaceutical Co., said in a statement that its drug "is safe and effective when used in a manner consistent with its label."
"It addresses a theoretical risk — a potential risk, not a demonstrated link," Dr. Joyce Rico, vice president for medical sciences research and development at Astellas, said of the warning.
While the two manufacturers dispute whether there is a cancer link, the FDA felt it had to convey notice of the cancer reports to doctors and patients, said Dr. Julie G. Beitz, an acting director of one of the FDA's drug evaluation offices.
Along with the small number of cancers reported in both children and adults treated with the drugs, animal tests have shown an increase in cancer associated with the drugs, the FDA said last year.
No causal link between use of the drugs and cancer has been established, Beitz said.
The long-term safety of the drugs has not been established, according to the FDA. While both companies are studying that issue, the results may not be known for years, the FDA said.
Elidel and Protopic are applied to the skin to control eczema by suppressing the immune system.
The companies estimate that roughly 10 million people combined have used the two drugs.

Dr. Angela Wingfield Answers The Question: What Is Eczema?

Q: What is eczema?
A: Eczema is a chronic skin condition caused by an irregularity in the immune system cells of your skin.
People with eczema have microscopic breaks in the protective skin layers which allow their skin to lose water more rapidly and become dry. The breaks also allow irritating substances to get in and cause more itching or burning.

Q: What are the symptoms of eczema?
A: The result is red, flaky rashes that usually itch or sting. Symptoms are made worse by sweating and exposure to irritating fabrics, chemicals, detergents or fragrances. It is common for people with eczema to have allergies to foods or plants, and allergy testing (plus allergy shots) is sometimes helpful.

Q: How is eczema treated?
A: There are many different ways to treat eczema.
Prescription cortisone creams and anti-inflammatory medicines are frequently used. For more severe cases, pills that suppress the immune system may be prescribed.
Light treatment (phototherapy) can also be useful under the direction of a dermatologist.
Over-the-counter lotions containing menthol, camphor, pramoxine and lidocaine provide temporary relief from the itching.
Oatmeal baths can be very soothing. Application of ice for five to 10 minutes is a useful way to avoid scratching.
Scratching causes more breaks in the skin and makes you itch even more.
Sometimes it is necessary to use antihistamine pills to help with itching.

Q: Are there other recommendations to care for the skin?
A: Good routine skin care is also very important for people with eczema. They should take brief showers with warm to lukewarm water, use mild soaps, pat dry with a soft towel, and immediately apply a fragrance-free, heavy moisturizer or petroleum jelly. This will prevent further damage to the skin barrier.

Relieve Itchy Skin

By interrupting the action of substance P, cream made with capsaicin will reduce swelling, itchiness and redness in dermatitis related cinditions by 75%.

"Capsaicin an ingredient in hot peppers, deactivates substance P, the neu-transmitter that regulates pain and inflammation, " says Gary Spector, M.D., an internal medicine specialist in Milford CT.

"The pepper extinguishes the cause of discomfort."

Pamper Eczema Skin in the Winter Months

Dry winter air can cause skin cracking, chapping and irritation, and the winter sun can be as damaging to skin as it is in the summer, says the American Society for Dermatologic Surgery (ASDA). Dr. Rhoda Narins, a dermasurgeon and past president of the ASDA, offers the following winter skin care advice:
Moisturizers help protect your skin against the harsh winter elements. Apply moisturizer immediately after a bath or shower to seal in necessary waters and oils.
Gloves are a simple, easy way to protect your hands from cold temperatures and dry air that triggers eczema. Gloves can also prevent cracked and splitting cuticles and fingernails.
If you develop dry and itchy skin or eczema, don't let the condition get worse. Consult a doctor.
Apply sunscreen to all exposed skin when you're outdoors.
Protect your lips by using lip balms or lipsticks that have a high SPF.
Don't take long, hot showers, which can strip skin of its natural elements and cause dry skin. Take shorter showers with lukewarm water.

The Healing Benefits of Jojoba Oil

Women have been using Jojoba oil as a beauty treatment for decades, if not centuries. Native Americans used to extract the oil from jojoba beans as a treatment for cuts, sores and bruises, as well as sunburn. It has been applied to both face and scalp to help prevent evaporation and provide lubrication for dry, flaky skin. It absorbs easily, is non-greasy, and is very pleasant and soothing no matter what your skin type. Many women claim that jojoba oil also has a minimizing effect on pores!

Jojoba oil, like other natural oils, is considered a "natural moisturizing factor". Just like the lipids that are naturally found in your skin, it helps fight surface roughness, flaking, and fine lines. But it isn't reserved just for those who have dry skin. People with acne-prone skin, who suffer more than others from clogged pores and blackhead formation, tend to avoid oil-based products like the plague. They assume that all oil-based products will make their acne worse.

Not so! Due to the unique molecular structure of jojoba oil, not only will it mix readily with the skin's natural oils, but studies have shown that it can even inhibit the growth of certain types of bacteria associated with acne.

Jojoba oil is also soothing for skin conditions like rosacea and sebborheic dermatitis, and will not cause flare-ups. By helping to reinforce the structure of the skin's outer layer (the epidermis), jojoba oil -along with the natural oils produced by the skin- is extremely helpful in the healing process. Natural oils help prevent individual cells from losing moisture, and aid in keeping the skin smooth and supple.