Thoughts On Eczema Treatments

Eczema is a chronic skin condition which can mean itchy, dry skin. It can erupt into lesions or, over time, thicken into scales. The condition affects both children and adults. Treatment often depends on the age of the person and where the eczema is located.
Children and babies tend to have involvement in the cheeks and involvements in the surface of the arms, the surface of the legs.
As people become older, the disease tends to localize in new sites. Often the creases, in the creases both behind the knees and behind the elbows are very common sites of involvement.
The first line of defense in treating eczema is something to keep the skin from being so dry. So we use lubricating creams or ointments. In the wintertime, when it's cold, you use an ointment to lubricate the skin. In the summertime, you might want to use a cream or a lotion, so you don't plug the pores.
If the person is flaring and they have lesions, then what dermatologists like to use topical steroids. And you have many classes, class basically 1 through 6, with 1 being the most potent.
We know that if they're used for prolonged periods, particularly if there are high-potency steroids used in a large surface area for long periods, that the patients can suffer from a number of things. One is thinning of the skin, atrophy of the skin or the development of large blood vessels over that area.
Systemic steroids may be appropriate when the topical steroids fail. You don't want to use them for a long period of time because they can cause shut down of the adrenal gland or a decreased function of the adrenal gland. So we try not to use them for long periods of time.
There's also a new group of medications out; the one's tacrolimus and one's pimecrolimus, Protopic and Elidel. And they have been found to work very well in patients who have eczema. The Protopic is an ointment, two different strengths, and the Elidel is a cream. It's not topical steroids where you have to be careful of atrophy and so forth. You can use them basically for years without the problem.
Thus far, they appear to be relatively safe drugs. Certainly with tacrolimus, we know that if you absorb too much, you could get some immunosuppression because that drug was used as a transplant immunosuppression. That doesn't appear to be the case with Elidel.
Deciding which treatment is a balancing act weighing several factors.
The area of the body involved is an important issue for you when deciding which treatment to use. There are certain areas of the body that are particularly high-risk when you use topical corticosteroids; those include the face, the eyelids, under the armpits, in the groin. The reason is those areas of the body have very, very thin skin. So the skin very easily can absorb more of the agent that you're putting on or be affected by it.
The age of the sufferer is also important. The smaller body size of children makes them even more susceptible to the affects of steroids.
Let's say a young child was smeared in these topical corticosteroids, they could absorb it, and it could have an affect on their growth. It could suppress glands in the body, the adrenals. So we know that too much steroid for too long is dangerous.
However, today, the non- steroidals give doctors a new element to factor into the decision on which treatment to use for each patient.
If there is a need to use something for a prolonged period, one of the new immunomodulators may be considered, on the face, particularly. It's a real gain to have an agent that can be used chronically that does not seem to have the risks of atrophy, thinning of the skin or cataracts. So, particularly around the eyelids, on the face, the choice may be the use the newer immunomodulators.
You think about the nonsteroidals with the age of the patient, the location of the lesions; if it's facial, if it's under the arms, if it's between the legs, if it's on the genitalia, then you would probably go with a nonsteroidal.
If it's recurrent, because they're taking their steroids and not getting better, then you would definitely think about them.
Having new non steroidal options is particularly good news for children and their parents.
There has been some new data that's come out with the newer immunomodulators, particularly with Elidel, and it has been found that it was very, very efficacious, very useful in preventing flare. And the absorption of the drug was minimal. So this is certainly an option that you can use with young children.
While eczema treatments are not cures, having a variety of options means people can have a broader range of safe and effective therapies to treat their condition.