Treatment of eczema

ATOPIC SKINS ARE SUPER SENSITIVE, ITCHES SEVERELY AND ALLERGIC CONDITIONS OF: EAR, NOSE, THROAT MAY BE PRESENT.

Atopic eczema is not an allergy like urticaria, but a sign of primary immunological over activity in the skin caused by excessive lymphokines.

Avoid aggravating factors as mentioned above
Wash with a neutral non irritating soap like Crème Classsique soap containing Triclosan for the staph super- infection. Moisturizing cream like Crème Classique cream may be used. Pat dry after bath, but do not rub the skin. Use a soft cotton towel or cotton wool containing Crème Classique cream. Bath water should be body temperature. Try to prevent prolonged bathing. 3 Minutes maximum as daily bath and to avoid excessive swimming. Avoid bubble baths, detergents. Baby shampoo or coal tar shampoo if eczema present on scalp.

Moisturize: The top epidermis in atopic skin is dehydrated due to a reduced lipid barrier function of the stratum corneum. Excessive evaporation takes place. Minute cracks in epidermis are noticed allowing allergens and bacteria to penetrate. Weeping, eczema and oozing due to spongiosis and leaking of tissue fluid as well as water through the epidermis. Excessive water contact like swimming absorbs excessive water and reduces the barrier function further. More evaporation takes place, aggravating the condition. Bath oils may help and Crème Classique cream applied frequently 3-5 times a day, even when the condition has cleared, is extremely important.

Non cortisone anti-inflammatory creams or ointment: Cetomagrocol wax behaves as an anti-inflammatory, antipruritic moisturiser and contains no cortisone by itself. It may improve and prevent attacks by applying 3-5 times daily. Crème Classique cream or ointment contains Cetomagrocol and Chlorocresol as preservative. Avoid Parabens as preservative as allergic contact dermatitis may frequently be triggered.

Diluted cortisone cream or hydro-cortisone 10-20% dilution of cortisone cream in Cetomagrocol 3x a day penetrates better than cortisone by itself and with the anti-inflammatory effect of the Cetomagrocol may be more effective, less damaging and cheaper than full strength ointments. A dilution may be applied for long periods with minimal cortisone detrimental effect

Alternative to cortisone creams: Coal tar cream still prescribed and may help if cortisone failed (as frequently prescribed in Psoriasis.)

Anti itch. The older oral sedating H1 anti-histaminics like Phenergan, Aterax, especially at night are very effective. Cetrizine may prevent future asthma attacks. Most cell stabilizers not effective in eczema and Evening Primrose oil disappointing.

Secondary infection: Local or systemic antibiotics. Super infection with staph treated with Triclosan in Crème Classique soap and Crème Classique cream. Oral Floxacillin or Cephalosporin.

Oral cortisone for exceptional cases only and should be avoided as growth retardation may be seen.

Narrow Band ultra violet 311 Nanometer. This treatment is very effective and remissions for months are noted. It is also used for Psoriasis (where it is at present the first line treatment.) Interleukin suppressed in the skin. Previous PUVA not as effective in atopic eczema and may cause cataracts and premature skin ageing and cancer.

Extreme cases: Cyclosporin treatment by a dermatologist or pediatrician on a 6 weeks course or shorter. Hypertension, kidney and liver function tests. Expensive.

New Treatments: Tacrolimus available in 2004 and the new immune suppression treatments as for psoriasis and rumatoid arthritis in the near future. These are very expensive.

Avoid scratching at all times as this may lead to the itch scratch cycle, wearing cotton gloves to protect the skin especially at night.