ANNOUNCER: No one wants to have eczema, an uncomfortable skin condition that affects adults and children alike. It can be both itchy and uncomfortable.
MEDWIN MINTZIS, MD: Usually eczema is seen as diffuse red patches which, at the edges, tend to blend in with the skin. They're dry and, if rubbed enough, can be scaly and thick.
ANNOUNCER: The good news is that today there are a variety of ways to lessen eczema's effects. One traditional treatment involves using steroids. Of course when most people think of steroids they think of the kind that "pump you up," but these are very different.
LAWRENCE EICHENFELD, MD: The anabolic steroids, which people will take to increase their bulk, is a very different class of medicines; it has nothing to do with the steroids that we talk about with eczema.
Those steroids, the topical steroids that we use for eczema, are generally cortisone-based products. And they work as anti-inflammatory medicines that decrease inflammation in the skin and, if you take it by mouth, systemic inflammation as well. And it's a very different set of side effects. So no one's going to have body-building problems, so to speak, or they're not going to bulk up by using topical steroids.
ANNOUNCER: The steroidal treatments used for eczema can be prescribed by a doctor or even obtained over-the-counter.
LAWRENCE EICHENFELD, MD: The important thing to know is that they vary greatly by strength.
For instance, there are some topical steroids that are over-the-counter. One percent hydrocortisone is over-the-counter. They can be pretty effective for eczema conditions that are on very thin skin, for instance, on facial skin.
On the other hand, there are prescription topical steroids that can be incredibly strong.
ANNOUNCER: In the case of very severe eczema, sometimes even more powerful steroids, taken orally, are the only option.
MEDWIN MINTZIS, MD: Really only reserved for the severest flares which are not responding to topical medications. Rare to have to use it for more than a week at a time and those weeks should be spread out really over months.
ANNOUNCER: With topical steroids as well, more is not necessarily better.
MEDWIN MINTZIS, MD: Using topical steroids more frequently than twice a day doesn't achieve any greater result than using the topical steroids and just lubricating throughout the day.
ANNOUNCER: Experts feel that any prescription steroidal treatment should be used sparingly and, only on certain areas of the body. The reason? The prolonged use of steroids can produce problematic side effects in both adults and children.
MEDWIN MINTZIS, MD: The most prominent side effect is skin atrophy; the skin is too sensitive and will rip and bleed easily. We have to be particularly careful about using high-potency topical steroids on the face or under the arms or in the groin, where the skin is thinner.
LAWRENCE EICHENFELD, MD: You can also get the development of blood vessels. One of the other big worries with long-term topical corticosteroid use is that the steroids get absorbed into the bloodstream. And this can cause problems in terms of your ability to fight infections; it can also impact on growth.
It can be several days up to two weeks or three weeks until the eczema comes under control. And then as the inflammation comes under control, we try to decrease the strength of topical corticosteroid that's used.
ANNOUNCER: The potential side effects also explain why experts have welcomed the introduction of new non-steroidal treatments for eczema.
LAWRENCE EICHENFELD, MD: Both Protopic, which is tacrolimus, which comes as an ointment, and Elidel cream, which is pimecrolimus, which comes as a cream, are highly useful as agents that can control the acute inflammation, the active rashes of eczema, even though there's no topical steroid in it.
They're also really useful for long-term use. So for patients who have frequent flares of their disease and who were sort of always on a week or two of topical steroids, trying to get off of it and within a few days or a week, they're flaring again, the new topical medications are tremendous breakthroughs, because it can really maintain a person disease-free for months and years at a time.
ANNOUNCER: These treatments can be used long term without hesitation.
MEDWIN MINTZIS, MD: About the only drawback is they're certainly not as strong as the strongest cortisone-based products.
LAWRENCE EICHENFELD, MD: Protopic is an ointment. Elidel comes as a 1% cream; it rubs in drier than the ointment might be. The incidence of stinging and burning appears to be less with Elidel, and they both appear to be pretty effective for eczema. Where Protopic has been approved for moderate to severe eczema as compared to the Elidel, which has been approved for mild to moderate eczema.
ANNOUNCER: What many experts suggest is a two-pronged attack.
LAWRENCE EICHENFELD, MD: If there's a patient with very mild disease, you can use intermittent, low-potency topical steroids, even over-the-counter stuff with moisturizers. On the other hand, you have the option of using some of the non-steroidals, especially in young children. And then if you have patients who have very frequent flares, maybe you use a non-steroidal, and then when there's real severe flares, you use topical steroids on top of that.
ANNOUNCER: So while it's never a great time to have eczema, at least today another weapon has been added to fight off the symptoms.
MEDWIN MINTZIS, MD: It's always a balance between getting a disease in control quickly versus greater side effects, as opposed to perhaps taking a little longer and having less possibility of side effects and where that equation lands up varies from patient to patient.
MEDWIN MINTZIS, MD: Usually eczema is seen as diffuse red patches which, at the edges, tend to blend in with the skin. They're dry and, if rubbed enough, can be scaly and thick.
ANNOUNCER: The good news is that today there are a variety of ways to lessen eczema's effects. One traditional treatment involves using steroids. Of course when most people think of steroids they think of the kind that "pump you up," but these are very different.
LAWRENCE EICHENFELD, MD: The anabolic steroids, which people will take to increase their bulk, is a very different class of medicines; it has nothing to do with the steroids that we talk about with eczema.
Those steroids, the topical steroids that we use for eczema, are generally cortisone-based products. And they work as anti-inflammatory medicines that decrease inflammation in the skin and, if you take it by mouth, systemic inflammation as well. And it's a very different set of side effects. So no one's going to have body-building problems, so to speak, or they're not going to bulk up by using topical steroids.
ANNOUNCER: The steroidal treatments used for eczema can be prescribed by a doctor or even obtained over-the-counter.
LAWRENCE EICHENFELD, MD: The important thing to know is that they vary greatly by strength.
For instance, there are some topical steroids that are over-the-counter. One percent hydrocortisone is over-the-counter. They can be pretty effective for eczema conditions that are on very thin skin, for instance, on facial skin.
On the other hand, there are prescription topical steroids that can be incredibly strong.
ANNOUNCER: In the case of very severe eczema, sometimes even more powerful steroids, taken orally, are the only option.
MEDWIN MINTZIS, MD: Really only reserved for the severest flares which are not responding to topical medications. Rare to have to use it for more than a week at a time and those weeks should be spread out really over months.
ANNOUNCER: With topical steroids as well, more is not necessarily better.
MEDWIN MINTZIS, MD: Using topical steroids more frequently than twice a day doesn't achieve any greater result than using the topical steroids and just lubricating throughout the day.
ANNOUNCER: Experts feel that any prescription steroidal treatment should be used sparingly and, only on certain areas of the body. The reason? The prolonged use of steroids can produce problematic side effects in both adults and children.
MEDWIN MINTZIS, MD: The most prominent side effect is skin atrophy; the skin is too sensitive and will rip and bleed easily. We have to be particularly careful about using high-potency topical steroids on the face or under the arms or in the groin, where the skin is thinner.
LAWRENCE EICHENFELD, MD: You can also get the development of blood vessels. One of the other big worries with long-term topical corticosteroid use is that the steroids get absorbed into the bloodstream. And this can cause problems in terms of your ability to fight infections; it can also impact on growth.
It can be several days up to two weeks or three weeks until the eczema comes under control. And then as the inflammation comes under control, we try to decrease the strength of topical corticosteroid that's used.
ANNOUNCER: The potential side effects also explain why experts have welcomed the introduction of new non-steroidal treatments for eczema.
LAWRENCE EICHENFELD, MD: Both Protopic, which is tacrolimus, which comes as an ointment, and Elidel cream, which is pimecrolimus, which comes as a cream, are highly useful as agents that can control the acute inflammation, the active rashes of eczema, even though there's no topical steroid in it.
They're also really useful for long-term use. So for patients who have frequent flares of their disease and who were sort of always on a week or two of topical steroids, trying to get off of it and within a few days or a week, they're flaring again, the new topical medications are tremendous breakthroughs, because it can really maintain a person disease-free for months and years at a time.
ANNOUNCER: These treatments can be used long term without hesitation.
MEDWIN MINTZIS, MD: About the only drawback is they're certainly not as strong as the strongest cortisone-based products.
LAWRENCE EICHENFELD, MD: Protopic is an ointment. Elidel comes as a 1% cream; it rubs in drier than the ointment might be. The incidence of stinging and burning appears to be less with Elidel, and they both appear to be pretty effective for eczema. Where Protopic has been approved for moderate to severe eczema as compared to the Elidel, which has been approved for mild to moderate eczema.
ANNOUNCER: What many experts suggest is a two-pronged attack.
LAWRENCE EICHENFELD, MD: If there's a patient with very mild disease, you can use intermittent, low-potency topical steroids, even over-the-counter stuff with moisturizers. On the other hand, you have the option of using some of the non-steroidals, especially in young children. And then if you have patients who have very frequent flares, maybe you use a non-steroidal, and then when there's real severe flares, you use topical steroids on top of that.
ANNOUNCER: So while it's never a great time to have eczema, at least today another weapon has been added to fight off the symptoms.
MEDWIN MINTZIS, MD: It's always a balance between getting a disease in control quickly versus greater side effects, as opposed to perhaps taking a little longer and having less possibility of side effects and where that equation lands up varies from patient to patient.