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Everyday Management of Eczema

Posted Aug 24 2008 1:49pm
SHEILA FRIEDLANDER, MD: Atopic eczema is a skin condition, which most of people refer to as plain old eczema, in which the person has extremely sensitive skin and they react to normal things in the environment in a way that causes them to be itchy. It causes their skin to become dry and they usually develop red, welty-type sometimes or thickened, scaling lesions.

ANNOUNCER: In other words, eczema, which strikes both children and adults, is something that can cause people great discomfort.

ALICE GOTTLIEB, MD: They itch. They're unsightly appearing. They have trouble with sports because sweating exacerbates it. But clearly the itching drives people crazy. Their appearance is unsatisfactory to our patients.

ANNOUNCER: While the origin of eczema is not fully known, we do know that certain things all around us can trigger flare-ups.

SHEILA FRIEDLANDER, MD: The condition is caused by things that we might think of as normal environmental agents. Let's say we have a dry day: for you and me, well, we feel it's a little dry. For a patient with eczema, they become very itchy, they scratch, they break out and they're in misery. Other things that can kick patients off are just the wrong clothing. If they wear wool, it may cause scratchiness for their skin. Polyesters, which will cause them to sweat will cause them to break out. The wrong detergents. Any of these things can cause them to become very itchy, then they break out. And they scratch and it's a vicious cycle. The more they scratch, the more they itch, then they can become infected.

ANNOUNCER: Naturally the first step in controlling eczema is to try and prevent outbreaks.

SHEILA FRIEDLANDER, MD: Moisturize, moisturize, moisturize. That's the most important word that you can emphasize to your patient. The other thing is avoidance. To try to avoid things that you know will kick your patient off, will make him worse.

ANNOUNCER: Luckily if an outbreak does occur, there are a variety of options to treat it. Often a priority is to stop the annoying itch.

SHEILA FRIEDLANDER, MD: We need to try to break that itch-scratch cycle. Unfortunately, we don't have any one particular great medicine to stop the itch-scratch cycle, but we do utilize antihistamines. And in large studies, it's been shown that they're mostly effective to make the patient drowsy.

ANNOUNCER: One very effective treatment has been steroid ointments and creams. The problem is that steroids can have significant side effects if used long-term.

SHEILA FRIEDLANDER, MD: 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. The other is if, 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.

ANNOUNCER: Severe eczema may have to be treated with an oral steroid. Far more potent than the steroid creams and ointments, the side-effects from oral steroids can be far more serious.

ALICE GOTTLIEB, MD: You can get problems like death of bone, it's called osteonecrosis; diabetes; hypertension; growth retardation in children. Because they have so many broad undesirable side effects, there has been a real push to develop topical, non-corticosteroid agents. And we have two now.

SHEILA FRIEDLANDER, MD: One is Elidel; the other is Protopic. Both have been found to be very helpful in patients, particularly patients who fail usual topical corticosteroid treatment. Thus far, they appear to be relatively safe drugs.

ALICE GOTTLIEB, MD: Protopic is in an ointment and Elidel is in a cream. And I often ask patients, "Which one do you prefer?" Ointments are more emollient so that they're greasier; therefore, if you have a very dry skin condition, many patients will prefer an ointment because it's more soothing ultimately.

Also, in some cases drugs penetrate better in ointments than creams. However, people live in the real world and they have to put clothes on and they can't afford to sit there two hours a day with nothing on waiting for the ointment to go in. And so creams are a good compromise between convenience and greasy formulation.

ANNOUNCER: There are several ways that these new treatments can be used since their safety and convenience mean they are long-term options.

SHEILA FRIEDLANDER, MD: In particular, Elidel, which has been studied as a means of preventing flares.

ALICE GOTTLIEB, MD: I actually use it as a maintenance treatment that I ask the parent or the child or adult to apply twice a day, as background maintenance. And when there is a flare, they can add a corticosteroid to that.

ANNOUNCER: Having new options in the battle against eczema means patients can have more effective and safer choices that they can use.

SHEILA FRIEDLANDER, MD: Now we have new medications; if you didn't respond to things that were used in the past, perhaps you will respond to some of the newer agents.

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