The primary treatment involves prevention, includes avoiding or minimizing contact with (or intake of) known allergens. Once that has been established, topical treatments can be used.
Topical treatments focus on reducing both the dryness and inflammation of the skin.
To combat the severe dryness associated with eczema, a high-quality, dermatologist-approved moisturizer should be used daily. Moisturizers should not have any ingredients that may further aggravate the condition.
Moisturizers are especially effective if applied 5–10 minutes after bathing. A doctor might prescribe lotion containing sodium hyaluronate to improve skin dryness.
Most commercial soaps wash away all the oils produced by the skin that normally serve to prevent drying. Using a soap substitute such as aqueous cream helps keep the skin moisturized.
A non-soap cleanser can be purchased usually at a local drug store. Showers should be kept short and at a lukewarm/moderate temperature.
If moisturizers on their own don't help and the eczema is severe, a doctor may prescribe topical corticosteroid ointments, creams, or injections.
Corticosteroids have traditionally been considered the most effective method of treating severe eczema.
Disadvantages of using steroid creams include stretch marks and thinning of the skin.
Higher-potency steroid creams must not be used on the face or other areas where the skin is naturally thin; usually a lower-potency steroid is prescribed for sensitive areas.
The use of the finger tip unit may be helpful in guiding how much topical cream is required to cover different areas.
If the eczema is especially severe, a doctor may prescribe prednisone or administer a shot of cortisone or triamcinolone. In some countries, over-the-counter hydrocortisone can be purchased for treatment of mild eczema.
If complications include infections (often of Staphylococcus aureus), antibiotics may be employed.
The immunosuppressants tacrolimus and pimecrolimus can be used as a topical preparation in the treatment of severe atopic dermatitis instead of or in addition to traditional steroid creams.
There can be unpleasant side effects in some patients such as intense stinging, itching or burning, which mostly get better after the first week of treatment.
However, the risk of developing skin cancer from the use of these drugs (especially when combined to UV exposure, such as sunrays) was not ignored by the FDA, which issued a "black box warning."
A more novel form of treatment involves exposure to broad or narrow-band ultraviolet light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares.
In particular, Meduri et al. have suggested that the usage of UVA1 is more effective in treating acute flares, whereas narrow-band UVB is more effective in long-term management scenarios.
However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk.
If ultraviolet light therapy is employed, initial exposure should be no longer than 5–10 minutes, depending on skin type. UV therapy should only be moderate, and special care should be taken to avoid sunburn (sunburn will only aggravate the eczema).
It does not necessarily have to be administered in a hospital; it can be done at a tanning salon or in natural sunlight, so as long as it's done under the direction and supervision of a dermatologist.
A study in April 2009 showed that bathing in a dilute household bleach solution (1/2 cup or 120 ml of ordinary household chlorine bleach (sodium hypochlorite) to a bathtub full of water) in combination with nasal application of mupirocin can be beneficial in patients with clinical signs of secondary bacterial infections.
It is believed that the antibacterial effect of these agents prevents the skin's colonization by ''staphylococcus aureus'' which can cause infections in an existing rash when the skin is broken by scratching; this in turn increases the itching, leading to more scratching and inflammation. If a bath is not available, swab onto reddened skin a dilute solution of 4.5 ml household bleach in 750 ml water.
The skin must be moisturised with the patient's preferred moisturiser or oil after the antibacterial swabbing or bath.
In severe cases that do not respond to other treatments, oral immunosuppressant medications are sometimes prescribed, such as ciclosporin, azothioprine and methotrexate.
However, these treatments require patients to take regular blood tests as they can have significant side effects on the kidneys and liver.
Alternative treatments
Oil from oenothera, commonly known as Evening Primrose, can in some cases, alleviate the symptoms of eczema.
Four small and low-quality randomized clinical trials found beneficial effects from a Traditional Chinese medicine herbal formulation called Zemaphyte, which is no longer manufactured.
A randomized clinical trial published in 2007 found that another Chinese herbal formulation increased quality of life and reduced topical corticosteroid use.
Alternative medicines may (illegally) contain corticosteroids, which are standard treatments for atopic dermatitis, raising a question of whether these illicit substances cause the effects; however, a 2006 study did not find corticosteroids in a PentaHerbs concoction that had shown beneficial effects.
Future research
It was less than ten years ago that the researchers discovered the first mouse model to spontaneously developed AE-like lesions, the inbred NC/Nga mouse.
These models have been used for tests that would have been impossible in humans, like the administration of Mycobacterium vaccae for the possible prevention of AE-like lesions.
Further Reading
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"Atopic dermatitis"
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