Tags: eczema | treatment | atopic dermatitis | dermatology

Many Options Available for Treating Eczema (Atopic Dermatitis)

Many Options Available for Treating Eczema (Atopic Dermatitis)
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Monday, 11 December 2017 11:32 AM Current | Bio | Archive

Atopic dermatitis, also known as eczema, is a frequent cause of visits to the dermatologist. According to the National Eczema Foundation, it is commonly seen as dry, itchy skin that can be associated with redness and scale. Typical areas that get involved include the fronts of the elbows, the backs of the knees, and the sides of the neck. Flares may be associated with stress, with exposure to certain chemicals, allergens, fibers, or foods. Dry skin is also a known factor in flares of eczema.

Atopic dermatitis has a constellation of signs associated with it. These range from an extra fold under the lower eyelid to extra lines on the palms of the hands. There may be a propensity for asthma or seasonal allergies in many of those affected by the disease. For both infants and adults, there may be a sensitivity to wool or to fragrances and preservatives. In these instances, one needs to be very careful about what touches the skin. Since the skin is a large, immunologically active organ it is wise to be aware of the different preservatives and fragrances that can cause a flare.

Since the skin knows how to react in a limited number of ways, it typically responds to irritation by getting red and inflamed. This triggers the itch-scratch cycle in which the skin gets very itchy and is then scratched. Scratching results in more inflammation which causes the skin to get thicker and more inflamed. After a while, the skin will become difficult to treat because medications applied topically can not penetrate into the skin. In addition to this thickening, the affected areas may get infected. For many patients, especially children, the infections cause a honey colored crust. The types of bacteria that cause this infection is wide ranging but in general it is caused by one or two bacteria. In my practice, I will frequently culture the skin to determine the type of infection but I will also use antibiotics if there is a suggestion of infection. If the infection is not treated, the underlying eczema will not get better. There is ample evidence to suggest that controlling the bacteria on the skin can help to decrease the amount of flares. One easy and inexpensive way of doing this is with a teaspoon or two of bleach in a tub of water. This will help to control the bacterial on the surface of the skin without using constant antibiotics.

The treatments for atopic dermatitis are varied. Many cases can be effectively treated with topical steroid creams and moisturizers. For patients that are widely impacted with significant disease, a short course of oral steroids may be effective. More recently, there have been advances in both topical and systemic treatments that have altered the landscape for both physician and patient. Topical alternatives now include Crisaborole (Eucrisa). This drug has been shown to improve mild–moderate eczema and does not contain steroids. Used twice daily, it has been helpful in treating atopic dermatitis and it represents the first new topical drug in a long time. Another drug that is effective in treating atopic dermatitis is Dupixent (dupilumab). This is an injectable drug used for moderate to severe atopic dermatitis. The first injection of this drug involves two syringes and after that, one syringe (300 mg) of drug is injected every two weeks. This drug binds to the IL-4Rα subunit and by doing so, it interrupts the inflammatory cascade that causes the skin to flare. At the present time, this is the first and only biologic modifier approved for this and it has very impressive clinical data to support its use. There are many other systemic drugs now under development (for more information look here). (Disclosure: I am an investigator for one or more of these drugs).

One area that remains in need of further clarification is the role of diet. Some of my patients note that they flare after certain foods. This may make sense for people that are sensitive to dyes and fragrances. Both of these are found in tomato sauce and a host of other foods. I think that this area will be further researched in years to come.

Atopic dermatitis is a widespread and serious problem associated with a great deal of discomfort and expense. If you are suffering from this, try to see a dermatologist as soon as possible. He or she will help map out a strategy that can help you live a less itchy life.

Kenneth Beer, MD is a board certified dermatologist and dermatopathologist in West Palm Beach and Jupiter, Florida (www.beerdermatology.com). He was an AB Duke Scholar at Duke University and then attended medical school at The University Of Pennsylvania. After completing a year of internal medicine in Philadelphia, he trained in dermatology at The University of Chicago. Dr. Beer has volunteered at the University of Miami for more than 20 years and believes strongly in their mission of providing healthcare. He is actively involved in clinical research for cosmetic medicine, general dermatology and skin cancer. He blogs at Newsmax to discuss issues that pertain to the skin as well as to healthcare in general. To read more of his reports — Click Here Now.

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Atopic dermatitis, also known as eczema, is a frequent cause of visits to the dermatologist.
eczema, treatment, atopic dermatitis, dermatology
Monday, 11 December 2017 11:32 AM
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