ECZEMA TREATMENT

The following medications are most commonly used to treat eczema:
Antihistamines such as diphenhydramine which is used to help decrease the amount of itching. These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness;
Topical steroid creams used to help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin.
Other options include oral antibiotics; oral cyclosporine designed to suppress the immune system; phototherapy; topical immunomodulators which are a new class of drugs for the treatment of eczema. These drugs are used topically to alter the immune response.

A therapy traditionally used on esophageal cancer and lung cancer is causing a buzz in dermatology circles as a way to treat precancerous skin lesions, sun damage and acne.
Called photodynamic therapy, or PDT, it is gaining popularity with claims that it's more convenient and less painful, and that it brings fewer side effects than conventional treatments.
The Food and Drug Administration has approved PDT only for the treatment of certain tumors and actinic keratoses, which are scaly or crusty bumps that form on the skin surface from too much sun. But now the procedure also is being widely used for sun damage and acne on an "off-label" basis.
"There are exciting new and improved cosmetic indications," says Dr. Ron Berne, an Elmwood Park, Ill. dermatologist who began using PDT on his patients in March.
He explained that PDT can improve sun damage such as blotchy complexion, fine lines and telangiectasia, which are dilated superficial blood vessels such as are found with rosacea. The procedure improves the entire area treated, creating a more uniform color, texture and tone, rather than just spot treating with liquid nitrogen or other techniques.
The procedure involves applying a topical solution called 5-aminolevulinic acid (Levulan Kerastick) directly to the skin, then activating it with a light source for a specific time. The solution is absorbed by the abnormal keratin in precancerous or sun-damaged cells or oil glands, depending on what is being targeted.
A variety of light sources may be used, from lasers and intense pulsed light to blue light, which refers to the light wavelength. Therapy can be repeated several times at the same site if necessary.
PDT also can dramatically improve mild to moderate inflammatory acne when used in combination with other treatments, Berne says, eliminating the need for oral antibiotics or the controversial drug Accutane. The Levulan is absorbed into the oil glands, significantly reducing them.
Accutane has a much higher risk of side effects, such as birth defects and liver problems, according to Berne.
Kim Nguyen, 32, of Chicago, Ill., is allergic to many antibiotics and benzyl peroxide, so she is limited in her choices of acne treatment. She has had two PDT treatments.
"I can see a reduction in the acne and scars, and the redness is less intense," she says.
She has two more treatments scheduled, and her health insurance has covered a portion of the cost.
A PDT treatment typically ranges from $250 to $350.
In general, patients must avoid all sunlight and even brightly lit rooms for 36 hours or risk getting a severe burn due to heightened skin sensitivity to light.
"Plan a day and a half inside in the shadows," Berne says.
Even with that drawback, Berne prefers PDT as a treatment for actinic keratoses.
The standard treatment uses liquid nitrogen to freeze off the lesions. But doctors can't treat more than a couple at a time, so return office visits are required, according to Berne.
"For multiple actinic keratoses, conventional therapy can be painful and inconvenient," he added.
PDT targets only abnormal cells, so all lesions can be treated at one time, or repeated if necessary, according to Berne.
The use of PDT in dermatology, however, isn't universally hailed, says Dr. Gregg Menaker, director of dermatologic surgery at Evanston Northwestern Healthcare and assistant professor of dermatology at the Feinberg School of Medicine at Northwestern University, Evanston, Ill.
While director of the dermatologic surgery unit at Massachusetts General Hospital (Boston), "I saw a steady parade of people from our lab to my surgical unit for lesions that didn't go away with PDT," he says.
In patients with multiple actinic keratoses, not every lesion may be an actinic keratosis, he explains. The lesion could be a squamous cell, a common skin cancer. "There are other treatments that are faster, cheaper and more effective," he says.
As for using PDT for acne, Menaker says, "Our standard acne therapies are going to end up being the preferred way to treat acne. Acne patients are mostly kids who are in school and don't want to come to the dermatologist. From a scheduling standpoint it's difficult. And there is no long-term data to support its use."
But PDT is in use at the Texas Dermatology Research Institute, where Dr. William Abramovits, a professor of dermatology at Baylor University Medical Center in Dallas employs it to treat actinic keratoses, acne and other skin diseases.
He says, however, that because low-energy light may not be able to penetrate deep enough into thick lesions, PDT may fail to destroy squamous cell cancers or thick actinic keratoses.
"Many centers, particularly in Europe, are exploring the potential of newer sensitizers, and light of wavelengths that will penetrate deep enough to destroy thicker lesions," Abramovits says. "The results are very promising.

People with eczema are often very sensitive to the weather. This skin condition, marked by dry, itchy, blistering skin, can be particularly troublesome in extremely cold or hot temperatures. And people living with this chronic condition, especially kids, know that doing certain exercises and sports activities can be aggravating.
The low humidity of cold, dry winters can cause skin to dry out, which can lead to itching and flare-ups. Heating homes in the winter can also dry out the air and the skin. And eczema is not just a problem during the winter months. High humidity during warmer months causes increased sweating, which for many people with eczema can lead to prickly heat-like episodes and flare-ups. Because people often sweat when they exercise, playing sports can also trigger flare-ups. Also, irritants that accompany certain sports, like chlorine in a pool, or team uniforms made from polyester, can cause anyone with eczema to avoid these pleasurable activities.

Many people with eczema are allergic to house dust mite. If you are allergic, you have to greatly reduce the number of house dust mite for any chance that symptoms may improve. However, it is impossible to clear house dust mite completely from a home, and it is hard work to greatly reduce their number to a level which may be of benefit.
Therefore, if your eczema is mild to moderate, and can be managed by the usual treatments of emollients and short courses of topical steroids, it is usually not worthwhile doing anything about house dust mite.
However, if you have moderate or severe eczema which is difficult to control with the usual treatments, you may wish to consider reducing the level of house dust mite from your home. (A skin prick test may help to confirm the allergy before embarking on the following measures which are hard work.)
To greatly reduce the number of house dust mite:
Remove carpets (where possible) from the bedroom. Avoid soft furnishing in the bedroom.
Use dust tight ('mite proof') covers for mattress, duvet, and pillow (a good bed retailer will be able to advise). This can be left in place for several months. The usual covers can be put on top of the special covers, but should be washed every 1-2 weeks at 60 degrees centigrade.
Use feather rather than synthetic pillows (this is the opposite to what used to be thought).
Wet-dust the bedroom furniture every 1-2 weeks. Some people advise dusting even more frequently - even daily dusting.
Vacuum or clean the bedroom floor regularly. Use a vacuum cleaner with a good filter (this removes the mite and prevents small particles coming out through the vacuum exhaust).
Vacuum the mattress once a week.
Regularly ventilate the bedroom (open the door and a window for a while on most days).
Keep soft toys to a minimum. Put them in the freezer in a plastic bag for 24 hours now and again. This kills any mites on them. If the toys are washable, wash them at 60 degrees centigrade after putting them in the freezer.
Try to keep humidity low (for example, do not dry washing on the radiator). An electric blanket decreases humidity in the bed which helps to keep mite numbers down in a mattress.

Soaps and detergents remove the natural 'oils' from the skin. This tends to make the skin dry and itchy, and more sensitive to irritants.
Therefore, avoid soaps, bubble baths, etc, when you wash. Instead, use a thick emollient (moisturiser) as a soap substitute and add an emollient to the a bath or shower. (See separate leaflet called 'Emollients (Moisturisers) for Eczema' for details.) Wear rubber gloves with a cotton lining when using detergents or working with other similar chemicals.
After you wash clothes with detergent, rinse them well. Some 'biological' detergents are said by some people to be irritating. However, there is little proof that commonly used detergents which are used in the normal way make eczema worse.

Moisturizers or emollients including bath oils, soap substitutes can be applied to the areas affected by eczema as frequently as required to relieve itching, scaling and dryness. Emollients should also be used on the unaffected skin to reduce dryness. Emollient therapy helps to restore one of the skin's most important functions, which is to form a barrier to prevent bacteria and viruses getting into the body and therefore help to prevent a rash becoming infected. Emollients are safe and rarely cause an allergic reaction. Occasionally, products with lanolin may cause a reaction. Ideally, moisturizers should be applied three to four times a day. Apply in a gentle downward motion in the direction of hair growth to prevent accumulation of cream around the hair follicle (this can cause infection of the follicle).

In the treatment of eczema food can play an important role in the control of your eczema. People with eczema often have other symptoms that suggest the diagnosis of food allergy. The involvement of the skin has often been a puzzle to some with eczema. Often, it is the symptoms of food allergy that motivate people to start diet revision and an improvement in their eczema condition is noted along with improvement in other symptoms such a gastrointentestinal disturbances, migraine headache, sinusitis, and fatigue.
There are different types of flushing caused by the intake of various foods and beverages. A very interesting note is that not everything affects everybody. Everyone is different! While you will find 50 foods below causing problems, the average supermarkets has thousands of foods available that can provide nutrition as well as energy. The allergy foods can be subdivided into the various categories as follows:
Eczema redness or vascular dilation is partially caused by high calorie carbohydrates (pastas, breads) and sugar spiking from all sweet foods. Just remember kids having a sugar high and bouncing off the walls due to energy available. So think of things that give you a high burn rate, high energy, or foods that would most likely add fat to your body, and you would be identifying the worst culprits So reducing food consumption with obviously less food reduces the heat/calories burned with the body being noticeably colder during the winter and less noticeable during the Summer helps to control facial redness. As there is less heat by calories burned, there is less redness or dilation. Therefore, three small meals with breakfast being the most important and grazing in between meals is better for limiting this kind of flushing, however it is important to keep the daily calorie intake within one's calorie budget to maintain your ideal weight.
Quite different are the foods that are blood vessel dilators such as vinegars, hot spices and various other spicy seasonings, hot sauces, peppers (including black pepper) and meat marinades. Also, tomatoes and many citrus fruits and related juices, bananas, and red plums, raisin, and figs, pasta, cheese, and chocolates are some of the worst offenders to many. Other very common known flushing foods are liver, yogurt, sour cream, cheese, vanilla, soy sauce, yeast extract eggplant, avocados, spinach, broad-leaf beans and pods, including lima, navy or peas. Also, allergies to malt and yeast beverages, and fermented alcohols would fall into the allergy category.

Extremes in temperature and humidity can worsen or trigger an eczema flare. While it may be tricky, maintaining a moderate and stable temperature and humidity all year is helpful.

When it's warm and humid in summer, make sure the temperature inside remains cool with an air conditioner. Also keep in mind that air-conditioned air may also be drying to your skin, so be sure to use a moisturizer.

In the winter, the air tends to be drier (cold air holds less moisture, and heating systems generally introduce very dry, hot air into homes), which makes it easier to develop dry skin. Since dry skin is more prone to itching, using a humidifier during the winter months can keep the humidity at an optimal level.

In the treatment of eczema, it's good a have a check list of possible skin irritants. This list of eczema skin irritants lends a clue to possible causes of skin irritation but is in no way a complete list. Irritants can be both physical and chemical. Avoid products containing potentially irritating chemicals. Usually, these are easy to identify—things like pesticides, paint strippers, etc.—but others may not be as obvious. Ingredients such as alcohol, astringents, and fragrances may trigger or worsen eczema. These ingredients can be found in cosmetics, emollients, cleaners, air fresheners, toilet paper, etc. Reading ingredient lists on products is a smart way to avoid contact with irritants.

Something as simple as the clothes you wear can have a great impact on eczema management—from the types of fabrics to how you care for them. It's best to avoid materials that feel "itchy," things like wool, burlap, etc. Try to wear soft fabrics like cotton, which tend to be less irritating. It's also a good idea to wash all new clothes, linens, and towels before using them for the first time. Many detergents and fabric softeners may contain chemicals such as fragrances that can irritate our skin. Always read the list of ingredients to avoid contact with irritants. Generally, it is good to choose a mild liquid detergent and put your cloths through an extra rinse cycle when they are brand new.

An important aspect of eczema treatment is understanding what triggers your eczema. Stress is a known ans powerful trigger for eczema. Sometimes, it's hard to stay relaxed, especially when your eczema flares-up. Yet research is now showing that keeping a calm head and good mental outlook may be one of the best ways to help keep eczema in check. Emotional stress is a well-known trigger of eczema flare-ups. Patients can have difficulties with anxiety, anger and hostility caused by having eczema. This only adds to the problem. Learning to reduce stress may lessen the frequency and, hopefully, the intensity of the flare-ups.
Meditation, relaxation techniques and stress management can help.
You may also find that you feel more in control if you keep a diary or other record of flare-ups.