Derms recommend these when lifestyle changes aren’t cutting it.
You’re following all the recommended lifestyle treatments for eczema: you take lukewarm showers, you’re moisturizing with rich creams and ointments, and you avoid all the common eczema triggers. So why are your eczema symptoms still flaring? UGH.
There are many different medication options for eczema, and it might be time to add one to your treatment plan. Imagine eczema treatment like a pyramid, says dermatologist Suzanne Friedler, MD, of Mount Sinai Hospital and St. John’s Episcopal Hospital.
The higher you go in the pyramid, the more severe your symptoms and the potentially more serious the treatment. The base of the pyramid involves the lifestyle habits that docs recommend to all eczema patients. The next level up is a barrier cream that creates a physical barrier over the skin and may be more effective than a basic moisturizer.
Topical steroids are the next level up. These will reduce redness, inflammation, and itching. For many eczema patients, this is as high on the pyramid as they’ll need to go.
One level up is antihistamines. Derms prescribe antihistamines for eczema patients who really struggle with itching, despite moisturizing and other lifestyle treatments. But take note: these oral antihistamines can cause drowsiness.
For a steroid-free option, calcineurin inhibitors and PDE4 inhibitors are the next level up. These are meant to be short-term solutions when other topical treatments haven’t worked. These medications “stop a piece of the immune system from ‘switching on,’ preventing it from causing certain eczema symptoms such as redness and itch,” according to the National Eczema Association.
The top (and most serious) treatment is immunosuppressive drugs, biologics, and phototherapy. These treatments cause serious side effects, so derms only recommend them when other treatments haven’t been effective.
Immunosuppressive drugs and biologics both address the immune system to stop the “itch-scratch cycle.” Phototherapy uses UVB light to relieve itch and help the skin fight bacteria. The obvious risk involved in phototherapy is the same as spending too much time on the beach or in tanning beds: sunburns and skin cancer.
Dr. Friedler is a dermatologist and clinical instructor at The Mount Sinai Hospital and St. John's Episcopal Hospital.
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There's no cure for eczema, but
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you can control most symptoms with
lifestyles changes and medications.
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You wanna keep your skin moist,
reduce inflammation and infection and
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minimize itch associated
with triggering the rash.
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I think of eczema
treatments like a pyramid.
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The base is what we recommend to everyone,
take shorter showers,
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moisturize more frequently.
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The second level is a really
good barrier cream.
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The third level is topical steroids and
level four might be antihistamines and
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any other adjunctive treatment
like antibacterial sprays.
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Level five might be a topical
calcineurin inhibitor or
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newer treatment like the PDE4 inhibitors.
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And the top layer is reserved for those
cases whose eczema is the most severe and
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isn't being managed well
through the other treatments.
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This is where we use immunosuppresive
drugs, biologics, and phototherapy.
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So, let's take a look at
each of these options.
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Topical steroids are the most commonly
prescribed medication for eczema.
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They ease redness and reduce inflammation
and itching so skin can begin to heal.
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Make sure you only apply the steroid
to eczema affected areas and
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follow directions from your dermatologist.
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Overusing steroids can have side
effects like thinning of the skin or
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darkening of the skin.
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For patients who are bothered by itching,
oral antihistamines can be very helpful.
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Make sure you follow directions from your
dermatologist on when to take them because
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some of these medications
can cause drowsiness.
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There are a couple of steroid-free topical
creams that we use to manage eczema for
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more of a maintenance phase.
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So you might use steroids
during an eczema flair, but
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other creams like calcineurin inhibitors,
PDE4 inhibitors, or
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great barrier creams to help reduce
inflammation and keep symptoms at bay.
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For patients who don't respond to
some of the basic treatment options,
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such as barrier creams,
topical steroids, and
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topical calcineurin inhibitors,
there's still hope.
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There are more advanced treatment options
such as light therapy with narrowband UVB,
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oral immunosuppressive agents such
as methotrexate and cyclosporine.
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And now is an exciting time for
patients with severe eczema,
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with more treatment options being
researched than ever before.
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There has been an introduction of
newer medications such as biologics,
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to help control some of the most
severe eczema symptoms.
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This can be used in patients who have
not responded to other types of therapy.
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Biologics. San Rafael, CA: National Eczema Association. (Accessed on September 5, 2017 at https://nationaleczema.org/eczema/treatment/dupixent/.)
Immunosuppressants. San Rafael, CA: National Eczema Association. (Accessed on September 5, 2017 at https://nationaleczema.org/eczema/treatment/immunosuppressants/.)
Phototherapy. San Rafael, CA: National Eczema Association. (Accessed on September 5, 2017 at https://nationaleczema.org/eczema/treatment/phototherapy/.)
Prescription topical treatment. San Rafael, CA: National Eczema Association. (Accessed on September 5, 2017 at https://nationaleczema.org/eczema/treatment/topicals/.)