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Dr. Fong's FREE
ECZEMA GUIDE

How to Cure Eczema Permanently

From the Inside, Out

Risks of Eczema

Medications

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Risks of Eczema Medications

Living with eczema can be a daily struggle, with symptoms ranging from itchiness and redness to discomfort and pain. In the quest for relief, many individuals turn to conventional medications, which offer immediate symptom relief but often come with potential side effects and fail to address the root cause of eczema. Understanding the mechanisms of action and potential risks associated with these medications is crucial for informed decision-making and long-term management of eczema.

TOPICAL MEDICATIONS

Topical Corticosteroids

TSW

Topical corticosteroids are a class of medications commonly used to treat inflammatory skin conditions such as eczema (atopic dermatitis), psoriasis, and allergic reactions. These medications contain synthetic versions of corticosteroids, which are hormones produced by the adrenal glands that regulate inflammation and immune responses in the body. Topical corticosteroids work by suppressing the immune system and reducing inflammation, itching, redness, and swelling associated with skin disorders.

Examples of Topical Corticosteroid Medications:

  1. Hydrocortisone: Available over-the-counter in various strengths, hydrocortisone is the mildest form of topical corticosteroid and is commonly used to treat mild eczema, insect bites, and allergic reactions.

  2. Betamethasone (Diprolene, Diprosone): Betamethasone is a medium-strength corticosteroid available in cream, ointment, and lotion formulations. It is often prescribed to treat moderate to severe eczema, psoriasis, and other inflammatory skin conditions.

  3. Clobetasol (Temovate, Olux): Clobetasol is a potent corticosteroid available in various formulations, including cream, ointment, foam, and gel. It is typically reserved for the treatment of severe eczema, psoriasis, and other recalcitrant dermatoses that do not respond to milder corticosteroids.

  4. Fluticasone (Cutivate): Fluticasone is a medium-strength corticosteroid available in cream and ointment formulations. It is commonly used to treat eczema, psoriasis, and dermatitis, particularly in sensitive areas of the skin such as the face and groin.

  5. Triamcinolone (Kenalog, Aristocort): Triamcinolone is a medium-strength corticosteroid available in various formulations, including cream, ointment, lotion, and paste. It is often prescribed to treat eczema, dermatitis, and other inflammatory skin conditions.

Risks and Side Effects:

 

While topical corticosteroids are effective at reducing inflammation and relieving symptoms of eczema, they are not without risks and side effects, especially with prolonged or excessive use. Common side effects of topical corticosteroids may include:

  1. Skin Thinning (Atrophy): Prolonged use of potent corticosteroids can lead to thinning of the skin (atrophy), making it more fragile and prone to injury. This side effect is more common with high-potency corticosteroids and when applied to thin skin areas such as the face, groin, and armpits.

  2. Stretch Marks (Striae): Corticosteroids can cause the skin to lose its elasticity, leading to the development of stretch marks, especially in areas where the skin is frequently stretched or folded (e.g., abdomen, thighs, buttocks).

  3. Acne (Steroid Acne): Topical corticosteroids may exacerbate or trigger acne breakouts, particularly in individuals prone to acne or with oily skin. Steroid acne typically presents as small red bumps or pustules on the skin and may resolve with discontinuation of the corticosteroid.

  4. Perioral Dermatitis: Prolonged use of topical corticosteroids on the face, especially around the mouth, can lead to perioral dermatitis, a type of facial rash characterized by redness, scaling, and small papules or pustules around the mouth, nose, and eyes.

  5. Skin Discoloration (Hypopigmentation or Hyperpigmentation): Corticosteroids may alter the pigmentation of the skin, leading to either lightening (hypopigmentation) or darkening (hyperpigmentation) of the treated areas. This side effect is more common in individuals with darker skin tones.

  6. Contact Dermatitis: Some individuals may develop allergic contact dermatitis in response to the ingredients in topical corticosteroids, leading to redness, itching, swelling, or blistering of the skin. Reactions may occur immediately upon application or after prolonged use of the medication.

  7. Topical Steroid Withdrawal (TSW): Long-term use of potent corticosteroids, especially when applied to large areas of the body or under occlusive dressings, may lead to a phenomenon known as topical steroid withdrawal (TSW) or topical steroid addiction (TSA). TSW is characterized by a rebound worsening of eczema symptoms, including intense itching, burning, redness, and skin sensitivity, upon discontinuation of the steroid. This withdrawal reaction can last for weeks or even months, making it a challenging experience for patients.

  8. Systemic Absorption: Although topical corticosteroids are primarily intended for local use, a small percentage of the medication may be absorbed into the bloodstream, especially when applied to large areas of the body or under occlusive dressings. Systemic absorption can lead to systemic side effects such as adrenal suppression, Cushing's syndrome, and growth retardation, particularly in children and infants.

It's important for individuals using topical corticosteroids to follow their healthcare provider's instructions carefully, including the prescribed strength, frequency, and duration of treatment. Short-term use of low-to-medium potency corticosteroids is generally safe for most individuals, especially when used to treat acute flare-ups of eczema. However, prolonged or excessive use of potent corticosteroids should be avoided to minimize the risk of side effects and complications. Regular follow-up appointments with a dermatologist can help monitor for any signs of side effects or TSW and adjust treatment as needed. Additionally, individuals with concerns about the safety or efficacy of corticosteroids should discuss alternative treatment options with their healthcare provider.

Topical Calcineurin Inhibitors (TCIs)

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Topical calcineurin inhibitors (TCIs) are a class of medications used to treat inflammatory skin conditions such as eczema (atopic dermatitis) and psoriasis. Unlike topical corticosteroids, which work by suppressing the immune response and reducing inflammation, TCIs target a specific enzyme called calcineurin. By inhibiting calcineurin, TCIs prevent the activation of T-cells, a type of immune cell involved in the inflammatory response, thereby reducing inflammation and symptoms associated with eczema.

Examples of Topical Calcineurin Inhibitor Medications:

  1. Tacrolimus (Protopic): Tacrolimus is a topical calcineurin inhibitor available in ointment form in two strengths: 0.03% and 0.1%. It is commonly prescribed for the treatment of moderate to severe eczema in adults and children ages 2 years and older.

  2. Pimecrolimus (Elidel): Pimecrolimus is another topical calcineurin inhibitor available in cream form in a 1% concentration. Like tacrolimus, it is indicated for the treatment of mild to moderate eczema in adults and children ages 2 years and older.

How Topical Calcineurin Inhibitors Work:

TCIs work by inhibiting the activity of calcineurin, a key enzyme involved in the immune response. In individuals with eczema, the immune system is dysregulated, leading to excessive inflammation and skin barrier dysfunction. By blocking calcineurin, TCIs help to modulate the immune response, reduce inflammation, and restore the integrity of the skin barrier.

Unlike topical corticosteroids, which are associated with side effects such as skin thinning and steroid rebound, TCIs have been shown to be safe and effective for long-term use in the management of eczema. They are particularly useful for treating sensitive areas of the skin, such as the face, neck, and eyelids, where the use of corticosteroids may be limited due to the risk of side effects.

Risks and Side Effects:

While generally well-tolerated, TCIs may cause some side effects in some individuals. Common side effects of topical calcineurin inhibitors may include:

  1. Mild Burning or Stinging: Some individuals may experience mild burning or stinging at the site of application, especially during the first few days of treatment. This side effect usually resolves on its own as the skin adjusts to the medication.

  2. Skin Irritation: In some cases, TCIs may cause skin irritation, redness, or itching at the site of application. This side effect is typically mild and transient but may require discontinuation of the medication if it persists or worsens.

  3. Skin Infections: Although rare, there have been reports of skin infections, including viral infections such as herpes simplex (cold sores) and bacterial infections such as impetigo, in individuals using TCIs. It is important to monitor the skin for signs of infection and seek medical attention if symptoms occur.

  4. Allergic Contact Dermatitis: Some individuals may develop allergic contact dermatitis in response to the ingredients in TCIs, leading to redness, itching, swelling, or blistering of the skin. Reactions may occur immediately upon application or after prolonged use of the medication.

  5. Lymphoma: While the risk of lymphoma associated with TCIs is considered low, a black box warning regarding the potential risk of lymphoma and skin cancer is included in the prescribing information for tacrolimus and pimecrolimus. However, studies evaluating the long-term safety of TCIs have not found a definitive link between these medications and an increased risk of cancer.

As with any medication, it is important to use TCIs as directed by a healthcare professional and to report any side effects or concerns promptly. Regular follow-up appointments with a dermatologist can help monitor for any signs of adverse reactions and adjust treatment as needed.

Topical Janus Kinase (JAK) Inhibitors

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Topical Janus Kinase (JAK) inhibitors are a relatively new class of medications used in the treatment of inflammatory skin conditions, including eczema (atopic dermatitis). Unlike traditional topical treatments like corticosteroids or calcineurin inhibitors, JAK inhibitors target the Janus Kinase enzymes, which play a key role in the inflammatory process.

Examples of Topical JAK Inhibitor Medications:

  1. Ruxolitinib (Opzelura): Ruxolitinib is a topical JAK inhibitor that works by blocking the activity of Janus Kinase enzymes in the skin. It is applied directly to the affected areas of the skin and is indicated for the treatment of mild to moderate eczema in adults and children ages 12 years and older.

How Topical JAK Inhibitors Work:

Janus Kinase enzymes are involved in the signaling pathways of various cytokines and growth factors that contribute to inflammation and immune responses. By inhibiting these enzymes, topical JAK inhibitors help to reduce the production of pro-inflammatory cytokines and prevent the activation of immune cells, leading to a decrease in inflammation and symptoms of eczema.

Unlike corticosteroids, which have broad immunosuppressive effects, JAK inhibitors target specific pathways involved in inflammation, potentially offering a more targeted and selective approach to eczema treatment.

 

Risks and Side Effects:

While generally considered safe and effective, topical JAK inhibitors may cause some side effects in some individuals. Common side effects of ruxolitinib (Opzelura) may include:

  1. Burning or Stinging: Some individuals may experience mild burning or stinging at the site of application, especially during the first few days of treatment. This side effect typically resolves on its own as the skin adjusts to the medication.

  2. Skin Irritation: In some cases, topical JAK inhibitors may cause skin irritation, redness, or itching at the site of application. This side effect is usually mild and transient but may require discontinuation of the medication if it persists or worsens.

  3. Skin Infections: Although rare, there have been reports of skin infections, including bacterial and viral infections, in individuals using topical JAK inhibitors. It is important to monitor the skin for signs of infection and seek medical attention if symptoms occur.

  4. Acne or Folliculitis: Some individuals may experience acne or folliculitis (inflammation of hair follicles) as a side effect of topical JAK inhibitors. These skin changes are typically mild and may improve with continued use of the medication.

  5. Allergic Reactions: In rare cases, individuals may experience allergic reactions to topical JAK inhibitors, leading to symptoms such as rash, hives, or swelling of the face, lips, or tongue. If any signs of an allergic reaction occur, the medication should be discontinued, and medical attention should be sought immediately.

  6. Changes in Blood Cell Counts: Systemic absorption of topical JAK inhibitors may lead to changes in blood cell counts, including decreases in red blood cells, white blood cells, and platelets. Regular monitoring of blood cell counts may be recommended during treatment with topical JAK inhibitors, especially in individuals with pre-existing blood disorders or compromised immune function.

As with any medication, it is important to use topical JAK inhibitors as directed by a healthcare professional and to report any side effects or concerns promptly. Regular follow-up appointments with a dermatologist can help monitor for any signs of adverse reactions and adjust treatment as needed.

Topical Phosphodiesterase 4 (PDE4) Inhibitors

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Topical Phosphodiesterase 4 (PDE4) inhibitors are a class of medications used in the treatment of inflammatory skin conditions, such as eczema (atopic dermatitis). They work by targeting the phosphodiesterase 4 enzyme, which plays a key role in the inflammatory process.

Examples of Topical PDE4 Inhibitor Medications:

  1. Crisaborole (Eucrisa): Crisaborole is a topical PDE4 inhibitor that is applied directly to the affected areas of the skin. It is indicated for the treatment of mild to moderate eczema in adults and children ages 3 months and older.

How Topical PDE4 Inhibitors Work:

Phosphodiesterase 4 (PDE4) is an enzyme that breaks down cyclic adenosine monophosphate (cAMP), a molecule involved in regulating inflammation and immune responses in the body. By inhibiting PDE4, topical PDE4 inhibitors like crisaborole help to increase levels of cAMP within immune cells, leading to a decrease in the production of pro-inflammatory cytokines and a reduction in inflammation in the skin.

Unlike corticosteroids, which have broad immunosuppressive effects, PDE4 inhibitors target specific enzymes involved in the inflammatory process, potentially offering a more targeted and selective approach to eczema treatment.

Risks and Side Effects:

While generally considered safe and effective, topical PDE4 inhibitors may cause some side effects in some individuals. Common side effects of crisaborole (Eucrisa) may include:

  1. Burning or Stinging: Some individuals may experience mild burning or stinging at the site of application, especially during the first few days of treatment. This side effect typically resolves on its own as the skin adjusts to the medication.

  2. Skin Redness or Irritation: In some cases, topical PDE4 inhibitors may cause skin redness, irritation, or itching at the site of application. This side effect is usually mild and transient but may require discontinuation of the medication if it persists or worsens.

  3. Skin Rash: Occasionally, individuals may develop a rash or allergic reaction to topical PDE4 inhibitors, leading to symptoms such as itching, redness, or hives. If any signs of an allergic reaction occur, the medication should be discontinued, and medical attention should be sought immediately.

  4. Dry Skin: Some individuals may experience dryness or flakiness of the skin as a side effect of topical PDE4 inhibitors. This side effect is usually mild and can often be managed with the use of moisturizers or emollients.

  5. Application Site Reactions: Rarely, individuals may experience application site reactions such as pain, swelling, or blistering at the site of application. If these symptoms occur, the medication should be discontinued, and medical attention should be sought promptly.

 

As with any medication, it is important to use topical PDE4 inhibitors as directed by a healthcare professional and to report any side effects or concerns promptly. Regular follow-up appointments with a dermatologist can help monitor for any signs of adverse reactions and adjust treatment as needed.

BIOLOGIC INJECTABLES

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Biologic injectables are a class of medications used in the treatment of various inflammatory conditions, including eczema (atopic dermatitis). Unlike traditional systemic medications that broadly suppress the immune system, biologics target specific molecules or pathways involved in the inflammatory process.

 

Examples of Biologic Injectable Medications:

  1. Dupilumab (Dupixent): Dupilumab is a monoclonal antibody that targets interleukin-4 (IL-4) receptor alpha subunit, thereby inhibiting the signaling of IL-4 and interleukin-13 (IL-13), which are key cytokines involved in the inflammatory response seen in eczema. It is administered as a subcutaneous injection and is indicated for the treatment of moderate to severe eczema in adults and children ages 6 years and older.

  2. Tralokinumab (Adbry): Tralokinumab is a monoclonal antibody that specifically targets interleukin-13 (IL-13), another key cytokine involved in the pathogenesis of eczema. It is administered as a subcutaneous injection and is indicated for the treatment of moderate to severe eczema in adults who are candidates for systemic therapy.

How Biologic Injectables Work:

Biologic injectables work by targeting specific molecules or pathways involved in the inflammatory process underlying eczema. For example, dupilumab inhibits the signaling of IL-4 and IL-13, which are cytokines that play a central role in the pathogenesis of eczema. By blocking the effects of these cytokines, biologics help to reduce inflammation, itching, and other symptoms associated with eczema, leading to improved skin clearance and quality of life for patients.

Unlike traditional systemic medications such as corticosteroids or immunosuppressants, which can have broad effects on the immune system and may be associated with systemic side effects, biologic injectables offer a more targeted approach to treatment, potentially minimizing the risk of systemic adverse effects.

Risks and Side Effects:

While biologic injectables are generally considered safe and effective for the treatment of eczema, they may cause some side effects in some individuals. Common side effects of biologic injectables may include:

  1. Injection Site Reactions: Some individuals may experience pain, redness, swelling, or itching at the injection site. These symptoms are usually mild and transient but may require medical attention if they persist or worsen.

  2. Upper Respiratory Tract Infections: Biologic medications may increase the risk of upper respiratory tract infections, such as the common cold or sinusitis. Patients should be advised to seek medical attention if they develop symptoms such as cough, congestion, or sore throat.

  3. Conjunctivitis: In some cases, biologic medications may cause inflammation of the conjunctiva (the thin, transparent layer of tissue that covers the white part of the eye and lines the inside of the eyelids), leading to symptoms such as redness, itching, tearing, or discharge.

  4. Allergic Reactions: Rarely, individuals may develop allergic reactions to biologic medications, leading to symptoms such as rash, hives, itching, swelling, difficulty breathing, or anaphylaxis. If any signs of an allergic reaction occur, the medication should be discontinued, and medical attention should be sought immediately.

  5. Elevated Liver Enzymes: Some biologic medications may cause transient elevations in liver enzymes, which can be detected through routine blood tests. Patients should be monitored regularly for signs of liver dysfunction, such as jaundice, abdominal pain, or unexplained fatigue.

  6. Malignancies: There have been reports of malignancies, including skin cancers and lymphomas, in patients treated with biologic medications. While the exact relationship between biologic therapy and the development of malignancies remains unclear, patients should be monitored regularly for signs of skin cancer and other malignancies during treatment.

 

As with any medication, it is important to weigh the potential benefits against the risks and to use biologics under the supervision of a qualified healthcare professional. Regular follow-up appointments and monitoring can help ensure the safe and effective use of biologic injectables for the management of eczema.

ORAL MEDICATIONS

Oral Janus Kinase (JAK) Inhibitors

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Oral Janus Kinase (JAK) inhibitors are a relatively new class of medications used in the treatment of inflammatory conditions, including eczema (atopic dermatitis). They work by blocking the activity of Janus Kinase enzymes, which play a key role in the signaling pathways involved in inflammation and immune responses.

Examples of Oral JAK Inhibitor Medications:

  1. Upadacitinib (Rinvoq): Upadacitinib is an oral JAK inhibitor that selectively targets Janus Kinase 1 (JAK1), which is involved in signaling pathways associated with inflammation. It is indicated for the treatment of moderate to severe eczema in adults who are candidates for systemic therapy. Upadacitinib is typically taken orally once daily, with or without food.

How Oral JAK Inhibitors Work:

 

Janus Kinase enzymes are involved in the signaling pathways of various cytokines and growth factors that contribute to inflammation and immune responses. By inhibiting the activity of JAK enzymes, oral JAK inhibitors help to reduce the production of pro-inflammatory cytokines and modulate immune cell function, thereby alleviating symptoms of eczema such as inflammation, itching, and skin lesions.

Unlike topical medications, which target the affected skin directly, oral JAK inhibitors exert their effects systemically, affecting multiple organs and tissues throughout the body. This systemic mechanism of action may offer advantages for individuals with widespread or severe eczema who may not respond adequately to topical therapies alone.

 

Risks and Side Effects:

 

While oral JAK inhibitors have shown efficacy in the treatment of eczema, they may cause some side effects in some individuals. Common side effects of oral JAK inhibitors may include:

  1. Upper Respiratory Tract Infections: Like other immunosuppressive medications, oral JAK inhibitors may increase the risk of upper respiratory tract infections, such as the common cold or sinusitis. Patients should be advised to seek medical attention if they develop symptoms such as cough, congestion, or sore throat.

  2. Headache: Some individuals may experience headaches or migraines as a side effect of oral JAK inhibitors. These symptoms are usually mild and transient but may require medical attention if they persist or worsen.

  3. Nausea: Oral JAK inhibitors may cause gastrointestinal symptoms such as nausea, vomiting, or abdominal discomfort in some individuals. These symptoms are usually mild and transient but may be bothersome for some patients.

  4. Liver Enzyme Elevations: Some patients treated with oral JAK inhibitors may experience transient elevations in liver enzymes, which can be detected through routine blood tests. Patients should be monitored regularly for signs of liver dysfunction, such as jaundice, abdominal pain, or unexplained fatigue.

  5. Lipid Abnormalities: Oral JAK inhibitors may cause changes in lipid levels, including increases in cholesterol and triglycerides. Patients should be monitored regularly for lipid abnormalities and may require lifestyle modifications or additional medications to manage these effects.

  6. Decreases in Blood Cell Counts: In some cases, oral JAK inhibitors may cause decreases in certain types of blood cells, including white blood cells, red blood cells, and platelets. Patients should be monitored regularly for signs of anemia, leukopenia, or thrombocytopenia and may require dose adjustments or discontinuation of the medication if these effects occur.

As with any medication, it is important to weigh the potential benefits against the risks and to use oral JAK inhibitors under the supervision of a qualified healthcare professional. Regular follow-up appointments and monitoring can help ensure the safe and effective use of oral JAK inhibitors for the management of eczema.

Oral Steroids

Oral steroids, also known as systemic corticosteroids, are potent anti-inflammatory medications that are taken orally to manage severe cases of eczema. They work by suppressing the immune response and reducing inflammation throughout the body, including the skin. While oral steroids can provide rapid relief from eczema symptoms, they are typically reserved for short-term use due to the risk of significant side effects associated with long-term or frequent use.

How Oral Steroids Work:

Oral steroids exert their effects by binding to glucocorticoid receptors in cells throughout the body, including immune cells and skin cells. Once bound to these receptors, steroids modulate gene expression, leading to a suppression of the inflammatory response. This helps to reduce itching, redness, swelling, and other symptoms associated with eczema.

Examples of Oral Steroid Medications:

  1. Prednisone: Prednisone is one of the most commonly prescribed oral steroids for eczema. It is available in various formulations, including tablets, and is typically taken once daily for a short duration to control acute flare-ups of eczema.

  2. Prednisolone: Prednisolone is a corticosteroid medication similar to prednisone but with a slightly different chemical structure. It is often used interchangeably with prednisone for the management of eczema.

  3. Methylprednisolone: Methylprednisolone is another oral corticosteroid that may be used to treat severe eczema. Like prednisone and prednisolone, it is typically prescribed for short-term use to control acute symptoms.

 

Risks and Side Effects:

While oral steroids can be effective at rapidly controlling severe eczema symptoms, they also come with significant risks and side effects, particularly with long-term or frequent use. Some of the potential risks and side effects of oral steroids for eczema include:

  1. Immunosuppression: Oral steroids suppress the immune system, making individuals more susceptible to infections. Patients taking oral steroids may be at increased risk of bacterial, viral, and fungal infections, including opportunistic infections.

  2. Adrenal Suppression: Prolonged or high-dose use of oral steroids can suppress the adrenal glands, leading to adrenal insufficiency. This can result in symptoms such as fatigue, weakness, weight loss, and low blood pressure.

  3. Osteoporosis: Long-term use of oral steroids can lead to bone loss and an increased risk of osteoporosis, a condition characterized by fragile bones that are prone to fractures.

  4. Glucose Intolerance: Oral steroids can cause insulin resistance and impaired glucose tolerance, leading to elevated blood sugar levels and an increased risk of diabetes, particularly in individuals with pre-existing risk factors.

  5. Fluid Retention and Hypertension: Oral steroids can cause fluid retention and sodium retention, leading to swelling, weight gain, and hypertension (high blood pressure).

  6. Psychiatric Effects: Some individuals may experience mood changes, irritability, anxiety, depression, or even psychosis while taking oral steroids. These effects are usually dose-dependent and reversible upon discontinuation of the medication.

  7. Gastrointestinal Effects: Oral steroids can irritate the lining of the stomach and intestines, leading to gastrointestinal side effects such as gastritis, ulcers, and gastrointestinal bleeding.

  8. Cataracts and Glaucoma: Prolonged use of oral steroids may increase the risk of developing cataracts (clouding of the lens of the eye) and glaucoma (increased pressure within the eye), leading to vision impairment or blindness.

 

Due to the significant risks and side effects associated with oral steroids, they are typically prescribed for short-term use only, often as a last resort for severe cases of eczema that have not responded to other treatments. Patients taking oral steroids should be closely monitored by a healthcare professional to minimize the risk of adverse effects and ensure safe and effective treatment. Alternative treatment options should be explored for long-term management of eczema to avoid the potential complications associated with oral steroids.

Traditional Systemic Medications for Eczema

Traditional systemic medications are oral medications that work throughout the body to modulate the immune system and reduce inflammation associated with eczema. These medications are typically reserved for individuals with moderate to severe eczema who have not responded adequately to topical treatments or phototherapy. While they can be effective at controlling symptoms, they often come with potential risks and side effects that require careful consideration.

 

Examples of Traditional Systemic Medications:

 

  1. Cyclosporine: Cyclosporine is an immunosuppressive medication that works by inhibiting the activity of certain immune cells called T-lymphocytes. It is commonly used in the treatment of severe eczema to reduce inflammation and symptoms. Cyclosporine is usually taken orally once or twice daily, with doses adjusted based on individual response and side effects.

  2. Methotrexate: Methotrexate is a systemic immunosuppressant that works by inhibiting the production of DNA and RNA in rapidly dividing cells, including immune cells involved in the inflammatory response. It is used in the treatment of moderate to severe eczema to reduce inflammation and symptoms. Methotrexate is typically taken orally once weekly, with doses adjusted based on individual response and side effects.

  3. Azathioprine: Azathioprine is an immunosuppressive medication that works by interfering with the synthesis of DNA and RNA in immune cells, thereby reducing their activity and inflammatory response. It is used in the treatment of severe eczema to suppress the immune system and alleviate symptoms. Azathioprine is usually taken orally once daily, with doses adjusted based on individual response and side effects.

 

How Traditional Systemic Medications Work:

 

Traditional systemic medications for eczema work by suppressing the activity of the immune system and reducing inflammation throughout the body. In eczema, immune dysregulation and inflammation play a central role in the development and persistence of symptoms such as itching, redness, and skin lesions. By targeting the underlying immune response, systemic medications help to alleviate symptoms and improve the overall condition of the skin.

 

Risks and Side Effects:

 

While traditional systemic medications can be effective at controlling eczema symptoms, they also come with potential risks and side effects that require careful monitoring. Common risks and side effects of traditional systemic medications may include:

  1. Immunosuppression: Systemic medications such as cyclosporine, methotrexate, and azathioprine work by suppressing the immune system, which can increase the risk of infections. Patients taking these medications may be more susceptible to bacterial, viral, and fungal infections and may require prophylactic treatment or close monitoring for signs of infection.

  2. Gastrointestinal Symptoms: Some individuals may experience gastrointestinal side effects such as nausea, vomiting, diarrhea, or abdominal pain while taking traditional systemic medications. These symptoms are usually mild and transient but may require dose adjustments or symptomatic treatment to alleviate discomfort.

  3. Hepatotoxicity: Certain systemic medications, particularly methotrexate and azathioprine, may cause liver toxicity in some individuals. Patients taking these medications should undergo regular liver function tests to monitor for signs of hepatotoxicity, such as elevated liver enzymes or jaundice.

  4. Bone Marrow Suppression: Methotrexate and other immunosuppressive medications may cause bone marrow suppression, leading to decreases in red blood cells, white blood cells, and platelets. Patients should be monitored regularly for signs of anemia, leukopenia, or thrombocytopenia and may require dose adjustments or discontinuation of the medication if these effects occur.

  5. Renal Toxicity: Cyclosporine, in particular, may cause renal toxicity in some individuals, leading to impaired kidney function. Patients taking cyclosporine should undergo regular kidney function tests to monitor for signs of renal toxicity, such as elevated serum creatinine levels or decreased glomerular filtration rate.

 

Overall, traditional systemic medications can be effective at controlling symptoms of eczema in individuals with moderate to severe disease. However, due to their potential risks and side effects, these medications should be used cautiously and under the supervision of a qualified healthcare professional. Regular monitoring and close communication between patients and healthcare providers are essential to ensure the safe and effective use of traditional systemic medications for eczema management.

OTHER TREATMENTS

Antihistamines

Antihistamines are a common class of medications used to manage itching and discomfort associated with eczema, also known as atopic dermatitis. They work by blocking the effects of histamine, a chemical released by the body during allergic reactions, which can cause itching, redness, and swelling in the skin. While antihistamines are not typically used as a primary treatment for eczema, they can be helpful in reducing itchiness and improving overall comfort, especially during flare-ups. Understanding how antihistamines work, the different types available, and their potential risks and side effects is essential for individuals seeking relief from eczema symptoms.

 

How Antihistamines Work:

Histamine is a neurotransmitter released by specialized cells called mast cells in response to allergens or other triggers. In individuals with eczema, histamine release can lead to intense itching and inflammation in the skin, exacerbating eczema symptoms. Antihistamines work by binding to histamine receptors on cells, preventing histamine from exerting its effects and reducing itchiness and other allergic symptoms.

Types of Antihistamines:

 

Antihistamines can be classified into two main categories: first-generation and second-generation antihistamines.

  1. First-generation Antihistamines: First-generation antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax), are older medications that readily cross the blood-brain barrier. While effective at reducing itching and promoting sleep, first-generation antihistamines are more likely to cause drowsiness and other central nervous system side effects.

  2. Second-generation Antihistamines: Second-generation antihistamines, such as cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra), are newer medications that are less likely to cause drowsiness and other sedative effects. They are often preferred for daytime use and long-term management of allergic conditions like eczema.

Examples of Antihistamines:

 

  • Diphenhydramine (Benadryl)

  • Hydroxyzine (Atarax, Vistaril)

  • Cetirizine (Zyrtec)

  • Loratadine (Claritin)

  • Fexofenadine (Allegra)

  • Desloratadine (Clarinex)

  • Levocetirizine (Xyzal)

 

Risks and Side Effects:

While antihistamines are generally safe and well-tolerated when used as directed, they can cause side effects in some individuals. Common risks and side effects associated with antihistamine use include:

  1. Drowsiness: First-generation antihistamines are more likely to cause drowsiness and sedation, which can impair cognitive function and motor skills. This effect is particularly pronounced in older adults and may increase the risk of accidents or falls.

  2. Dry Mouth and Urinary Retention: Antihistamines can cause dry mouth and difficulty urinating in some individuals due to their anticholinergic effects. This can be bothersome, especially in older adults, and may require dose adjustments or discontinuation of the medication.

  3. Cognitive Impairment: Long-term use of antihistamines, especially first-generation agents, may be associated with cognitive impairment and memory problems, particularly in older adults. It's important to use these medications cautiously, especially in individuals at risk for dementia or cognitive decline.

  4. Blurred Vision: Antihistamines can cause temporary blurred vision or difficulty focusing, particularly at higher doses or in combination with other medications that have sedative effects. This can impair visual acuity and increase the risk of accidents, especially while driving or operating heavy machinery.

  5. Cardiovascular Effects: Some antihistamines, particularly first-generation agents, may have cardiovascular effects such as palpitations, tachycardia (rapid heartbeat), or changes in blood pressure. Individuals with pre-existing cardiovascular conditions should use these medications with caution and under the guidance of a healthcare professional.

  6. Allergic Reactions: While rare, some individuals may experience allergic reactions to antihistamines, including rash, hives, or swelling of the face, lips, or tongue. It's important to seek medical attention if signs of an allergic reaction occur.

Despite these potential risks and side effects, antihistamines can be an effective adjunctive therapy for managing itching and discomfort associated with eczema, particularly during flare-ups. It's essential to use antihistamines as directed and to consult a healthcare provider if symptoms persist or worsen despite treatment.

Prescription Phototherapy

Prescription phototherapy, also known as light therapy, is a medical treatment that involves exposing the skin to ultraviolet (UV) light under controlled conditions to manage eczema symptoms. This form of therapy can be particularly beneficial for individuals with moderate to severe eczema who have not responded adequately to other treatments. Phototherapy works by targeting inflammation in the skin and suppressing the abnormal immune response that contributes to eczema flare-ups. While phototherapy can be effective at reducing symptoms and improving the overall condition of the skin, it also comes with certain risks and side effects that need to be carefully considered.

How Phototherapy Works:

Phototherapy for eczema typically involves exposure to either ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications known as psoralens, which enhance the effects of UV light. UV light penetrates the skin and modulates the immune response, leading to a reduction in inflammation and a decrease in symptoms such as itching, redness, and scaling. Phototherapy may also help to normalize the growth and turnover of skin cells, leading to improvements in the skin barrier function.

Examples of Phototherapy Treatments:

  1. Narrowband UVB (NB-UVB) Therapy: Narrowband UVB therapy involves exposure to UVB light within a specific wavelength range (around 311-313 nanometers). This form of phototherapy is considered one of the most effective treatments for eczema and is often used as a first-line therapy for moderate to severe cases.

  2. Broadband UVB Therapy: Broadband UVB therapy uses UVB light with a broader spectrum of wavelengths compared to narrowband UVB. While less specific than narrowband UVB, broadband UVB therapy can still be effective for treating eczema, particularly in individuals who do not respond to narrowband UVB or who have widespread involvement of the skin.

  3. PUVA Therapy: PUVA therapy combines exposure to UVA light with the administration of a photosensitizing medication called psoralen. Psoralen sensitizes the skin to UVA light, making it more responsive to the therapeutic effects of UV radiation. PUVA therapy is typically reserved for individuals with severe or refractory eczema and may be used in combination with other treatments.

Risks and Side Effects:

While phototherapy can be an effective treatment for eczema, it also carries certain risks and side effects that need to be considered:

  1. Skin Damage: Prolonged or excessive exposure to UV light can damage the skin and increase the risk of premature aging, sunburn, and skin cancer. Patients undergoing phototherapy should be monitored closely to minimize the risk of skin damage, and protective measures such as the use of sunscreen and protective clothing should be encouraged.

  2. Photosensitivity Reactions: Some individuals may experience photosensitivity reactions, including sunburn-like symptoms, itching, and redness, following phototherapy sessions. These reactions are usually temporary and can be managed with supportive care, such as moisturizers and cool compresses.

  3. Eye Damage: UV light can also pose a risk to the eyes, increasing the risk of cataracts, macular degeneration, and other eye conditions. Patients undergoing phototherapy should wear protective eyewear during treatment sessions to minimize the risk of eye damage.

  4. Hyperpigmentation: Prolonged exposure to UV light can cause changes in skin pigmentation, leading to areas of hyperpigmentation (darkening) or hypopigmentation (lightening) on the skin. These changes are usually temporary but may persist in some cases.

  5. Risk of Skin Cancer: Long-term or repeated exposure to UV light increases the risk of developing skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma. Patients undergoing phototherapy should be monitored regularly for signs of skin cancer and advised to perform regular self-examinations of their skin.

Despite these risks and side effects, phototherapy remains a valuable treatment option for many individuals with eczema, particularly those who have not responded to other therapies. However, the decision to undergo phototherapy should be made in consultation with a healthcare professional, taking into account the individual's specific circumstances and medical history. Close monitoring and appropriate protective measures are essential to ensure the safe and effective use of phototherapy for eczema management.

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