Other Therapies Used to Treat Eczema
Topical (applied to
the surface of the skin) medications play an integral role in
controlling the signs and symptoms of eczema, and moisturizer is an
essential part of most treatment plans. Systemic medication (medication
that circulates throughout the body and is taken orally or given by
injection or infusion) also may be prescribed.
medication and other therapies to:
- Control itching
- Reduce skin
- Clear infection
- Loosen and remove
- Reduce formation
of new lesions
A patient (or parent) may be instructed to use one medication
or a combination of therapies. Research is showing that combination
therapy (use of two or more therapeutic agents) can in some cases
increase effectiveness and reduce side effects. Medications and other
therapies that dermatologists may use to treat eczema include:
Skin affected by eczema frequently becomes infected. A topical or
systemic antibiotic may be prescribed to clear the infection.
a medication more frequently, or in greater amount than
prescribed, will not increase effectiveness and can trigger a side
effect. If uncertain about how often or how much to use, be sure
to ask your dermatologist.
that an oral antibiotic can
be highly beneficial when
the skin becomes infected
or a secondary infection develops. Oral
are frequently prescribed when a patient has atopic dermatitis
because individuals with this condition often have Staphylococcus
aureus, a bacterium that causes “staph” infections, colonizing their
skin. This bacterium is frequently the cause of secondary infection.
Oral antibiotics should be taken exactly as prescribed.
What it does: Kills bacteria causing the infection.
Usage: This depends on the antibiotic prescribed and severity of the
infection. It is especially important to use antibiotics as prescribed.
Patients should not skip doses nor stop using the medication as soon as
they feel better. Doing so may allow some of the bacteria to remain and
possibly become resistant to the medication.
When itching is severe, antihistamines may be prescribed. While
there is little scientific evidence that
either sedating or non-sedating antihistamines are effective in
relieving itch and other symptoms, sedating antihistamines can be useful
for patients experiencing significant sleep disruption due to a
constant, unbearable itch and other symptoms. It is believed that the
improvements associated with antihistamine use are due primarily to the
patient getting a restful sleep.
What it does:
These pills do not
clear eczema. However, sedative antihistamines may promote a restful
sleep, and this restful sleep is believed to decrease the severity and
improve the patient’s quality of life.
depends on the antihistamine and severity of the eczema. Antihistamines
should be taken exactly as prescribed. While
research shows that antihistamines are safe and not associated with
significant adverse effects, even in very young patients when taken as
prescribed, taking a higher dose than prescribed can be dangerous,
especially for young children.
Pimecrolimus and tacrolimus belong to a class of drugs
called calcineurin inhibitors, which effectively reduce the inflammation
of atopic dermatitis. Available in topical form by prescription, these
two steroid-free medications are the newest treatment option for atopic
dermatitis and a much-welcomed addition because they do not produce the
side effects, such as thinning skin and loss of effectiveness,
associated with long-term use of topical corticosteroids. As such,
calcineurin inhibitors can be used for longer periods.
pimecrolimus and tacrolimus are FDA-approved for treating atopic
dermatitis in patients who are two years of age or older and cannot use
or have not responded to other treatments for eczema. Both medications
can be used for short-term and intermittent long-term treatment.
Tacrolimus received FDA approval for the treatment of moderate to severe
atopic dermatitis in December 2000. Pimecrolimus received approval in
December 2001 for treating mild to moderate atopic dermatitis.
In clinical trials,
side effects were mild and temporary. Some patients using pimecrolimus
experienced a mild to moderate temporary
sensation of warmth or burning at the application site, headache or
cold-like symptoms. When applying tacrolimus, some patients also
experienced stinging and burning upon application. The more
severe the eczema, the more likely the patient was to experience these
side effects. The burning sensation was usually confined to the area
being treated and tended to subside after the first week.
calcineurin inhibitors (TCIs) reduce inflammation. Scientists
believe that these medications work by
or suppressing the over-response that occurs
in the immune system, which causes the inflammation.
The recommended dosage for both pimecrolimus and tacrolimus is to apply
a thin layer twice a day to the affected area(s) until the skin clears.
Who should not use: Neither medication should be used
by a patient with a weakened immune system.
Avoid sunlight and other UV exposure:
Patients should avoid exposure to sunlight, tanning beds, sun lamps and
treatment with ultraviolet (UV) light while taking these medications.
Sun protection is essential. Be sure to avoid the midday (between 10
a.m. and 4 p.m.) sun. Even when going outdoors for a few minutes
sun-protection practices must be followed. Wear loose-fitting clothing
that protects the treated area from sunlight, apply a sunscreen with an
SPF of 15 or higher to all exposed skin 20 minutes before going
outdoors, use a sunscreen for the lips that has an SPF of at least 15,
and wear a wide-brimmed hat and sunglasses.
Pregnancy: Women who are pregnant, breast-feeding or may become
pregnant should discuss safety with their dermatologist. Research shows
that the oral form of
tacrolimus crosses the
placenta and appears in breast milk, making it inappropriate for use by
pregnant or breast-feeding women.
Coal tar has
a soothing effect on inflamed skin and has been used for many years to
treat atopic dermatitis. Today, coal tar comes in numerous preparations,
and some of these are available over-the-counter. Best results are
typically seen when use is supervised by a dermatologist. While
effective and free of serious side effects, patients often prefer other
treatment options because coal tar has an unpleasant odor and stains
just about everything it touches.
What it does: Reduces inflammation and itching.
Usage: Coal tar preparations are available in many forms, including lotion,
shampoo and a preparation that can be added to the bath. All forms
should be used as directed by a dermatologist.
Available both over-the-counter and by prescription, topical
corticosteroids have been used since the 1950s to treat eczema. Today,
dermatologists use topical corticosteroids more than any other
medication to alleviate the signs and symptoms of eczema. Also known as
glucocorticoids and steroids, corticosteroids come in a
variety of strengths, ranging from mild to extremely potent. The
strength prescribed depends on the patient’s age and medical history,
severity of the eczema, where on the body the medication will be used
and the size of the area(s) to be treated. While many patients have
concerns about using corticosteroids due to potential side effects, the
likelihood of a side effect occurring is rare when corticosteroids are
used as prescribed. Side effects, such as thinning skin, dilated blood
vessels, stretch marks and loss of effectiveness, tend to occur when
high-potency corticosteroids are used over long periods of time.
cases, intramuscular injections of a corticosteroid or short-term
therapy with a corticosteroid in pill or liquid form may be prescribed
to provide relief from chronic itching. These therapies also may be used
to prevent major exacerbations of atopic dermatitis.
corticosteroids are used sparingly in adults and rarely in children due
to the possibility of:
effectiveness with use
that may occur when the medication is stopped
treatment is not recommended for long-term use. Fortunately, significant
improvement is usually seen within a few weeks, and the remaining signs
and symptoms can be successfully treated with topical agents and
What it does: Corticosteroids tend to rapidly and effectively reduce
inflammation, which relieves itching.
Usage: Topical corticosteroids are applied in a thin layer to the skin as
prescribed and used for limited periods of time. To prevent potential
side effects, care should be taken when applying this medication around
the eye, to skin that is diapered or bandaged and to body folds.
Systemic corticosteroids may be prescribed in a pill or liquid form or
given as an injection.
Pregnancy: Pregnant and breast-feeding women
should not take systemic corticosteroids because these medications cross
the placenta. Children who may have been exposed to systemic
corticosteroids before birth (or while being breast-fed) should be
monitored for suppression of adrenal and pituitary hormones. A woman who
is pregnant or becomes pregnant during a course of systemic or
high-potency topical corticosteroid therapy should discuss safety issues
with her dermatologist or obstetrician.
A corticosteroid should only be used as prescribed. This medication
should not be used more frequently or for a longer period of time than
directed, and a corticosteroid should never be shared. This last fact is
especially important for parents to know. Since atopic dermatitis tends
to run in families, a parent with atopic dermatitis may believe that
using a corticosteroid already in the home will help a child. This
should never be done without consulting a dermatologist.
a potent immunosuppressant used to prevent rejection of a transplanted
heart, kidney or liver. It also is used to treat severe cases of
psoriasis and atopic dermatitis. In fact, oral cyclosporine has been
used for many years to treat severe atopic dermatitis that does not
respond to other treatment. In clinical
trials, patients taking cyclosporine experienced prompt relief from the
symptoms of eczema; however, rapid relapse usually occurs soon after the
patient stops taking the medication. Long-term maintenance therapy tends
to gives patients satisfactory remission.
number of side effects, including lowered immune response, limit the use
of oral cyclosporine. Due to potential side effects, each patient’s
kidney function and blood pressure must be checked before the drug can
be prescribed, and these need to be monitored regularly during therapy.
Other side effects include increased risk of developing cancers,
headache, tingling or burning sensations in the arms or legs, fatigue,
abdominal upset and musculoskeletal or joint pain.
Topical preparations of cyclosporine are not available due to the
medication’s inability to effectively penetrate the skin.
Reduces skin inflammation by inhibiting T-cell (a type of white blood
Take only as prescribed.
traditionally used to treat eczema, interferon gamma has been
investigated in a small number of studies. Findings indicate that while
injections can provide significant relief, a high overall rate of side
effects was demonstrated. Interferon gamma is a protein produced by the
human body that is involved in the regulation of the immune system and
What it does:
More research is needed to fully understand how interferon gamma works.
It is believed that interferon gamma regulates immune responses;
thereby, preventing the overactive immune response that leads to
inflammation of the skin.
Take only as prescribed.
Approved for preventing organ rejection in transplant patients, research
suggests that the medication may effectively treat severe atopic
dermatitis in adults. Potential side effects include increased risk of
cancers and infections.
In animal studies,
mycophenolate mofetil has been shown to cause birth defects. Women are
advised to use effective contraception before and during therapy and for
six weeks after stopping therapy with mycophenolate mofetil.
What it does:
Prevents the exaggerated, one-sided immune response that
leads to inflammation.
Usage: Take only as prescribed.
A cold compress is a cloth dipped in ice water that is wrung out and
applied directly to the skin that itches. When first placed on the skin,
the itching or pain may become more intense; however, this soon
What it does: Helps relieve inflammation and itching.
Usage: If your dermatologist believes cold compresses are beneficial, the
parent or patient will be instructed in how to use and how often to use.
Most eczema treatment plans include use of moisturizers, also called
emollients, since one of the symptoms of eczema is an intense almost
Contrary to popular belief, moisturizers do not add moisture to the
skin. Rather moisturizers serve as a barrier that reduces water loss
from the skin. This is why dermatologists recommend that a moisturizer
be applied after bathing while the skin is still damp. This “locks in”
the moisture from the bath or shower. Moisturizers come in many, many
forms. Ointments are best for very dry skin. Creams and lotions are used
to treat mild to moderate eczema. Most moisturizers are applied directly
to the skin; however, some are added to a bath.
Since many moisturizers contain added preservatives and fragrances that
can irritate the skin, people with eczema should consult a dermatologist
to find appropriate products.
What it does:
Acts as a protective barrier to prevent water loss from the skin, which
prevents the dry skin that leads to itching.
Moisturizer should be applied to the skin or added to a bath.
AAD Guidelines of Care for Atopic Dermatitis.
July 26, 2003
N. “Hydrocortisone Cuts Irritation Associated with Tacrolimus, Skin &
Allergy News. February 2004, p. 28.
are you prescribing an ointment?
Explains the many forms that topical eczema medications can take and why
Phototherapy: A Treatment Option for Atopic Dermatitis
the types of phototherapy used to treat atopic dermatitis as well as the
benefits and drawbacks
Lifestyle modifications that can help prevent flare-ups, includes links
to guidelines for bathing and moisturizing, what you can do around the
home that may help bring relief, stress-reduction techniques and more