PART 3: CONVENTIONAL MEDICAL TREATMENTS
3.1 What conventional treatments are available?
The main conventional treatments are:
* Bandaging or Wet Wrapping
* Evening Primrose Oil
These are described in the following sections.
With eczema the skin becomes dry and itchy. Emollients are preparations which moisturise the skin by trapping moisture. There is a wide range of emollients available as creams, ointments and lotions.
In general they are perfectly safe and can be used frequently. However, certain emollients may contain substances such as lanolin or preservatives which may irritate the skin of some people. It is best to experiment and find the type of emollient which suits you best.
A list of emollients is contained in appendix A.1 of this document.
The best time to apply an emollient is after bathing so that it can trap the moisture whilst the skin is still wet.
Emollients can also be used in the form of bath oils, which will leave a film of oil all over the body. Care must be taken when using these oils as the bath may become slippery.
Topical steroids are applied to the skin as creams or ointments and reduce inflammation. As there are possible dangers associated with over-use of steroids over a long period then they should be used only in accordance with your medical practitioner’s directions.
Topical steroids are classified by strength as: Mild, Moderately Potent, Potent, Very Potent. Very Potent steroids should only be used for a short time whereas Mild steroids may be used to control eczema over a long period.
It is important that the correct strength is chosen and this choice should be reviewed periodically.
Frequent use of emollients can be used to reduce the need for steroid creams.
Oral steroids will sometimes be prescribed for short term use in acute cases but they are not recommended for long term use.
Oral antihistamines may be prescribed to reduce itching. Antihistamine creams should not be used on eczema.
Antibiotics may be prescribed to treat eczema which has become infected.
Sometimes the antibiotic seems to help the eczema itself, rather than just the infection. The exact reasons for this are not known, but some research suggests that certain staphylococcus bacteria interact with the eczema to produce a higher level of skin reaction than either would alone.
Tar based treatments can be very effective for certain types of eczema. The products used tend to be black, sticky and smelly but are effective and reducing inflammation and itching.
Examples of bath additives containing tar are Zetar, made by Dermik Laboratories, Collegeville, PA and Balnetar.
Shampoos containing tar are useful for itchy, scaly scalps. Examples of these are T-Gel and Polytar.
Creams containing zinc are effective at reducing inflammation and promoting healing of damaged skin.
Examples of these creams are zinc oxide cream and zinc and castor oil cream. The branded cream Sudocrem also contains an antiseptic.
These creams are also used for diaper/nappy rash.
3.1.7 Bandaging or Wet Wrapping
This treatment involves enclosing the skin in bandages covered with emollient or steroid, or applying emollient or steroid to the skin followed by bandages soaked in warm water. It is particularly useful for children as it helps to reduce scratching.
A second layer of dry bandages is applied over the layer of wet bandages.
It works by keeping the skin moist and cool therefore reducing itchiness and by protecting the skin from scratching. It also increases the efficacy of lower strength steroids.
3.1.8 Evening Primrose Oil
Evening Primrose Oil has found to be beneficial for some people with eczema. It can be fairly expensive and needs to be taken for a minimum of three months. People with a history of epilepsy should avoid this treatment.
Doctors in the UK can now prescribe evening primrose oil for the treatment of eczema.
Some people find it beneficial to apply the oil directly to the skin.
3.2 What dangers are associated with the use of steroid creams?
The most likely possible side effects are associated with the stronger steroids and include thinning or discoloration of the skin. These effects are unlikely if the steroids are used in accordance with the instructions of your doctor and the manufacturer.
3.3 What dangers are associated with the use of oral steroids?
Oral steroids such as Prednisone and Prednisolone work by suppressing the immune system and long term use can lead to damage to the kidneys, bones and heart. They are useful for short term use in acute cases but should only be used as prescribed.
However, if you are already using oral steroids and you are concerned about side effects, DO NOT STOP SUDDENLY as this can be dangerous. Withdrawal from oral steroids should only be done gradually under the supervision of a medical practitioner.