Allergy, Eczema | May 8, 2014 | Author: The Super Pharmacist
Also commonly known as atopic dermatitis, eczema affects up to 20% of children and 3% of adults1. Dry, itchy, red and inflamed skin are the characteristic symptoms of this chronic condition, which usually develops during the first year of life in affected children. Eczema often occurs together with asthma and hayfever and tends to run in families2. While up to half or more eczema patients experience complete remission around the time of puberty, 20% continue to experience symptoms into adulthood. The disease can also show its first signs after childhood, with nearly one-fifth of all adults experiencing eczema symptoms at some point in their lives1. Accelerated loss of moisture from the skin and allergic sensitivity to plants, chemicals and foods are considered the primary causative factors of eczema. Scratching contributes to the problem, causing abrasions known as excoriations. Often blisters form, which then burst, oozes fluid and develops into a dry crust. Over time, the skin can lose its ability to carry out its function as a protective barrier and skin infections may set in as a secondary complication of the disease. A variety of both medical and alternative therapies are available to aid in effectively managing and potentially curing this often debilitating condition. Topical therapies for eczema aim to control itching and inflammation, restore the skin's protective barrier, and treat and prevent bacterial infection.
The conventional medical approach to the treatment of eczema relies on corticosteroid therapy. Also referred to simply as steroids, these strong chemicals are a necessary and important component of your body's natural immune response and are produced by the adrenal glands in response to various forms of stress or illness. Synthetic steroid drugs are incorporated in various formulations for topical use, including creams, gels, ointments, oils, foams and sprays. Their judicious use can decrease the severity of eczema symptoms, control itching and help reduce skin damage that occurs from scratching. However, along with their powerful anti-inflammatory benefits steroids bring a long list of dangerous potential complications and side effects and the subject of steroid use is fraught with controversy. Excessive use of topical steroids, over too much time or through excessively high doses, causes thinning and bruising of the skin and impairs wound healing, which can cause eczema to worsen3. These drugs also cause elevated blood pressure and blood sugar, increased appetite and abdominal fat, decreased bone density and increased susceptibility to infection. While the lowest-effective-dose rule has long been the prevailing approach, this protocol can fall short in terms of overall effectiveness. Newer thought on the use of topical steroids proposes short-term use of higher doses to gain control of symptoms followed by lower-dose or intermittent use of steroid therapy4. In one study, short-term use of the steroid fluocinonide in a 0.1% cream once per day cleared eczema outbreaks in 59% of adult participants within two weeks without causing adverse effects or skin atrophy4.
This category of drugs is designed to suppress the immune system. Certain calcineurin inhibitors are used by organ transplant patients to ensure that their body does not reject their transplanted organ. Some of these drugs have also been used for topical treatment of eczema. In a pediatric study, a non-steroidal, immune-suppressing drug called tacromilus applied 3 times per week for up to 40 weeks demonstrated effective stabilization of eczema with fewer disease relapses than a control group that did not receive the drug5. Tacrolimus can cause a skin burning sensation as a side effect. This generally occurs at the beginning stages of therapy and can be managed with use of an anesthetic agent such as lignocaine several minutes prior to application. An immune-suppressing drug developed specifically for use in eczema, called pimecrolimus, has yielded conflicting results. One review of previously published studies on pimecrolimus reported that it improved symptoms and delayed flare-ups in pediatric and adult patients with mild to moderate symptoms6. However, another review found pimecrolimus no more effective than placebo for pediatric patients7.
The drug doxepin, an anti-depressant when taken orally, offers antihistamine and anti-itch benefits for adult eczema patients. A 5% doxepin cream is approved by the U.S. Food and Drug Administration for up to 8 days use8. Synergistic effects have been noted when doxepin is combined with hydrocortisone, whereby greater and faster results are obtained via the combination the two than with the steroid alone8. Side effects of doxepin include drowsiness, stinging and burning. Doxepin has also reportedly caused dry mouth, itching and worsening of eczema symptoms. In one study, a cream containing 0.3% of a topical antihistamine called N-palmitoylethanolamine, or PEA, decreased dryness, scaling, redness and itching by an average of 59% in eczema patients with mild to moderate symptoms9. Frequency of corticosteroid use decreased by 62% by the end of the 6-week study. Participants ranged in age from 2 to 70 years.
This thick, viscous brown or black liquid is the by-product of coal processing. Though its mechanism remains a mystery, it is thought to have antibacterial, antifungal, anti-inflammatory and anti-itch effects and claims a long history of use for a variety of inflammatory skin conditions. Coal tar remains a viable non-steroidal option for treating eczema10 and is an ingredient in numerous over-the-counter medicated soaps, shampoos and ointments. Its main adverse effects are its strong, unpleasant odor and its tendency to stain skin and clothing. It can also cause irritation and burning of the skin.
Keeping skin hydrated is a key component of managing itchiness in eczema. Emollients, substances that hydrate and lubricate the skin, help to replenish lost fluids, alleviate itch, improve the skin's barrier function against irritants and infection, and increase the effectiveness of corticosteroids, potentially decreasing the amount of corticosteroid drugs that patients require10. For best results, apply emollients within a few minutes of getting out of the shower or bath to seal the moisture in. Lipid-based moisturizers made with fatty, waxy molecules known as ceramides, have been found to be particularly effective at absorbing into the skin. A specially-designed moisturizer containing ceramides, fatty acids and cholesterol, meant to imitate the skin's moisture-retaining mechanism, eliminated symptoms in 69% of participants with mild to moderate eczema, in one study11. Ceramide-based moisturizers have been found to be safe, effective and useful for both first-order therapy and as part of a maintenance regime12. In a study on ceramide-based moisturizer in children with eczema, two-thirds of participants obtained benefits13. However, the moisturizer tended to be less effective for girls and those with skin infections, in this study. In children with moderate to severe eczema, treatment with a commercial ceramide-based moisturizer for 28 days was found to be as effective as the steroid fluticasone propionate at decreasing itching and improving sleep quality14. Using a glycerol-based cream may also improve eczema symptoms by keeping skin hydrated15. Glycerol combines with fatty acids to form compounds known as glycerolipids. Additionally, the compounds ammonium lactate – a moisturizer, and urea, which promotes shedding of loose, scaly skin cells, are often used together for treating inflammatory skin conditions16. Urea and lactate, in combination with polidocanol, an anti-itch and pain-relieving substance, and the herb licorice decreased dryness, itching and inflammation in patients with scalp eczema, in one study17. Participants applied a leave-on tonic containing the combination of ingredients three times per week for four weeks.
A wealth of gentle, natural substances is available to help manage the symptoms of eczema. Many have been historically recommended by herbalists and natural health practitioners. Some have been substantiated through medical studies while others lack the backing of evidence. Always seek the guidance of your healthcare practitioner for appropriateness and safety before using any remedy.
This soothing succulent plant demonstrated immune-modulating effects on eczema in a preliminary study18. Aloe contains a wide range of antioxidant and anti-inflammatory compounds19 and is readily available in topical gels, lotions and creams.
Used topically, vitamin B-12 has been shown to improve eczema symptoms in both adults and children. It is thought to work by decreasing levels of nitric oxide, a chemical messenger that increases circulation throughout the body by causing blood vessels to dilate. In one study, topical vitamin B-12 produced significant symptom improvement within two weeks20. Vitamin B-12 cream received a rating of “very good” from 59% and was found to have a high safety profile in another study21.
The same chemical that gives cayenne peppers their spicy flavor may provide relief of pain and itch for some eczema patients10,22. Skin cream containing concentrations of 0.025% to 0.3% applied four to six times per day have been found to decrease burning and redness and help speed skin healing, without causing damage to the skin22.
This herb, with its pleasant apple-like flavor and calming benefits, has been consumed as an herbal tea and medicinal plant for centuries. A member of the ragweed family, one potential drawback of chamomile is that it may be highly allergenic23. However, a commercially prepared cream containing active compounds from a hypoallergenic variety of chamomile demonstrated slightly superior results compared to a 0.5% hydrocortisone cream, in one study24.
Herbalists have traditionally recommend licorice for a variety of skin ailments. Recent evidence has shown effectiveness of a 2% gel for relief of itching and inflammation in eczema patients25. Licorice also provides skin-lightening benefits and may be helpful for reducing hyperpigmentation that can occur after eczema flareups26.
Traditionally, oats have been used for centuries, added to bath water, as a remedy for skin irritation. A finely ground form that disperses well in water, known as colloidal oatmeal, is used for bathing27. Proteins in oatmeal help replenish collagen, the skin's main protein component28. Oatmeal also contains lipids and saponins that lubricate and hydrate the skin28. Additionally, a family of recently discovered compounds in oatmeal has been found to help heal the skin29,30. Members of the polyphenol family of antioxidants, these compounds reduce inflammation and alleviate itching31.
Alkaloid compounds in Oregon grape provide antioxidant benefits that have been used in the treatment of psoriasis32,33.A commercial homeopathic preparation containing an extract of Oregon grape was rated substantially beneficial for relieving itching in a study of adult eczema patients34.
Hyperforin, one of the active compounds in St. John's wort, has been found to stimulate healthy growth and reproduction of skin cells35. St. John's wort also provides antioxidant and anti-inflammatory benefits. However, it also causes skin cells to become more senstitive to ultra-violet rays. While this process, known as photosensitivity, can lead to skin damage, concentrations of 1.5% hyperforin have been used safely in the treatment of eczema35. St. John's wort cream reduced formation of free radicals – waste products that can disrupt normal cellular function – by up to 80%, in one study of healthy volunteers, and was 20% more effective than a placebo36. Researchers noted that the effects of St. John's wort are temporary and daily application is required to obtain the full effect. In another study, St. John's wort cream significantly decreased healing time in patients with mild to moderate eczema37. Its antibacterial activity also helped reduce levels of Staphylococcus aureus, a common skin bacterium that can cause infections.
1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923967/ 2. http://www.med.nyu.edu/content?ChunkIID=21529#ref45 3. http://goo.gl/mQeaQ3 4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923967/ 5. http://pediatrics.aappublications.org/content/122/6/e1210.long 6. http://www.ncbi.nlm.nih.gov/pubmed/17296454 7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972203/ 8. http://www.ncbi.nlm.nih.gov/pubmed/11260249 9. http://www.ncbi.nlm.nih.gov/pubmed/18181976/ 10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704137/#R79 11. http://www.ncbi.nlm.nih.gov/pubmed/19626524 12. http://www.ncbi.nlm.nih.gov/pubmed/22825649 13. http://www.ncbi.nlm.nih.gov/pubmed/23456759 14. http://www.ncbi.nlm.nih.gov/pubmed/20027938 15. http://www.ncbi.nlm.nih.gov/pubmed/18025807 16. http://cancer.dartmouth.edu/pf/health_encyclopedia/d05774a1 17. http://www.ncbi.nlm.nih.gov/pubmed/23549137 18. http://www.ncbi.nlm.nih.gov/pubmed/20817082 19. file:///C:/Users/Owner/Downloads/molecules-13-02169%20(1).pdf 20. http://www.ncbi.nlm.nih.gov/pubmed/19368512 21. http://www.ncbi.nlm.nih.gov/pubmed/15149512 22. http://www.ncbi.nlm.nih.gov/pubmed/11209117/ 23. http://www.ncbi.nlm.nih.gov/pubmed/15503788 24. http://www.ncbi.nlm.nih.gov/pubmed/10799352 25. http://www.ncbi.nlm.nih.gov/pubmed/14522625 26. http://www.ncbi.nlm.nih.gov/pubmed/18277662 27. http://umm.edu/health/medical/altmed/condition/dermatitis 28. http://www.ncbi.nlm.nih.gov/pubmed/23072529 29. http://www.ncbi.nlm.nih.gov/pubmed/18277662 30. http://www.ncbi.nlm.nih.gov/pubmed/19941618 31. http://www.ncbi.nlm.nih.gov/pubmed/18461339 32. http://www.ncbi.nlm.nih.gov/pubmed/15358297 33. http://www.ncbi.nlm.nih.gov/pubmed/16148424 34. http://www.ncbi.nlm.nih.gov/pubmed/17890932 35. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0033-1351019 36. http://www.ncbi.nlm.nih.gov/pubmed/23614743 37. http://www.ncbi.nlm.nih.gov/pubmed/12634994