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Dermatology Practice Today

Treating Eczema Appropriately

Published November 17, 2011 9:29 AM by Amy Gouley
As the seasons change, we begin to see an influx of xerosis, dermatitis and eczema cases. Far too often these patients receive topical cortisone creams and kenalog shots visit after visit.

Prolonged, excessive usage of steroids in the treatment of eczema can create a chronic dermatitis by producing vasodilation.

These photos show a 26-year-old patient with history of eczema since childhood. She was treated with topical steroid creams and kenalog injections continuously starting in the third grade. Now, this patient suffers from steroid dermatitis and is nonresponsive to topical and oral cortisone, as well as conventional eczema treatments.

          

Steroid rebound flares are controlled for this patient with cyclosporine 400 mg daily. After 4 years of nonsteroidal treament, this patient is finally feeling and looking better.

In my practice, I lean toward hydroxyzine (Atarax), an antihistamine, as my primary treament for eczema, instead of prednisone. What about you?

10 comments

I suddenly had eczema like symptoms on my face and the face wash / cleanser I had been using for years started agitating it even more. I tried several other brands meant for sensitive, eczema prone skin, everything would worsen it. Finally I came to know of Made from Earth products. None of their products agitate my skin. Started using the Aloe & Jojoba Therapy and the Green Tea Cleanser. My face is completely clear and healthy now. I have seen a major improvements. It reduced redness, itchiness and breakouts.

Simone H January 29, 2013 1:16 PM

I also use atarax for the itching and for the histamine blocking mechanism but I also use Triamcinalone cr bid until resolution then aquaphore. If we continue to see flare ups then I do allergy panels for foods, etc. I have not ever seen Atarax alone fix eczema. What are your thoughts? This has worked for me for 11 years and most are seasonal eczema that I am dealing with. Only in extreme cases would I use oral prednisone (where the child is miserable---head to toe eczema) for 5 days at 1mg/kg.

Chase Thomas, Pediatrics - CRNP, Pediatrics Plus December 8, 2011 8:01 AM
Anniston AL

Good to hear from you Juliana, and yes Kelly and I are in contact and I am ready to help in anyway I can. I know Dr. Rapaport very well and had the fine pleasure of assisting him for several years. He has taught me everything I know about steroid addicted skin.

Jill: Sounds like you need to cut the steroids 100%. Clobetasol is very strong and should never be used longer than 10-14 days.

Amy Gouley December 2, 2011 8:41 PM
Claremont CA

Prolonged usage of topical steroids causes real damage to the skin. it goes beyond the usual "skin thinning" as we know. I wished that more dermatologist acknowledge this fact and stop giving steroid creams to eczema patients.

Dear Dr Amy, have you heard of Dr Marvin Rapaport? He has written about the red skin syndrome. We (the people who are going through steroid withdrawal) need more doctors like you to support the cause. Would you please join us in the fight against steroids? Kelly is heading the steroid warning network, her e-mail is kelly@palaceproperties.com and I'm sure she would be pleased if you will join us.

Juliana Y December 2, 2011 7:34 AM

Having personal battle with recurring eczema mostly on legs.  Have used Vanos or Clobetasol which works, but ecxema recurs shortly after discontinuation.  Experiencing worsening now possibly due to radiation therapy to breast 6 months ago??  Has anyone had flare post radiation?  I am also experiencing recent insulin resistant while using the ultra potent topical cortisones.

Jill, Women's Health - CRNP November 23, 2011 7:13 AM
Dingmans Ferry PA

Hi Guys,

not sure if this can help you but I run an on-line store called The Allergy Shop - www.theallergyshop.com.au - which is specialised in products to cure and treat Eczema.

Regards

Christian

Christian Antonini November 23, 2011 2:03 AM
Bexley IA

Thank you for your comments Iwan and Cindy.

I have experienced wonderful results with UV light therapy in the treatment of eczema.

This particular patient visited our in office light box 3-4 times a week. Light therapy can be a difficult commitment for the majority of patients with a traditional work schedule. Insurance can also be a challenge.  

Cindy: I typically prescribe a night dosage. This also helps the patient sleep and reduces excoriations while asleep.

Amy Gouley, Derm - PA-C November 21, 2011 6:15 PM
Beverly Hills CA

Hi -

These photos are quite startling. My son has eczema and at one point it was quite severe. We tried everything, including cortisone, but the eczema would always come back worse when we stopped. We finally learned that food allergies were triggering his eczema. After we eliminated certain foods, his eczema improved about 90%.

When he was extremely itching we did use hydroxyzine, the minimum dose, and found it soothed the itch for 2 days! And it relaxed my son a bit, but not too much - he always has super human energy anyway :)

I'm looking for guest bloggers on my site that talks about our family's battle with eczema, allergies, and asthma. I would be honored to feature a guest post from your point of view. I don't think parents know enough about the long term side affects of cortisone. http://itchylittleworld.wordpress.com

Please contact me if you're interested.

Thank you.

Jennifer

Jennifer November 20, 2011 9:24 PM

What is your experience with UV light therapy for treatment of eczema?

Iwan van Vijfeijken November 20, 2011 7:08 AM
Eersel

How do you deal with the sedation factor?

Cindy, family - NP November 18, 2011 1:54 PM

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