Whelehans Pharmacys Eamonn Brady: Atopic Eczema Part 2
Atopic Eczema Part 2
This is a continuation of last week’s article..
More Over the Counter options
Last week I discussed how the initial approach to treatment of atopic eczema involves the avoidance of exacerbating factors and hydrating the skin.Triggers include specific allergies to foods, overheating, secondary infection, wool next to the skin, cat and dog fur, soaps, detergents, house dust mites and pollen.
Urea
Urea is a hydrating agent naturally found in many emollients sold over the counter in pharmacies including Calmurid® and Eucerin® cream. It is one of three natural moisturising factors (NMF) in the outer horny layer of our skin. The other two NMFs are lactic acid and amino acids. There are markedly reduced amounts of urea in dry skin conditions.
Urea is strongly hygroscopic (water-loving) and draws and retains water within skin cells. Urea softens the horny layer. Urea can be beneficial in dry skin conditions where scaling and flaking occur and can be useful in elderly patients. It can also be used in conjunction with corticosteroids to enhance to penetration of skin. Whelehans Intensive Moisturising Cream was developed by our pharmacist because brands such as Calmurid® Cream, while effective, are very expensive. Our cream contains 10% urea and is over half the price of brands such as Calmurid® Cream.
Itch
The efficacy of preparations containing crotamiton (Eurax®)for itch is uncertain so are best avoided in Eczema. Similarly, calamine lotion is best avoided. Topical doxepin (Xepin cream®: prescription only) is rarely prescribed for itch due to the risk of drowsiness and the stipulation that coverage should be less than 10% of body surface area.
Oral antihistamines are widely used for itch in patients with atopic eczema. The evidence supporting their use is relatively weak since no major studies with definitive conclusionshave been performed. However, sedating antihistamines appear to be most effective. There is little evidence to support the use of one sedating antihistamine over the others. The response to different antihistamines varies from patient to patient. Chlorphenamine (Piriton®) is the only sedating antihistamine available over the counter in Ireland. Although not as effective as sedating antihistamines, non-sedating antihistamines such as cetirizine (Zirtek®, Cetrine®) and loratadine (Clarityn®, Lorat®) can be useful where sedation will be an issue. Tepid baths to hydrate and cool the skin can also temporarily relieve itching.
A gem from La Roche Posay
La Roche Posay’s Cicaplast Baume B5® balm is one of the best products for flare ups. It is suitable for everyone, including babies, and will not only help clear up the irritated areas, but also relieve skin from itching. Our pharmacy team recommend it as they find it often delays or prevents the need for subsequent use of stronger prescription medicines like steroid creams. Whelehans health and beauty team find La Roche Posay’s Cicaplast Baume B5® cream not only has excellent healing powers for eczema but also for chapped lips, dry or cracked skin, skin tightness, minor everyday injuries caused by daily aggressions or sensitive and irritated baby skin.
Precription medication options for Eczema
Apart from Hydrodrocortisone 1% Cream (which is also available over the counter from pharmacies after consultation with your pharmacist), all the treatments mentioned in the rest of this article can only be prescribed by a medical professional and must be used under strict supervision from your healthcare professional.
Corticosteroids
When skin is not inflamed, patients should bathe daily and then immediately apply an emollient. Patients should use the highest oil content emollient ((eg. Emulsifying Ointment). Patients with inflamed skin can be initially treated with topical corticosteroid such as hydrocortosone 1% cream. Consult with your pharmacist or GP before considering these steroid creams or ointments.
The face and skin folds are areas that are at high risk of thinning/marking with corticosteroids. Initial treatment in these areas should start with a low potency steroid such as hydrocortisone 1% cream. A moderate or potent corticosteroid such as clobetasone-Eumovate® (moderate) or betamethasone-Betnovate® (potent) may be needed for more severe cases. Higher potency topical corticosteroids (clobetasol-Dermovate®) can be used for up to 10 days in some patients with severe flares, and then replaced with lower potency preparations until symptoms resolve. Potent steroids are generally avoided on the face and skin folds. However, limited brief use of potent steroids can produce a rapid response after which patients can be switched to a lower potency preparation. This approach is best restricted to supervision by a dermatologist. The British Association of Dermatologists recommends using topical steroids for 10-14 days when eczema is active followed by “holidays” or “breaks” with just emollients.
Topical corticosteroids can be used one or more times daily, however the benefit of using more than once daily is unclear. There is some evidence that the intermittent use of corticosteroids as maintenance can help prevent relapse. Generally, ointments are more effective than creams, as the emollient action and occlusive effect results in better penetration. Ointments also require fewer preservatives so the potential for irritant and allergic reactions is lower.
Free Eczema skincare consultation at our Eczema Clinic
Whelehans Pharmacy offer free Eczema skincare consultations at our Eczema Clinic on Saturday July 16th with skincare expert Trish Wallace. Learn how to reducerednessandirritation and how to reduce frequency of flare-ups. Whelehans offer a range of effective products that give clearer skin in a safe and effective way without the need for stronger and potentially damaging prescription medicines like steroid creams. Book your free appointment; call Whelehans at 04493 34591 to discover clearer skin.
To be continued....next week I will discuss more specialist options for resistant cases as well as top tips from your pharmacist on managing eczema.
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591. You can also e-mail queries to info@whelehans.ie.