Eczema: What’s the Best Treatment for You?Discussion in ' Community Discussion ' started by hierobryanFeb 5, Do you take oral steroids? Jan 4, Location: I've been trying to get my ciclo winstrol y oxandrolona oral to give me prednisone or other oral steroid more often than one prescription every 3 dczema because that's the only thing that completely clears up my rash. It's like a side effects of steroid pills for eczema drug that gives me baby soft skin everywhere. Are any of you fo to get oral steroids for "minor" eczema? Is there anything I can say to my doctor to convince him to give me a long term oral steroid prescription?
Eczema pill - Natural treatment for eczema
I have been writing about our experiences with eczema or more specifically Atopic Dermatitis for almost 2 years now. I have written about the various treatments we have tried in various posts but I realised that I have not really written in details and in a comprehensive manner about the first, second line and third line treatments that are usually used to treat eczema. I will refer to Atopic Dermatitis as eczema in my post from here on to simplify matters. In this post I have written about the regular medical treatment that is used once the moisturisers alone are not able to control the inflammation.
Moisturisers are an essential part of the treatment for eczema and works very well in mild forms but may not be sufficient to bring the eczema under control once the skin becomes red and inflamed in moderate to severe eczema.
I have myself been confused at times with the myriad topical, steroidal and non steroidal creams that are prescribed by the doctors at various points in time. Then there are also the oral steroid medications and different immunosuppressants and phototherapy treatment that we have used to control flare ups.
I believe it would help a lot of parents and those adults suffering from eczema if they had some idea about the basics of the different types of treatments and medications that they may be using on their child or even on themselves. It would definitely help in controlling and reducing the side effects that some of these strong medications can have on a person if not used properly.
This is especially true for young children and babies. In any case, the topical corticosteroids are prescribed only when the risks from eczema far outweigh the risks from the side effects of using these medicines. You should also know there is an overlap in these topical medications since they are usually available in both cream and ointment forms and the potency for the same dosage will differ based on the form.
The cream form has roughly half water and half oil, they spread easily, are well absorbed and usually wash off with water. B eing occlusive, an ointment will allow the medication to get absorbed much more completely than a cream and hence are more potent at the same dosage as a cream. Topical corticosteroids should be used in a step up manner in terms of increasing potency starting from a low potency and only moving up if required.
Usually the doctor will prescribe the milder ones like desonide cream brand name- Desowen and only graduate to a stronger medication like Fucibet if required later on. However, sometimes the rashes may be quite widespread all over the body. In that case, the doctor may prescribe a 1: Side effects from these steroidal creams are varied and depends on the age of the person, the frequency of application, the potency of the drug amongst other factors.
The thinning of the skin or skin atrophy is one such side effect which can take place if potent to highly potent steroidal creams are applied too frequently or without any break. The other thing to keep in mind that in case of excessive scratching due constant itchiness in case of under medication, the skin tends to become thick and discoloured. Thus the treatment needs to be carried out in a timely manner under the supervision of a doctor and the instructions should be properly followed to minimise the side effects.
These topical medications work by suppressing the immune system and are usually prescribed to children over 2 years of age and adults and are recommended for use as a second line treatment for eczema. As with steroidal medications, these type of immunomodulators should also be applied only when prescribed by the doctor and for the recommended duration of time.
Even though it does not have the side effects like thinning of the skin which is associated with steroidal treatments, one still has to be cautious while using these medications since they are relatively new medications and not much is known about their long term usage.
There is a possible risk of skin cancer only in the long run after prolonged usage but it is still advisable to apply these creams at night to avoid sunlight exposure. Another treatment that is prescribed once the topical treatments have not really worked for a person in controlling the eczema is phototherapy.
In this treatment light or a particular narrow band of Ultraviolet rays are used to treat the eczema which is beneficial for skin diseases. It can be used both for localised as well as general areas of the skin covering the entire body. This treatment works effectively for some people but not for everyone and usually takes about 1 to 2 months to show the desire results.
If this treatment is effective then it can effectively put the eczema in remission for a while at least. It may also minimise the usage of topical steroids and there its side effects. Phototherapy is carried out in a special booth filled with UV rays for general treatment of eczema all over the body and hand-held devices for treatment of specific areas like hands, ankles etc.
Nowadays, a high intensity phototherapy treatment is available in the form of a laser called Excimer. It is much more powerful than the regular phototherapy and emits Ultraviolet rays of a particular frequency which is used to treat different skin conditions like eczema, psoriasis etc. It is given in the form of a hand-held gadget and takes much less time than a regular phototherapy due to the high intensity of the rays and is more useful for treatment for localised areas of the body.
However, one needs to be careful in protecting the eyes when undergoing this treatment. The risks associated with prolonged treatment are skin burns, increased ageing and increased risk of skin cancer. Like any other such treatment this has to be carried out under the supervision of a medical professional and all the instructions need to be followed carefully.
The third line of treatment for eczema is the use of systemic medications like oral steroids. Prednisone is one of the most commonly used oral steroids given in cases of severe eczema where an immediate result is required and is given under strict supervision of the doctor. It is given as a daily dose starting with a high dosage and then is slowly tapered down once the eczema is under control.
Oral steroids work by suppressing the immune system and helps in controlling the overactive immune system in the case of a person suffering from eczema. But this also makes it possible for the person to catch infections easily due to a weakened immune system and hence has to be monitored at all times.
Also, in the case of a child, oral steroids may slow down growth and development and hence again one needs to be very careful. There are other side effects as well which can be minimised by following instructions carefully and keeping a lookout for any symptoms which may arise on taking this medication.
This is also done by carrying regular blood tests to determine adverse side effects if any. Due to the various side effects of this medication and its quick action, oral steroids are usually prescribed for short periods of time when results are needed fast.
The other third line of systemic treatments include the immunosuppressive medications like azathioprine, cyclosporine and methotrexate. These are all very powerful medications and are given only when all other options have failed to yield the desired results.
All of these medications work by suppressing the immune system and hence bring the eczema under control. But once again, due to the various side effects these medications have to be given under strict supervision of the doctor prescribing this and by following all the instructions carefully. Since eczema is a chronic condition and these medications may be required to be given for long periods of time, regular testing is required to ensure that there are no side effects.
Azathioprine works by tweaking the growth of certain white blood cells which contribute to the inflammation associated with eczema and thus suppresses the immune system. It takes a while longer to show results than cyclosporine and may not suitable for acute flare ups. The main side effect of azathioprine is bone marrow suppression and that is why a specific test is carried out before prescribing this medication which is called the TPMT enzyme test.
This test determines the suitability of the person by determining the ease by which the person is able to break down azathioprine in the normal way. However regular testing would be required to keep a track of any adverse effect on the immune system.
This medication is taken orally in the form of tablets and on a daily basis in the prescribed dosage. We had a traumatic experience with this medication which was prescribed by a leading pediatric dermatologist in London for our then 7 year old daughter. In her case, even though she had a normal TPMT result, her body reacted disastrously to this medication and she suffered from bone marrow suppression and had to fight for her life.
This was a one in a million kind of event and has never happened before to someone with normal TPMT levels. It is prescribed in low doses for eczema under strict supervision and once the eczema is under control, the medication is tapered off. One of the main risks associated with this medication is damage to the kidney especially with increased dosage and duration of medication and hence regular tests would be required to monitor the kidney activity.
This medication has to be taken orally on a daily basis as per the prescribed dosage. I have written more about our experience of dealing with cyclosporine and azathioprine medications in my blog post where I have compared both at https: Methotrexate is another systemic immunosuppressant which is used mainly in treatment for psoriasis and different types of arthritis.
It is also given in low doses in cases of severe eczema and usually takes longer to work than cyclosporine. Thus a folic acid supplement is a must on a daily basis for those taking this medication. This medication is taken once a week in the form of tablets. This dosage may also be split up into 2 doses taken within 24 hours to minimise any nausea that may occur. One of the main possible side effects of this medication is again adverse effects on the immune system especially on the white blood cells which fight infection and platelets which help stop bleeding.
Thus regular blood tests are required to keep a look out for any adverse side effects. Sometimes the hardest thing and the right thing are the same.
Of course we would prefer to find some alternative which is much safer and without any of the side effects that I have mentioned above. Things can also go horribly wrong like it did in our case in spite the very best of intentions. We have been very lucky and have learned to take this in our stride and be more vigilant in the future since our daughter still requires immunosuppressants to keep her severe eczema under control. This has not stopped us from looking for other options and neither should you.
As one wise person had said, it does not matter how slowly you go as long as you do not stop. It has been some time since I have put up a post. There have been a couple of developments at my end due to which I have been a bit tied up.
The first and the most important one is that the combination of the new immunosuppressive medication, Methotrexate, and her new diet seem to be working for my daughter. I will be writing more on this particular diet later in this post. The second one is that the support group for eczema that I started a few months back has been slowly gathering steam at a pace that I am comfortable with. Diet and its impact on various disorders.
Doctors do not really recommend any dietary changes unless allergy tests prove to be positive for various foods. However, I found that there more than a few genuine cases where people suffering from severe autoimmune and other disorders like Hashimoto, Lupus, Postural Tachycardia Syndrome, Irritable Bowel Syndrome as well as eczema have found relief from the symptoms due to dietary changes and have managed to go off medication completely over time.
It took me more than 6 months to come to this point of view after reading about the life altering experiences of these people and then figure out a diet which I was willing to try out on my daughter. The life stories of some of the people who influenced my decision to try out diet as an option for my daughter are captured in their blogs whose links are as given below-.
In my post https: Her daughter had severe eczema as well when she was a 2-year-old and with changes in her diet, Karen managed to control the eczema successfully.
She has since written this book based on her own experience with her daughter and the feedback over the years from her patients who have successfully brought their eczema under control using this diet. This diet is practical and comprehensive with information on products and backed by research; it has menus and recipes for babies, children and adults.
It also has non diet information like skin care products and general recommendations for eczema. The objective of this diet is to temporarily take out all the eczema unfriendly foods from the diet and add all foods which are highly nutritious and eczema safe. This diet thus helps restore the acid alkaline balance in the body. Stage 2 is an extension of the first stage where the food groups are gradually expanded by adding back different food groups in moderation no processed foods, artificial colourings, preservatives etc depending on the improvement in the skin condition.
I started this diet for my daughter after going through it thoroughly and arranging for most of the eczema safe ingredients as there are quite a few changes in ingredients that we usually use at home.
Infact, it took me almost a month to assimilate all the information, answer the different questionnaires and make notes and list down the essential foods and recipes as a part of my preparation before starting this diet.