Atopic Dermatitis Treatment With Medications

By Heather Brannon, MD, About.com
Treating atopic dermatitis often requires a combination of home measures and medications, or other treatments. Because the skin in atopic dermatitis is "leaky," the foundation of treatment is improving the barrier function of the skin.
Basic Treatment of Atopic Dermatitis
Because the atopic dermatitis rash can come and go, different medications are often prescribed and used for various stages of the rash. The following are medications that may be prescribed to help manage the condition.
Topical Steroids
Topical steroids are still the first-line treatment for atopic dermatitis flares because they are effective at reducing the inflammation caused by this disease. Topical steroids come in 7 different strengths, and it is important to use the correct strength for the affected part of the body.
High-strength steroids are typically reserved for use on the arms and legs. Atopic dermatitis on the face and skin folds (armpits, groin, etc.) are usually treated with a low-strength steroid. More potent steroids are generally avoided when treating these areas, though limited and brief use -- prescribed by a dermatologist -- may help produce rapid results; patients can then be switched to a milder steroid.
Calcineurin Inhibitors
The calcineurin inhibitors are Protopic (tacrolimus) and Elidel (pimecrolimus). They are known as immunomodulators because they change some of the functions of the immune system that cause atopic dermatitis without suppressing the whole immune system. They should only be used during flare-ups.
Antihistamines
Oral antihistamines, such as Benadryl (diphenhydramine) or Atarax (hydroxyzine), can be used to treat itch associated with atopic dermatitis. It's important to note, however, that they can cause sleepiness and may not help in all cases of atopic dermatitis. Antihistamine creams should not be used on atopic dermatitis rashes because they contain chemicals that can actually worsen the rash.
Oral Antibiotics
Atopic dermatitis reduces the skin's natural defenses, making it easier for skin to become infected. If a person's atopic dermatitis is not improving as expected, this may be because the skin is infected. In this case, antibiotics are often prescribed. Antibiotics, such as Duricef(cefadroxil) or Keflex (cephalexin), are often prescribed at the first sign of infection.
Oral Steroids
Oral corticosteroids, such as prednisone, prednisolone, and medrol, may be used for more severe flares of atopic dermatitis. They are used if the rash covers a large part of the body and face. Oral steroids used long term have numerous side effects, including weight gain, thinning of the bones, and suppression of the immune system. Though they may clear atopic dermatitis well, the side effects are too risky to warrant using them as a first-line treatment. To avoid these side effects, but still benefit from the medication, oral steroids are often prescribed for a short course (5 days) to calm the rash. Topical steroids can then be used on the remaining rash.
Coal Tar
Coal tar, actually made by melting coal, has long been a treatment for a variety of skin conditions. Shampoos and soaps containing coal tar can help with mild cases of atopic dermatitis. Coal tar tends to work better on thickened skin that is not scaly, or to ease very early symptoms of itching. However, coal tar can be very irritating to already inflamed skin. It is OK to try coal tar for mild cases of atopic dermatitis, but use should stop immediately if there is any increase in itching or redness of the rash.
Leukotriene Inhibitors
Leukotriene inhibitors, such as Singulair (montelukast) or Accolate (zafirlukast), are medications that may help reduce the inflammation that leads to atopic dermatitis. These medicines are often used to treat other allergy-related diseases, such as asthma and allergic rhinitis (seasonal allergies). Though they may be recommended by some, there is currently no good data that shows that leukotriene inhibitors improve atopic dermatitis.
Other Immune-Suppressing
MedicationsMany medications are being investigated to see if they can be used to treat atopic dermatitis. Most of them are used to treat other related diseases, such as psoriasis or allergic rhinitis. These medications include:
Cyclosporine
Interferon
Methotrexate
Azothiaprine

Atopic Dermatitis Home Treatment

By Heather Brannon, MD, About.com
Atopic dermatitis is a persistent, itchy skin condition that comes and goes. Even though there is no cure for atopic dermatitis, with the right knowledge, it can be managed. This means that you can:
- Reduce itchiness, redness and scaling
- Go longer with normal, non-itchy skin
- Take care of flare-ups before they get worsen
First, Keep in Mind that Avoiding Allergens May Not HelpWe have long recommended various strategies to reduce exposure to certain allergens such as reducing dust mites, waiting to give solid foods to infants until they are older, restricting certain foods in the diet for moms who are pregnant or breastfeeding, breastfeeding as long as possible and avoiding pollen.
While these strategies seem to make sense based on our knowledge of what causes atopic dermatitis, recent medical studies do not clearly show that they actually help.

But Avoiding Known Triggers Is Helpful

Of course, if certain triggers have caused flare-ups in the past, it makes sense to avoid these triggers. Examples of common triggers include:
- Perfumes or scented skin care products
- Exposure to cats or dogs
- Known food allergies -- especially to milk, eggs, peanuts and shellfish
- Heat, perspiration, or low humidity
- Rough clothing, especially wool
- Viral skin infections such as herpes simplex
- Stress and anxiety

How to Minimize Scratching

To break the itch-scratch cycle, you have to stop scratching. For some people this may seem like an almost impossible goal, but here are some things that can help:
- Taking antihistamines like Benadryl or Zyrtec can help control itchiness and prevent scratching during sleep
- Cut your nails short
- Wear mittens at night to keep from scratching
- Use loose gauze wraps to protect the skin
- Slather on the right moisturizers to help with itching

Atopic Dermatitis Skin Care

Good skin care for atopic dermatitis is one of the most important measures you can take to keep flare-ups from starting. And if you do have a flare and need to use medication, if you've taken good care of your skin, it will heal faster.

Eczema Skin Care

How to Take Good Care of Your Skin if You Have Eczema

By Heather Brannon, MD, About.com
It is important for people with eczema and their loved ones to understand how to take care of their skin because using the wrong soap or moisturizer can cause flare-ups that are itchy or painful. On the other hand, using the correct soap or moisturizer can calm down inflamed skin or prevent flare-ups.
Eczema - "Leaky Skin"
In general people who have eczema have "leaky skin," meaning the barrier function of their skin does not work well. Practically this means:
- Anything that goes on the skin soaks in to the deeper layers that activate the immune system.
- The skin loses water and the natural oils that normally moisturize it and keep it supple. These changes cause the skin to be drier than normal skin and more sensitive to anything that comes in contact with the skin.
Water - Good or Bad?
You would think that putting water on the skin would moisturize it more, but the opposite is true. Plain water that comes in contact with the skin evaporates and takes with it many of the skin's natural oils called natural moisturizing factor (NMF). The more often the skin has contact with water, the drier it gets unless those natural oils are replaced. But your skin has to come in contact with water when you bathe and wash your hands. Is it more important to bathe to clean the skin or avoid water to keep the skin moisturized? The following are some guidelines to follow when it comes to water contact:
- Water temperature should be tepid -- hotter water takes more oils away than cooler water.
- The length of contact should be short -- no long, hot showers especially if you have a flare-up.
- Using antibacterial gels for hand-washing does not cause the skin to dry out because the alcohol does not bind to NMF taking them away when it evaporates.
- When drying off, pat the skin dry with a towel until the skin is not dripping -- do not rub the skin vigorously.
- Use a good moisturizer on the skin immediately after any contact with water.
Soaps for Eczema
The effect of soap on the skin is not good for people with eczema. Most soaps, especially bar soaps, dry the skin out. Liquid cleansers are much less damaging to the skin than bar soaps. Using an emollient-rich liquid cleanser that leaves a moisturizer on the skin when the soap is washed off is the best choice for people with eczema. For specific product recommendations, see the best soaps for eczema.
Moisturizers for Eczema
Not only is it important to use a moisturizer often (up to three times a day), it is important to use one that does not contain perfumes, fragrances or essential oils, because these are all potentially very irritating to eczematous skin.
Moisturizer Recommendations
I don't have one moisturizer I would recommend over the others -- they all have pros and cons. The following are different types of moisturizers to consider:
The moisturizers for scaly eczema would be a good choice if you have a lot of flaking without a flare because they can sting if applied to open areas on the skin.
The emollient moisturizers are a low-cost option, especially if you are in the middle of a flare-up, because they are not irritating.
The new ceramide moisturizers help the skin heal faster during a flare, but the only low-cost option does not have published data proving it is effective. If you can afford them, these moisturizers would be a great choice with or without a flare.

Atopic Dermatitis Treatment Overview

By Heather Brannon, MD, About.com
We are learning more and more about the best ways to treat atopic dermatitis - the most common form of eczema. Atopic dermatitis is never cured, but it can be managed. Taking care of your atopic dermatitis means learning about condition, practicing good skin care, and having appropriate medicine for flare-ups.
While a visit to the dermatology is often needed, after that, atopic dermatitis is one of those diseases that requires people to manage their (or their child's) condition on their own -- because changes can occur from day to day. Someone who knows how to manage their atopic dermatitis can do a lot to keep it under control.
Skin Care
More Important Than You ThinkThere is an astounding amount of research under way to help doctors understand the stratum corneum, the top layer of skin. Even more astounding is how complex this tiny layer -- about 10 cells thick -- is. Recent research has shown that using the right liquid cleansers and moisturizers in a consistent skin care routine can not only keep the skin from drying out as much, but also replace the skin's natural oils that are low in atopic dermatitis.

Things You Can Do at Home
Atopic dermatitis is known as "the itch that rashes." Managing itching is an important part of managing atopic dermatitis.

Medications for Atopic Dermatitis
Most people need medications at some point to manage their atopic dermatitis. Some people have to use medication every day because their atopic dermatitis is severe, while others only have to use medication for flare-ups. Often people have a range of medication they can use stronger ones for severe symptoms and milder ones for milder symptoms. It is important to know how and when to use the medications you are prescribed. If you ever have any question about your medication, you should always ask your doctor.

Aromatherapy For The Respiratory System

By Kathi Keville, Mindy Green
Afflictions of the respiratory system include irritation and infection of the ears, nose and throat. Respiratory problems also may involve congestion, which can be decreased by inhaling rosemary (especially the verbenone type), hyssop (use var. decumbens only), tea tree, eucalyptus, lavender or peppermint. Cypress helps dry up a persistent runny nose, and peppermint, tea tree and eucalyptus reduce sinus infection. Anise and cypress help reduce coughing.
Many asthma sufferers wage a constant battle with low-level congestion. Don't use essential oils during an asthma attack, but between attacks try a chest rub of German chamomile, frankincense or lavender. The chamazulene in chamomile releases cortisone from the adrenals. During an asthma attack, give a bath or treat the feet with these oils. (Hyssop can also be used, but be careful to only use var. decumbens.)Ninety percent of respiratory ailments are caused by viruses. Oils of thyme, rosemary, peppermint, ravensare, tea tree, eucalyptus, bergamot, black pepper, melissa and hyssop inhibit most flu viruses. Lemon and eucalyptus oils are effective against bacteria that cause staph, strep and pneumonia infections. A 2-percent dilution makes an effective antiseptic gargle or vapor steam.
Steam treatment carries essential oils directly to sinuses and lungs, and provides warm, moist air to help open nasal and bronchial passages. To do a steam, boil a pan of water, turn off the heat, cool 1 minute, add 3-6 drops of essential oils to the water, and use a towel to corral the steam around your head as you breathe deeply. Essential oils can also be used in many humidifiers, or as an ingredient in steamy hot bath water.If steaming is impractical-at the office, say, or while traveling-inhale a tissue scented with the oils, or use a natural-products nasal inhaler. These are sold in natural food stores, or you can make your own:

Homemade Nasal Inhaler
- 2 drops eucalyptus
- 2 drops rosemary
- 1 drop peppermint
- 1 tablespoon rock salt
Place a few pieces of rock salt in a vial and add the oils. The salt will quickly absorb the oil. Inhale.
An aromatic diffuser-a glass piece (often hand-blown) connected to a small electrical compressor- disinfects the atmosphere by releasing droplets of essential oil as a cool, fine mist. One advantage to using a diffuser is that the essential oil vapor can be directed into the nose, throat or even ear passages. It can be turned on in a sickroom for 10 to 15 minutes every hour to clear airborne bacteria.
Do not use thick oils such as vetiver, sandalwood, vanilla, myrrh and benzoin in a diffuser unless they are diluted with a thin oil-such as the citruses, eucalyptus or rosemary-or mixed with alcohol. If oils sit too long in a diffuser, they oxidize and thicken. Also, expressed citrus oils often contain sediment that may clog a diffuser.
To clean or unclog it, soak the glass unit in alcohol and unplug the opening with a pin or toothpick. Rinse and air dry.Diluted essential oils can also be used as a throat spray through "nebulization." A nebulizer sprayer, with its long spout that reaches to the back of the throat, used to be a standard item in the home medicine cabinet. A perfume atomizer or spray bottle will work just as well.If you don't have a diffuser, simply combine water and essential oils in a spray bottle. Studies show that a two-percent dilution of eucalyptus oil kills 70 percent of airborne staph bacteria.

Disinfectant Room Spray
- 3 drops eucalyptus
- 1 drop peppermint
- 2 drops pine
- 1 drop tea tree
- 2 drops bergamot
- 1 ounce of waterCombine ingredients.
Shake well before using. The combination is also suitable as a chest rub. (Replace the water in this recipe with a carrier oil.)Generations of Europeans, especially singers, have gargled sage, thyme or marjoram tea sweetened with honey to relieve laryngitis and tonsillitis. A few drops of essential oils diluted in two ounces of water may also do the trick. In case of sore throat, gargle frequently, at least every half-hour.

Throat Spray/Gargle
- 1/2 cup thyme or sage herb tea
- 3 drops each cypress, lemon, tea treeShake well to disperse the oils before each use. For a gargle, half a teaspoon of salt may be dissolved into the solution.

For lung congestion a salve or a massage oil containing essential oils can be rubbed over the chest, back and throat. The oils will be absorbed through the skin and lungs as the vapor is inhaled. Place a flannel fabric on the chest after rubbing in the oil to increase warmth. Commercial "vapor balms" still use derivatives of essential oils (or their synthetic-oil counterparts), such as thymol from thyme and menthol from mint, in a petroleum ointment base. Natural alternatives are also sold in natural-food stores.

Vapor Balm
- 2 teaspoons peppermint oil
- 3 teaspoons eucalyptus oil1 teaspoon thyme oil (chemotype linalol is best)
- 1 cup olive oil
- 3/4 ounce beeswax

Melt beeswax into olive oil over very low heat. Cool a bit, add essential oils and stir. (Be sure to keep your face away from the oils as you stir them in.) Allow to harden. Store at room temperature.
Poultices are an age-old remedy for chest congestion. A ginger or onion compress on the chest breaks up lung congestion and makes breathing easier. Onions also help curb asthma and allergic reactions.

Poultice
- 1 onion, chopped and 1/4 cup ginger, gratedwater
Lightly cook together in a little water until soft. Cool slightly, mash and apply to the chest while still warm. Cover with a soft cloth.Herbal Adjuncts-Herbs that loosen mucus from the lungs include elecampane, horehound and mullein.

Respiratory relaxants, such as wild cherry bark and wild lettuce, are used in cases of extreme spasmodic coughing. Demulcent herbs, which soothe inflamed mucous membranes, include flaxseed, marshmallow root and licorice. Use these herbs in a tea, tincture, pills or syrup.

Allergies Are on the Increase

By Jane Thurnell
A third of the population believe that they suffer from allergies, and even though some of these people may be mistaken, everyone agrees that eczema, asthma, hay fever, irritable bowel syndrome, etc. are now more and more common. So, what has happened?It is often unclear why a person has a tendency to be allergic or intolerant to a range of substances. Medical practitioners talk about atopic individuals - atopic means out of place. To the unknowing this sounds like a medical diagnosis, but in fact all it means is: You have a tendency to have allergies; you may have several different symptoms caused by your allergic reactions; this often runs in families; we don't know why. Describing someone as an atopic individual is not saying anything the person does not already know about themself!
Genetic Predisposition
Allergy problems undoubtedly do run in families, so there may be a genetic component, although the exact mechanism is not clearly understood. Some small genetic mutation can cause the immune system to be triggered more easily, so that family members sharing this mutation will all have a tendency to allergic reactions, although not necessarily to the same substances, but this does not explain the rise in the incidence of allergies in recent years.
Severe Virus Infections
A severe virus infection can lead to damage to the immune system, so that the individual is more likely to develop allergies in the future. Again, although this may explain why someone has allergies, the incidence of virus infections is not on the increase.So we have to look elsewhere to explain the rise, and there are several completely different possibilities.
Parasites
One allergy theory now being proposed is that the lack of the proper enemies (liver fluke, tapeworms, etc.) has led to an idle immune system finding inappropriate work in allergic reactions. There are many antibodies produced in the body to protect it against invasion by harmful organisms. IgE antibodies deal effectively and quickly with the extreme danger of infection by large parasites, such as tapeworms. Parasites' effect on health can be devastating, so over the years individuals with efficient IgE mechanisms have lived to reproduce and pass on their genes at a greater rate than people with a less efficient IgE mechanism.The IgE antibodies are also involved in allergic and hypersensitivity reactions, so people with these inherited efficient IgE mechanisms are more likely to suffer allergy problems than people who have inherited a less efficient system. This super-charged immune system was a plus for an asthma sufferer's distant ancestors inhabiting a world with many life-threatening parasites, but now leads to a trigger-happy immune system firing off inappropriately.Other practitioners (notably Hulda Clark in Cure For All Diseases) take the opposite view, and see many allergy symptoms as being a reaction to an infestation of parasites.
Excessive Cleanliness
The obsession with the danger of 'germs' is thought to have led to an increase in allergies. Much of this obsession with cleanliness seems to be driven by the media and advertising. Headlines about 'killer bugs', and advertisements that claim a product kills even more germs have led many people to buy more and more products to wipe out these dangerous enemies.A view now gaining ground among many researchers and some doctors is that a certain level of dirt is good for us, particularly during infancy and early childhood when the immune system is maturing.T-helper cells in the immune system recognize foreign antigens and then secrete substances to activate other cells to fight the invader. In pregnancy the T-helper cells that attack invaders directly without producing antibodies (Th1 cells) are less active, as these could lead the mother's system to reject the fetus.This means that the T-helper cells that are responsible for antibody reactions (Th2 cells) are more prominent. These are the ones that are involved in allergic reactions. The new baby's immune system has the same emphasis as the mother's had during pregnancy. It is believed that the exposure of the very young to some level of dirt is beneficial in that it helps to rebalance the immune system to emphasize the T-helper cells that are not involved in the allergy process.In an excellent article ('New Scientist' July 18th 1998) Garry Hamilton talks about 'the gentler side of germs'. If the young are not exposed to 'dirt', the immune system does not go through this rebalancing process, and a tendency to allergy can result. Linda Gamblin in 'The Allergy Bible' cites several medical research projects, which support the idea of allowing children to be exposed to dirt and minor infections to help protect against allergies.
Vaccination
Our children are now being vaccinated against a bigger and bigger range of diseases. While some of these are serious, many are mild illnesses that were once considered part of a normal childhood. Many alternative practitioners consider that these childhood illnesses help to prime the immune system so that it is better able to cope with a whole range of illnesses later in life.This view is not accepted by most of the medical profession, and indeed it would be difficult to prove. However, there is some evidence that vaccination alters the ratio of T-helper cells and T-suppresser cells. This would be likely to have an effect on the vaccinated child's susceptibility to allergy reactions. It is also known that most vaccines stimulate the branch of the immune system that is concerned with the more extreme immune reactions to invaders such as parasites (New Scientist July 18th 1998).
Ubiquitous Presence Of Some Foods
Before the advent of freezers and airfreight most people ate local foods in season. Now most fruit and vegetables are available all year round, so that our systems are exposed to the same foods continually without respite.There has been a dramatic increase in people experiencing soya allergy, since soya has become a common ingredient in many processed foods. In Europe and North America rice allergy is relatively uncommon, whereas in Asia where it is consumed more frequently it is much more common.
Technological Developments
Developments that make modern life more comfortable have also led to an increase in allergies. With the advent of air conditioning, central heating and wall-to-wall carpeting, house dust mites and moulds such as alternaria have an ideal environment in which to thrive. Modern offices with sealed windows mean that everyone is exposed to the perfumes worn by other people. The increasing use of plastics, formaldehyde, benzene etc. have led to all of us being exposed to an amazing variety of chemicals.
Contamination By Environmental Pollutants
The chemicals in diesel fumes are known to damage the outer membranes of pollens. This means that when the pollen is breathed in, the pollen proteins are immediately in much closer contact with the delicate membranes in the mouth, nose and lungs than they would be if the pollen had not been damaged in this way.It has now also been suggested that the immune system is reacting to some harmless substances because they have been contaminated by environmental pollution: the immune system does not recognize the food, for example, if it has molecules from tire rubber attached to it. These molecules sometimes appear similar to enzymes produced by parasites and so the immune system attacks the 'parasite'.Although more and more evidence is accumulating for a role for environmental pollutants, this does not explain why New Zealand, which is relatively unpolluted, has one of the highest incidences of asthma in the world.
Electro-Magnetic Pollution
An increase in electro-magnetic pollution has run parallel with the increase in allergies. The scientific jury is still out on the danger of mobile phones, power lines, etc., but many people are becoming more concerned about our constant exposure. People who are sensitive to computers, etc. often also show many symptoms typical of allergic individuals. In some cases correcting this sensitivity to electro-magnetic sources, results in all or most of the adverse reactions disappearing. (I recommend health kinesiology for this.)
Stress
The pace of life is quickening all the time: modern technology gives us more possibilities and many of us want to experience as many of these as we can. A survey found that half of the 950 young people in their 20's interviewed said that they would feel a failure if they did not own a home by 26, were not married by 27 and not both rich and parents by 29. Many of the interviewees said they were prepared to sacrifice a healthy diet and way of life to achieve this. These expectations and pressures are not conducive to long-term health and can also lead to stress and allergies. Pre-packaged, processed foods eaten in front of the television, too much alcohol, too little fresh air and exercise all take their toll.Sometimes particular traumatic events can explain a particular allergy. One of my clients was allergic to wool and tea. She told me that when she was a small child she had pulled a cup of hot tea on to herself. At the time she was wearing a wool sweater, and the tea soaked into the sweater and burnt her very badly.DietIt is now well known that bottle-fed babies are more likely to be prone to allergy problems than breast-fed ones. Sudden or early weaning can contribute to the problem too.Sadly the modern diet may be abundant in calories, but there is more and more evidence that it is low in some important nutrients. People are eating more pre-processed foods, which may be nutritionally compromised.Soil is becoming depleted of some minerals, because they have long been taken up by plants grown in the soil. If the mineral is not in the soil, it cannot be in the plant, and so it is not available in the foods we eat either.It is unlikely that there is one simple answer as to why people are allergic, intolerant or sensitive in general or to particular substances. Research is still being carried out in this fascinating area. Fortunately with the tools that are available it is not necessary to know why someone has allergy problems in order to be able to detect and correct them.
Jane Thurnell-Read is a writer and researcher on health, stress, alternative medicine, and happiness. Visit her web site http://www.healthandgoodness.com for tips and information on how to live a happier, healthier life no matter how busy you are.