Eczema is a skin condition that causes inflammation and itching of the skin. Lesions can appear as dry, reddened skin that may ooze fluid or thicken from repeated scratching. The causes of eczema are multifactorial; people’s eruptions can be triggered by contact with an irritating substance, by ingesting a food allergen, or by repeated aggravation such as repetitive hand washing.
Eczema can be transient, appearing only one time or it can be chronic, plaguing an individual for a lifetime. Fortunately, there are treatments to help combat eczema and relieve symptoms. This article will detail an overview of conventional medical treatments as well as their limitations and side effects. To learn more about alternative therapies without harsh side effects, please read the many articles detailing natural therapies for eczema on this site.
Eczema Drugs: Topical Corticosteroids
The first line approach by most general practitioners and dermatologists is to prescribe topical corticosteroids. These are steroids that are applied in a cream or gel base to the areas of eczema on the skin. They decrease inflammation by suppressing immune cell activity in the area and by changing the permeability (how easily fluid passes through the area) of the tissue. Since eczema is largely an immune hypersensitivity, steroid use is aimed at halting immune reactivity.
Side effects of topical steroid use include impaired wound healing, skin thinning, and secondary infection. This means that any area of skin with repeated steroid application is more likely to become infected with a bacterium such as Staph aureus. It also can delay normal skin healing after surgery or trauma.
Some people have an allergic response to the steroids themselves resulting in itching, white bumps called milia, and a rash that resembles acne. Unfortunately, eczema can also become tolerant to steroids after prolonged use and reappear despite the continued application of the cream. Some eczema sufferers will experience relief from topical steroids only to have eczema reappear as soon as the steroids are discontinued. Common topical steroids: hydrocortisone, betamethasone, fluticasone, clobetasol, and mometasone.
Eczema Drugs: Topical Calcineurin Inhibitors
Calcineurin inhibitors are a newer method of controlling eczema topically. They work by halting the activity of the immune system’s T cells, specifically by inhibiting proteins that signal T cells to activate.
They also stifle the function of mast cells, which produce histamine, a compound that changes the permeability of the skin. Histamine release leads to the characteristic reddening and swelling of eczema eruptions. Both mast cells and histamine are crucial components of the allergic response.
The most common side effects of calcineurin inhibitors are skin reaction, flu-like symptoms, rash, and infection. Prolonged use increases the risk of certain cancers such as skin cancer at the site of application and lymphoma. Burning, stinging, tingling, and soreness are the most often-reported skin symptoms.
Calcineurins have also been associated with muscle pain, alcohol intolerance, and headache. Pimecrolimus and tacrolimus are the two types of topical calcineurin inhibitors. Studies comparing the two have found tacrolimus to be significantly more effective with similar side effects. Pimecrolimus does not leave a shiny sheen so is often used on the face for daytime applications.
Eczema Drugs: Antibiotics, Antifungals & Antivirals
As discussed earlier, skin afflicted with eczema, especially skin treated with topical medications that suppress immune function, is more prone to infection. Bacteria, fungi, and viruses can cause opportunistic infection in eczematous skin; opportunistic in that they take advantage of a weakened host to replicate and invade.
Staph aureus is the most common bacterial infection of eczema skin. Interestingly, staph aureus is also a trigger of eczema so it contributes to a vicious cycle of weakening the skin by erosion of the defense systems and then taking over and setting up shop. Both topical and oral antibiotics are used to treat secondary bacterial infections of eczema lesions. Erythromycin is the most commonly used topical antibiotic.
There are quite a few oral antibiotics used for eczema infections, the most common are macrolides, cephalosporins, amoxicillin-clavulanate, and clindamycin. The most common side effects of antibiotics are hypersensitivity reaction (allergic response) and tolerance (bacteria no longer killed or inhibited by the drug).
Herpes is the virus that most commonly infects eczema skin. It appears as clusters of small, reddened, fluid-filled bumps that resemble blisters or ulcers. Acyclovir is the most common anti-viral medication that is most often administered IV because of the potential severity of secondary herpes infection. It can also be given orally, often preventatively to those with a history of eczema herpeticum (herpes eczema rash).
Fungi cause the rarest infections of eczema lesions. Ketoconazole is the drug most often prescribed and is administered either topically or orally. Side effects of topical application are burning and skin reactions. Liver damage (hepatotoxicity) and lowered testosterone (a hormone) are rare but possible side effects of oral ketoconazole.
Eczema Drugs: Anti-histamines
Itching is the most complained about symptom of eczema. Quality of life can be compromised when people are kept awake at night scratching; therefore doctors often prescribe a class of drugs called antihistamines to decrease the urge to scratch.
Histamine is the compound, discussed earlier in the discussion of calcineurin inhibitors, which causes changes in the permeability of blood vessels. The vessels become more leaky, leading to fluid build-up and swelling. This edema stimulates nerves that message your brain, signaling a response to scratch.
There are two categories of anti-histamines: those that are sedating and those that are low sedating.
The most prescribed sedating histamine is diphenhydramine (Benadryl) and it is given orally.
- Diphenhydramine may alleviate itching but it causes fatigue and sleepiness in most users. It can also cause digestive upset and urinary retention.
- Cetirizine (Zyrtec) is the low-sedating anti-histamine most widely used by eczema sufferers. It can still cause some fatigue as well as nausea, sore throat, headache, and dizziness.
Eczema Lotions And Creams: Emollients
Topical lotions and creams are standardly recommended to patients with eczema that is dry or scaling. They also provide a layer of protection between the already irritate skin and potential allergens.
Unfortunately, conventional medical doctors recommend creams and lotions laden with preservatives and additives that can further aggravate the immune system.Read our article on natural, topical treatments to find a suitable cream, lotion, or salve.
The Bottom Line: Conventional Treatments Don’t Offer Permanent Resolution
The limitations and side effects of these conventional treatments should encourage you to pursue natural treatment options that offer real solutions to treat the underlying cause.
These alternative therapies rarely have significant side effects and their use is long-lasting as opposed to the temporary “band-aid” approach taken with the conventional pharmaceutical approach.