What is the treatment?

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It is important to realize from the outset that Atopic Dermatitis is a chronic condition, and that treatment at present is aimed at controlling the symptoms.

 

 

1. TOPICAL CORTICOSTEROIDS in the form of creams and ointments form the mainstay of treatment for the acute attack. Strong steroids eg. Diprosone, Betnovate, Advantan Fatty ointment are used for a short period of time on body areas to bring the eczema under control. Once relief is obtained, a milder steroid is then substituted eg. Elocon, Advantan, Cutivate, Procutan. The rash should be kept under control using the mildest possible steroid cream. On the face, nothing stronger than 1% hydrocortisone cream (Procutan, Dilucort) is usually necessary. Bear in mind the dangers of using strong cortisones for too long ie.  thinning of the skin, enlargement of blood vessels in the skin and development of acne.

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2.  TOPICAL CALCINEURIN INHIBITORS

This class includes Tacrolimus (Protopic 0.03% and 0.1%) and Pimecrolimus (Elidel). They are used when the eczema is mild. They do not steroid side effects such as thinning of the skin, hair growth and acne. 

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3.  TOPICAL CRISABOROLE (STAQUIS)

Just launched in South Africa, this novel medication  is a phosphodiesterase 4 inhibitor, and works to reduce signals in the skin that result in eczema. It is applied twice a day and is used for mild to moderate Eczema

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4. EMOLLIENTS must be applied regularly to keep the skin moist. Examples are Vitasure Classic Cream and Vitasure ultra moisturiser.

 

5. BATH EMOLLIENTS are also beneficial eg. Vitasure repair cream.

 

6. SOAPS should be restricted and emulsifying oint eg. Vitasure Repair substituted as a cleansing agent. A tablespoon dissolved in a jug of hot water and poured into the bath works well.

 

7. ORAL ANTIHISTAMINES are useful to suppress itching. The older sedating antihistamines eg Aterax, Phenergan, and Polarmine are of greater benefit as they allow the patient to have a good sleep in addition to the relief from itching. However, in a school going child, the newer non-sedating antihistamines often have to be used so that lack of concentration does not become a problem eg. Clarityne, Zyrtec, Telfast, Kestine and Deselex.

 

8. ANTIBIOTICS taken either orally or applied topically may be necessary to control secondary infection.

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For extremely severe Atopic Eczema, the following forms of systemic therapies are available:

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1.  Narrow band UVB (Ultra violet B light)

2.  Dapsone

3.  Azothiaprine

4.  Methotrexate

5.  Cyclosporin

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All these drugs have side effects which necessitate their close monitoring by your dermatologist.

 

Localised areas of eczema may be treated with the Excimer laser which provides relief in a much shorted time compared to narrow band UVB.

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While the above measures are useful in controlling acute flare-ups of the disease, one cannot underplay the importance of preventive measures in the long term control of the eczema.