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The Consideration of Alternative Eczema Treatments

Updated on May 15, 2019

Introduction

One of the most common skin disorders in the world is atopic dermatitis, otherwise known as eczema. It affects more than 10% of the American population, and of that total, more than 33% have moderate to severe eczema that negatively affect their quality of life. Eczema is thought to be caused by an abnormality in the immune system and skin barrier. While there are many different types of eczema, the most common theme is itchy, discolored rashes that can appear chronically due to various reasons such as allergens or even simply genetics. However, although eczema is such a common disorder, there is no actual cure; instead, various methods are used to treat the symptoms. Topical steroids, emollients, and changes in lifestyle like dietary intervention can be used in an attempt to combat the symptoms of eczema. The most common treatment doctors prescribe are topical steroid creams due to their potency and speed in clearing up the rashes. However, steroids are also one of the most high-risk treatments due to the severity of their side effects. Prolonged usage of steroids can damage the adrenal gland, cause blindness, and even overall deterioration of the skin over time. Because of all of this, it is clear that while topical steroids are often the most widely used and effective drug to combat eczema, the severe long-term side effects makes the further exploration of other treatment methods worth considering.


Corticosteroids and Their Side Effects

Corticosteroids, known more contemporarily as steroids, are drugs used to treat a variety of disorders such as eczema, asthma, and autoimmune disorders. They work by acting as synthetic corticosteroid hormones and suppressing the immune system, decreasing inflammation. The first recorded usage of corticosteroids was in 1948, and it successfully treated a patient with severe arthritis. Reichstein, Kendall, and Hench were later awarded a Nobel Prize in 1950 for their contribution in isolating cortisone. Corticosteroids are separated and ranked from one to seven based on potency. Depending on the potency, the risk factor and side effects also vary.

The reason steroids are so popular in treating skin conditions is because of how effective and fast it gets rid of the symptoms of eczema. It works best if applied twice a day, and with fingertip units, which help the patient control and measure how much of the steroid cream they are using so that they don’t overuse it in relation to their body mass. Depending on the severity of eczema and how strong the steroid is, the symptoms of eczema should disappear about a week after use. The main purpose of steroids is to control flares; it is not meant for long-term use. Generally, one should not use steroids for more than two weeks. The choice of topical steroids depends on the area it will be used on, the age of the patient, and how severe the eczema is. If directed and used properly, many of the side-effects can be avoided.

However, problems appear when doctors do not tell the patient of the strength of the steroid they’re prescribing or how long they should use it, which happens more often than one would think. Many doctors advise the patient to stop after the symptoms of eczema disappear instead of warning them of the worser side effects. This can cause issues because sometimes the rashes don’t disappear, or if they do, they come back soon after the steroid is discontinued. This is especially apparent if a trigger of eczema is unknown or not something easily avoided, like dust. This can prompt the patient to use steroids more for longer periods of time. Soon, it becomes a vicious cycle of continuing and discontinuing the steroid. All the while, the body is developing a tolerance to the drug, forcing the doctor to prescribe stronger steroids. All of this can make the side effects of steroids worse.

The most common and well-known side effect of steroids is the thinning of the skin, or skin atrophy. Usually, it is temporary, because when the patient discontinues usage of the steroids, the skin gradually recovers on its own. However, with prolonged use, it can become permanent, and even actively damage the skin and worsen the eczema. Frequent application of the steroids around the eyes can also cause glaucoma and cataracts, which can result in permanent blindness. When enough steroids are applied over a large area of the body, this can inhibit the body’s natural production of the corticosteroid hormone, resulting in adrenal suppression. In some cases of infants and children, steroids can even impair growth. This all confirms that while it is true that steroids are very effective for some people, other people may experience severe side effects that force them to consider other treatment options. Since everyone has different skin and eczema triggers, they may react differently to various treatments. Although steroids are the most widely used and effective treatment for eczema, there are several other treatment options such as emollients, antimicrobial agents, dietary intervention, and complementary therapy.


Alternative Treatments: Emollients, Antimicrobial agents, Dietary Interventions, and Complementary Therapies

Emollients, similar to steroids, are topical agents that are applied to a certain part of the body. However, unlike steroids, emollients contain no harmful side-effects. In layman's terms, emollients are moisturizers. They help combat eczema because eczema is partly caused by abnormalities in the skin barrier, such as defects in the skin lipids and impaired barrier function. The defects in the skin lipids can cause cracking in the skin, and impaired barrier function can increase the chance of bacteria and infection setting in and decrease water retention. Because of this, emollients can serve both as a synthetic barrier and as a hydrating function. Emollients can also soothe the itchiness that often comes with eczema, preventing scratching and further damage to the skin barrier. Unfortunately, if one has severe eczema triggered by allergens, this type of treatment would not be very effective, because it only soothes the skin and doesn’t target the inflammation caused by the dysfunction of the immune system. However, emollients are often used in conjunction with other treatments such as steroids and dietary intervention. Currently, some of the more popular emollients recommended by doctors to treat eczema are Vaseline and Vanicream, which hold the stamp of the National Eczema Association.

Much like emollients, antimicrobial and antiseptic agents also work off of the concept of the broken skin barrier. It was found that those with eczema have up to 90% of their total aerobic bacterial flora made up of Staphylococcus aureus compared to the 30% of individuals with normal skin. Such bacteria can cause infections that can severely intensify eczema flares. Wet, oozing eczema, in particular, is prone to infection, especially if it is in an area that is exposed often to air or dirt. Due to this, if the eczema is severe enough, antimicrobial and antiseptic agents can help kill the bacteria and clear up the eczema. However, it is difficult for doctors to tell if it is bacteria that is playing a role in worsening the eczema because skin swabs are unreliable due to the fact that everyone has bacteria in their skin. Similar to steroids, antimicrobial agents should be limited to short term use because it can lead to tolerance and increased sensitivity. This treatment method is best used if the patient’s eczema is prone to wet, open sores that easily get infected.

The purpose of dietary interventions is to avoid foods that can potentially trigger eczema and to reinforce the diet with foods that can stimulate healthier skin. Eczema is very much closely linked to food allergies and food sensitivities. Because of this, it is crucial to test for allergies and be aware of what can be exacerbating the eczema. However, some sensitivities don’t show up in allergy tests. If the skin is already inflamed, foods that normally wouldn’t cause irritation can cause the eczema to get worse. This is because the body’s sensitivity is very high, and it’s threshold to flare is very low. Gluten, eggs, and dairy products are the most common types of food that many people with eczema can be unknowingly sensitive to. This is why elimination diets can be very useful; it can remove them from the diet one at a time to identify which one is making the eczema worse. Unfortunately, it will not be very effective if it isn’t a food allergy or sensitivity that is contributing to the eczema flares. People with known allergies are more inclined to have unknown food sensitivities, but some people may not have a food sensitivity that is causing their eczema. Dietary interventions can also be difficult to perform, especially if the food that is trying to be excluded is well-loved. However, it is important to know that a healthy diet is crucial for good health and can be transformative to some people.

Complementary therapies are things that are often used alongside conventional medical treatment and are often used to improve the quality of life or provide a more natural solution. Traditional Chinese medicine, aromatherapy, and massage therapy are all examples of complementary therapy. Traditional Chinese medicine includes acupuncture and various applications of herbs and is rooted in ancient Taoism. Acupuncture is the application of needles into pressure points, where it can then be manipulated by hand, or more recently, by electrical stimulation in order to promote the natural self-healing process. Many Chinese herbs have been found to be able to reduce inflammation and boost the immune system. This is shown in the Zemphyte trials, where it was found that the active treatment of Zemphyte was effective in treating eczema. This shows that Chinese medicine can be relatively successful in treating eczema. However, not much research has been done, and the validity of many Chinese herbs can be questioned. It can also be relatively hard to find a reputable practitioner of Chinese medicine. Aromatherapy is another type of complementary therapy that involves the application of essential oils in hopes of easing stress. It has been found that stress has a direct relation to eczema as well, so it was no wonder that aromatherapy was found to be relatively successful. In a preliminary study where sixteen children were treated with either counseling or massage with essential oils for eight weeks, significant improvement was found. Similarly to aromatherapy, massage therapy is also proven to help eczema by reducing stress and increasing peripheral circulation. It is often combined with either aromatherapy or the use of emollients and steroids.

Complementary therapies can be helpful because eczema is a disorder that not only harms physically, but also mentally and psychologically. This can cause additional stress and make the eczema worse, turning it into a ruthless cycle. Eczema has a direct negative impact on the amount of sleep and even the life decisions one has to make, such as what to wear and what activities one can do. It affects the social functioning and psychological wellbeing of eczema sufferers. Victims of eczema often face social exclusion and discrimination that can later go on to lead to many mental problems. For example, people with eczema are shown to be more pessimistic, and the psychological distress caused by bullying can even cause them to avoid certain sports and jobs. They can also be affected economically because they have a greater financial burden due to the costs of medication, diet, other eczema management strategies, and medical consultations. Eczema can be a major handicap with considerable personal, social, and financial burden, increasing stress and exacerbating the flares all over again. Because of this, complementary therapies can be useful by reducing stress and helping the patients cope better.


Conclusion

Every day, scientists and doctors are researching and working on new eczema treatments. One such recent development includes the creation of bacteria-infused cream that counteracts the harmful bacteria on the patient’s skin. Similar to the concept of antimicrobial agents, the beneficial bacteria makes natural antibiotics that kill the harmful S. aureus, restoring the natural balance of the skin’s bacterial flora. This is a better alternative to antimicrobial agents because it would be harder to build a tolerance, and researchers hope that the microbiome cream can serve as a better long-term treatment than antimicrobial agents or steroids. With all these new developments and safer alternatives, it is easy to see that steroids should not be the catch-all first option that doctors give to their patients. While it may be a better choice for some people, everyone has different skin and circumstances that can make different treatment methods better.

Despite eczema being one of the most common skin disorders that can cause not only physical, but mental, emotional, and financial issues, there is no actual concrete cure. Because of this, many treatment options have been developed; however, the most popular treatment by far is steroids. Although steroids are the most effective and common treatment for eczema, because of their harsh side effects, it may be better for some others to consider alternative treatment options such as emollients, antimicrobial agents, dietary intervention, and complementary therapies. While it is true that steroids can be temporarily helpful towards some people, it may not be suited for others. Due to this reason, doctors and patients alike should be more aware of different treatment options and carefully consider them to see what works best in the future.


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