What Topical Treatments Help Atopic Dermatitis
Topical treatments can come in many forms. It is important that the correct formulation is used for the different patterns and distributions of atopic dermatitis.
- Lotion: smooth liquid. These are not greasy and cosmetically leave little or no residue. When applied to broken skin they can be very painful.
- Gel: semi-liquid and often clear.
- Foam: Bubbles within a liquid.
- Cream: Water-in-oil mix. Smooth and easy to spread especially on moist skin.
- Ointment: Oil-in-water. Greasy and more difficult to spread but better for dry skin than creams.
How Do Topical Steroids Work
Topical steroids are available in several different forms. These
- lotions and creams
A doctor will prescribe the appropriate strength topical steroid for a persons needs. They also advise them how much to apply, how often to apply it, and for how long.
Some steroids are stronger than others, and there are seven different classes that define steroid potency . These classes range from superpotent to least potent.
High-potency steroids work on areas with thick skin, such as the palms or soles. Low-potency steroids are best for treating larger surface areas of skin.
A doctor can recommend the best steroid form and potency for a persons eczema.
Ners On Opposite Sides Of The Argument
Using a prescripton steroid creams is a devisive topic.
If you and your partner are not on the same page try talking it out with your doctor. Try to get an understanding of how steroids work. Let your doctor explain why they have prescribed the medicine and then you can try to reach a compromise about use.
Take a realistic look at how severe the eczema is and how long it can take to get through the current flare-up.
Try to understand it can be difficult to compromise when you are passionate about what is best for your child. Remember that your partner feels just as passionately about your child as you do.
Try to treat this as a problem you both have to tackle with no wrong or right answer.
Create a plan for what to do with steroids and what to do without steroids. Begin one plan and if its not working change the plan.
When you are figuring out what works for your child the plan will change many times. Be honest about what you can handle and about what your child can handle.
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Treatment For Infective Complications Of Atopic Dermatitis
- Oral antibiotics are important for secondary bacterial infection of atopic dermatitis. Skin swabs should be taken to determine the responsible bacteria and their antibiotic sensitivity. Bacterial resistance to multiple antibiotics is an increasing problem. Topical antibiotics should not be used as this increases bacterial resistance. Consider using a topical antiseptic instead.
- Atopic dermatitis can also be complicated by viral infections such as herpes viruses , molluscum contagiosum, and Coxsackievirus , which may require specific treatments.
Benefits And Limitations Of Topical Steroid Treatments
People can use topical steroids to treat flare-ups once they occur. They may also use them intermittently to future flare-ups.
However, people should not use topical steroids long term. Using a topical steroid for too long can skin thinning, stretch marks, and rosacea.
Research has shown that topical steroids have
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Stay Away From Skin Irritants
Sometimes the problem is that you need to identify and remove an irritant in order for the inflammatory rash to go away. Here are some examples:
- Medicated skin creams or oral retinoid medication
- Metals like nickel that are commonly found in jewelry
- Soaps, detergents, and fabric softeners
- Foods that have a lot of acid, such as tomatoes, pineapples, or citrus fruits
Oral And Injected Medications
If symptoms of eczema and dermatitis are not relieved by topical medications, doctors may recommend stronger medications that are taken by mouth or injected into the skin.
In many instances, oral medications are prescribed for a short period to help get symptoms under control, and treatment then, ideally, shifts to management using topical medications and at-home therapies. But for severe eczema or dermatitis that is unresponsive to other treatment and causes persistent symptoms that interfere with your everyday life, some medications may be prescribed for months or years.
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Why Your Doctor Will Prescribe Steroids
During a doctor visit your pediatrician will see the eczema and ask you questions about it. They will want to know how your baby is sleeping and if they are scratching.
Even if the doctor doesnt ask, now is the time to speak up. Do not be afraid. Let the doctor know if your baby has been having hard nights. Every bit of information you give will help.
The doctor will prescribe a steroid for eczema if the doctor notices the eczema is severe. They will be prescribed because steroids reduce inflammation.
The severity of the eczema can be determined by inflammation, or the look of the skin and the behavior that goes along with it.
For example, severe eczema could be skin that is dry, red, itchy or darkened and accompanied by behavior like lack of sleep and constant scratching. Other factors could be timing, if the eczema has been there since your last visit.
Does Diet Play A Role
But what if steroids arent an option? What about other remedies or lifestyle changes, such as avoiding certain foods? Dr. Davis explains:
We know that the incidence of food allergies in people with eczema is higher than in the general population, but food allergies are not directly related, she says. Both are a type of atopic disease, so some people with food allergies will also coincidentally have atopic dermatitis, just like some people with atopic dermatitis will also coincidentally have asthma or hay fever.
That being said, if people do eat a food theyre truly allergic to such as peanuts the entire immune system will react, which causes inflammation, which causes an eczema flare. In that case, the food in question should be avoided. But that isnt to say all children with eczema should avoid dairy or soy or nightshades. Overly regimented diets in children can have an adverse affect and have been known to cause nutritionally based dermatitis.
Thats not that uncommon, Dr. Davis says. We work very carefully on nutrition and have admitted some people to the hospital to feed them to be sure that they wont have anaphylaxis and to keep them safe.
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What General Measures Help Atopic Dermatitis
- Education: Understanding the disorder and being fully informed by health care providers is important, Effective education facilitates effective treatment.
- Skin irritants: Where possible avoid triggers that can directly inflame the skin. These may include fabrics, chemicals, humidity, and dryness.
- Food: The relationship between atopic dermatitis and food is complex. Food allergies may exacerbate atopic dermatitis, but avoidance diets do not cure the problem. Avoidance may exacerbate atopic dermatitis. Food allergy testing is needed if there is concern of an immediate life-threatening reaction .
- Psychological support: The psychological effects of atopic dermatitis are considerable, for both the sufferer and the carer. Counselling and cognitive behavioural therapy can be beneficial.
Obstacles To Following Your Treatment Plan
Eczema treatments can effectively get this skin disease under control — if you follow them as your doctor prescribes. But that can be challenging.
Did you take your medications as you were supposed to? Have you been able to avoid your triggers? Donât worry if your answer is âno.â Just be honest about what you found challenging at your next appointment. These are just some of the reasons people may not be able to follow their doctorâs recommendations:
- Frustration with how well or fast the medication works
- Confusion about how to use the medications
- Not understanding how the medications work
- Not understanding what might happen if you donât treat the rash
It may feel awkward to tell your doctor you havenât followed up on your treatment plan. But itâs an important conversation to have so that you can work together on ways to overcome the barriers, even if theyâre financial. Also, your doctor will not want to prescribe stronger medications when the current medication hasnât had a fair chance to work.
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What Is An Eczema Flare
An eczema flare-up can affect a persons everyday life. The discomfort can make it hard to sleep and focus, and some people may feel self-conscious due to the appearance of their skin.
Environmental factors often trigger flare-ups. Although eczema triggers vary from person to person, some of the most common ones include:
- irritants, such as perfume or disinfectants
- stressful situations
- changes in the weather
- food allergies
It is not always possible to avoid potential triggers. As people learn more about their eczema, they can try to stay away from their primary triggers.
How Does Prednisolone Work
Oral steroids work by attaching themselves to special receptors in cells, resulting in reduced production of inflammatory mediators and inhibiting movement of white cells to sites of inflammation. In eczema, these effects lead to a marked and rapid reduction in the redness, weeping and irritation associated with the condition.
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Some People Use Too Little
A common mistake is to be too cautious about topical steroids. Some parents undertreat their children’s eczema because of an unfounded fear of topical steroids. They may not apply the steroid as often as prescribed, or at the strength needed to clear the flare-up. This may actually lead to using more steroid in the long term, as the inflamed skin may never completely clear. So, you may end up applying a topical steroid on and off for quite some time. The child may be distressed or uncomfortable for this period if the inflammation does not clear properly. A flare-up is more likely to clear fully if topical steroids are used correctly.
Why Your Doctor Wont Always Prescribe Steroids
The doctor will not prescribe steroids right away if the eczema is not severe.
A light rash in one location or a rash that is showing signs of healing, may not be considered severe. If the rash is new and you are concerned the doctor may ask you to track the rash before giving you any medication.
You wont be prescribed steroids unless the doctor thinks its necessary. If the doctor does decide to give you steroids for a skin rash, they will be a low potency steroid cream.
Even though Elis eczema was severe, when if his rash ever appeared mild the doctor would suggest using a more gentle topical treatment for eczema.
Its so important that you follow doctor instruction when using steroids because misuse is the main reason side effects occur. Be extra careful when using steroid cream for baby eczema.
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My Sons Journey With Topical Steroids
Eli has gone from hydrocortisone to Mometasone. Mometasone is so potent we couldnt use it on his face.
With infants a lower dosage is better, so your doctor will always start you with the least amount of strength that they can.
However it is best to use the right strength from the start, so you dont prolong the problems. We never made it to an oral steroid which can be an option. By that time we decided not to use steroids.
I began using a non steroid ointment after seeing an allergist. We got to the root of the problem which led us to the ability to stop the topical steroid use.
Eli had severe eczema, but our doctor still recommended us not to use the steroid cream on sensitive areas.
He had a bad experience with steroids early on. The steroids seemed to clear his eczema right away. But soon they stopped working and when I tried to use them his eczema became worse.
His skin began to thin to the point of constant breakage. Then I learned about the cons of using steroids and found another way. I was able to use them to the point where they worked well and identify when not to use them.
After a long journey of understanding the root cause of Elis eczema, we were able to find a plan I was comfortable with that worked for him.
How Do Oral Steroids Work
Oral steroids enter the body and latch on to specific cell receptors. This process reduces the bodys inflammatory response, which can provide quick relief from an eczema flare-up.
Most oral steroids come in pill form. These pills can offer an immediate or delayed release of the medication.
Although oral steroids can relieve symptoms, they are
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What Treatments Work
MoisturisersThe best thing you can do for your child is apply plenty of moisturiser to their skin. Moisturisers act by repairing the skin barrier, and reducing water loss. This in turn decreases the itch and can reduce the frequency of flares.
Moisturisers come as ointments, creams and lotions. Ointments and creams are best as they are more moisturising. You can use as much moisturiser as you like, but must use it at least twice per day, head to toe. The best time to apply moisturiser is after a bath.
BathsYou should bath your child once per day in a lukewarm bath for 10-15 minutes. Use bath oil in the bath and aqueous cream or soap free cleanser. Pat your child partially dry, and while the skin is still moist, apply moisturiser liberally.
Corticosteroid ointments and creamsCorticosteroid ointments and creams should be used on the red, oozing and inflamed areas to reduce inflammation and therefore itch. They are often called cortisone or steroids for short but they are not the same as the steroids athletes and body builders may take. Corticosteroids are similar to the chemicals your body makes naturally to fight inflammation.
Corticosteroids come in different strengths for different parts of the body and for severity of eczema flare. Your doctor will prescribe the right one for your child.
Are There Any Side
Short courses of topical steroids are usually safe and cause no problems. Problems may develop if topical steroids are used for long periods, or if short courses of stronger steroids are repeated often. The main concern is if strong steroids are used on a long-term basis. Side-effects from mild topical steroids are uncommon.
Side-effects from topical steroids can either be local or systemic. Local means just affecting that bit of skin and systemic means affecting the whole person.
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When Is Prednisolone Used
Prednisolone is very helpful for controlling severe flares of eczema. A short course may also be useful for florid cases of acute allergic contact dermatitis , or for cases of severe vesicular hand eczema.
For adults, doses of 2030 mg are commonly used initially, although occasionally higher doses are used. The tablets are usually taken as a single dose in the morning.
Rebound flares of eczema can occur on stopping treatment, and side effects prevent prednisolones long-term use.
Prednisolone may be prescribed off-licence for children as a gradually decreasing course.
What Are The Side Effects Of Prednisolone
Oral steroids such as prednisolone suppress the immune system. This means that the risk of bacterial, fungal and viral infection is greater, and live vaccines can cause problems. People on prednisolone should therefore seek their doctors advice if they feel unwell, if they are exposed to measles, or the chicken pox or shingles viruses, and before being vaccinated.
Prednisolone can have numerous side effects if it is taken for a long period of time. For this reason it tends only to be used to manage a crisis flare of eczema and is not recommended for long-term treatment of eczema. If prednisolone is prescribed, doctors will aim to keep the dose as low as possible.
Weight gain is the most common initial side effect. Osteoporosis is an important problem in adults. Extra care is needed for people who are already known to have diabetes or hypertension as these conditions may be made worse with prednisolone. Longer-term use of this medication for children is generally avoided because of its effects on general growth and bone formation. Other potential side effects include: cataracts, muscle weakness, fluid retention, peptic ulcers, easy bruising, and altered mood .
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If Steroids Arent Used And Diet Isnt Enough Then What
Outside of diet, Dr. Davis says there are several nonsteroid options that families can discuss with their doctors. Creams that contain calcineurin inhibitors, such as tacrolimus and pimecrolimus , treat eczema by altering the immune reaction that causes flare-ups.
Theres also phototherapy, which uses light either sunlight or narrow band ultraviolet B to treat eczema. This option comes with some risk, however, including skin aging and an increased risk of skin cancer. Phototherapy is not recommended for infants and is not commonly used for young children.
Wet dressings are an effective, though labor-intensive, option. This involves wrapping affected parts of the body in wet bandages that stay on for an extended period. A doctor can demonstrate this technique so that people can do it at home.
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