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Treatment

Eczema can be treated by reducing the irritation and inflamation and therefore breaking the itch cycle. To reduce skin irritation, apply a moisturizer after bathing and a few minutes of drying. A hypoallergenic soap, like pine tar soap, may reduce skin itchiness. Drinking 30 ml of hemp oil a day may reduce skin dryness, skin itchiness and use of medication. Taking 4,000 IU of Vitamin D per day may prevent skin infections. For some people, eczema can be reduced by avoiding certain foods. Scratch habit reversal may help break the itch cycle. Protective barriers like moisturizing gloves can be worn when sleeping. Environmental factors such as air exchange rates, relative humidity and room temperature might have an effect on eczema .Candidiasis is a common cause of eczema, and should be treated. Itch relief for a flare can be found by cooling the skin. If these safe treatments don't work, then medications are available to reduce symptoms, but they have a risk of side effects. Ultraviolet light therapy also has a risk of side effects.

Moisturizer

Eczema is exacerbated by dryness of the skin. Removing the protective layer of skin oil leads causes the skin to become dry and vulnerable to infection, which leads to itchiness and eczema, and so oils which keep the skin moisturized will help with eczema. Moistening agents are also called emollients.

One of the best oils for this purpose is coconut oil, preferably extra virgin coconut oil, which isn’t just a good moisturizer but also a great way protect the skin from bacteria. Coconut oil contains antiseptic acids and when it’s consumed or applied topically it can help to form a chemical barrier on the skin to prevent fungal and bacterial infections. Our bodies best chemical barrier is our own oil and sweat that we produce. The oil that our bodies produce is called sebum that contains medium fatty chains. When these fatty chains are broken into free fatty acids they become great antibacterials. Coconut oil is the closest resembling thing to medium fatty chains in terms of available products and while it doesn’t have immediate antimicrobial action, once it’s broken down it can work wonders. It’s best to use it after bathing and a few minutes of drying because when showering the soaps and shaving gels wash off that protective layer of oil. Applying coconut oil directly to skin boosts the skin's natural antimicrobial layer.

If the eczema is in a moist place such as the underarms, baby powder is a possible additional remedy. It removes any moisture and soothes the redness and itchiness, once the area is dry coconut oil can be applied. Johnson's baby powder is a good product, as it is perfume free and will not irritate the skin.

Coconut oil generally increases basic metabolic functions in the body when applied topically in the skin, so it can sometimes lead to skin problems, especially if the skin is not cleaned right before applying the oil. If this happens, switch to another moisturizer which you can tolerate. There are many moisturizers, there is no need to keep taking one in particular if it is causing trouble.

If coconut oil is not being used and there is a choice of moisturizers, it is best to match thicker moisturizers to the driest, flakiest skin. Light moisturizers may not have any effect on severely dry skin.

Recently, ceramides, which are the major lipid constituent of the stratum corneum, have been used in the treatment of eczema. They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory.

Hypoallergenic Soap

Detergents are ubiquitous in modern environments in items like tissues, and persistent on surfaces, so “safe” soaps are necessary to remove them from the skin in order to control eczema. Although many eczema recommendations use the terms ”detergents” and ”soaps” interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances (“increase antigen penetration”).

Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms “hypoallergenic” and “doctor tested” are not regulated, and no research has been done showing that products labeled “hypoallergenic” are in fact less problematic than any others. That being said, a soap often used by eczema sufferers is pine tar soap. Some commercial pine tar soaps contain chemicals or preservatives, and you should avoid these. Of the pine tar soaps, Granpa Brands Pine Tar Soap is popular.

Hemp Oil

According to the [www.finola.com/FinolaOilandAtopy.pdf “Efficacy of dietary hempseed oil in patients with atopic dermatitis”] study, 30 ml of hemp oil per day reduced skin dryness and itchiness. As listed in table VI, on a scale of zero to five, patient ratings of skin dryness were reduced from 3.19 to 2.52, ratings of skin itchiness were reduced from 2.56 to 1.56, and ratings of medication use were reduced from 2.69 to 1.69. Hemp oil worked much better than olive oil.

Vitamin D

The "Oral Vitamin D.." study led by researchers at the University of California, San Diego School of Medicine suggests that taking 4,000 IU of Vitamin D per day vitamin D3 bolsters production of a protective chemical normally found in the skin, and may help prevent skin infections that are a common result of atopic dermatitis, the most common form of eczema. It can be noted that the production of vitamin D3 is catalyzed by UV radiation and may influence histocompatibility expression, correlating with both the seasonality of eczema and its relation to the immune system.

Diet

Recent studies provide hints that food allergy may trigger atopic dermatitis. For these people, identifying the allergens could lead to an avoidance diet to help minimize symptoms, although this approach is still in an experimental stage. Dietary elements that have been reported to trigger eczema include dairy products, coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies vary from person to person. However, in 2009, researchers at National Jewish Medical and Research Center found that eczema patients were especially prone to misdiagnosis of food allergies.

Scratch Habit Reversal

In the 1980s, Swedish dermatologist Peter Noren developed a behavioural approach to the treatment of long term atopic eczema. This approach has been further developed by dermatologist Richard Staughton and psychiatrist Christopher Bridgett at the Chelsea and Westminster Hospital in London.

Patients undergo a six-week monitored program involving scratch habit reversal and self-awareness of scratching levels. For long-term eczema sufferers, scratching can become habitual. Sometimes scratching becomes a reflex, resulting in scratching without conscious awareness, rather than from the feeling of itchiness itself. The habit reversal program is done in conjunction with the standard applied emollient/corticosteroid treatments so that the skin can heal. It also reduces future scratching, as well as reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema.

Protective Barriers

Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. Ointments with less water content stay on the skin longer and need fewer applications, but they can be greasy and inconvenient. Steroids may also be mixed in with ointments.

For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.

Environmental Factors

A controlled study suggested that a number of environmental factors such as air exchange rates, relative humidity and room temperature might have an effect on the condition. Various measures may reduce the amount of mite antigens, in particular swapping carpets for hard surfaces. However it is not clear whether such measures actually help with eczema.

Candidiasis

Candidiasis is a yeast or fungal infection that is a common cause of eczema, according to many studies; such as "Evaluation of Candida albicans..", "Association between Candida Albicans and Lesions..", "Infection and Eczema", and "Candida Overgrowth and how it is Related..". If Candidiasis is diagnosed, it should be treated. Besides the eczema, the Candidiasis would often be causing other problems.

Itch Relief

Itch relief methods will reduce the inflammation and lessen the desire to scratch. This practice works best at the first sign of a rash in order to stop it from getting worse; however, it can be used at any point during an outbreak.

Temporary but fast-acting relief can be found by cooling the skin via water (swimming, cool water bath or wet washcloth), air (direct output of an air conditioning vent), or careful use of an ice pack (wrapped in soft smooth cloth, e.g., pillow case, to protect skin from damage).

Capsaicin in a 0.075% http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Chronrev/Analges/CP063.html cream applied to the skin] four times daily for six to eight weeks was useful in alleviating the pain associated with psoriasis, and so would probably also be useful for pain from eczema. [http://en.wikipedia.org/wiki/Anti-itch_drug Anti-itch drugs], often [http://en.wikipedia.org/wiki/antihistamine antihistamine], may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the "[http://en.wikipedia.org/wiki/Itch_cycle itch cycle]"). However, in some cases, significant benefit may be due to the sedative side effects of these drugs, rather than their specific antihistamine effect. Thus sedating antihistamines such as promethazine (Phenergan) or diphenhydramine (Benadryl) may be [http://www.cks.nhs.uk/eczema_atopic/evidence/supporting_evidence/antihistamines more effective at preventing night time scratching] than the newer, nonsedating antihistamines. ===Medications=== ====Corticosteroids==== [http://en.wikipedia.org/wiki/Corticosteroids Corticosteroids are highly effective in controlling or suppressing symptoms in most cases. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects. Because Candidiasis often develops on skin with eczema, many physicians prefer an antifungal and corticosteroid combination cream.

Side effects

Prolonged use of topical corticosteroids is increases the risk of side effects, the most common of which is the skin becoming thin and fragile (atrophy). Because of this, if used on the face or other delicate skin, only a low-strength steroid should be used. Additionally, high-strength steroids used over large areas, or under occlusion, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis suppression (HPA axis suppression). Finally by their immunosuppressive action they can, if used without antibiotics or antifungal drugs, lead to some skin infections (fungal or bacterial). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma or cataracts.

Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids may be relatively safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment.

Some recent research claims that topically applied corticosteroids did not significantly increase the risk of skin thinning, stretch marks or HPA axis suppression (and where such suppression did occur, it was mild and reversible where the corticosteroids were used for limited periods of time). Further, skin conditions are often under-treated because of fears of side effects. This has led some researchers to suggest that the usual dosage instructions should be changed from “Use sparingly” to “Apply enough to cover affected areas”, and that specific dosage directions using “fingertip units” or FTUs be provided, along with photos to illustrate FTUs. However, caution must always be used as long-term use, prolonged widespread coverage, or use with occlusion, can create side effects that are permanent and resistant to treatment.

Topical immunosuppressants

Topical immunosuppressants like pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic) were developed after topical corticosteroids had come into widespread use. These newer agents effectively suppress the immune system in the affected area, and appear to yield better results in some populations. The U.S. Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings;

  • The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's disease).
  • Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use.
  • In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing,headaches, flu-like syndrome, photosensitive reactivity and possible drug interactions with a variety of medications, alcohol and grapefruit.

Oral and parenteral immunosuppressants

When eczema is severe and does not respond to other forms of treatment, immunosuppressant drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin, azathioprine and methotrexate. These drugs were generally designed for other medical conditions but have been found to be effective against eczema.

Ultraviolet Light Therapy

Light therapy (or deep penetrating light therapy) using ultraviolet light can help control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Exposure to ultraviolet light increases the risk of getting skin cancer. In the study of 1,380 patients with psoriasis treated with PUVA in 1975/6, Dr. Robert Stern and colleagues at Harvard Medical School found that about 15 years after the first PUVA treatment, the risk of malignant melanoma increased more than fivefold, with the greatest risk observed in patients who received 250 treatments or more.

When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen. This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer. This risk is greater in patients exposed to high doses of PUVA, appears to increase with time, and must be considered in determining the risks and benefits of this therapy.

Overall, because of the enormous increase in skin cancer risk, ultraviolet light therapy should only be used after all safe treatments have been tried.

Alternative

<!– Please add new items only if you provide some explanation AND source. –> Saunas may help eczema, perhaps by clearing allergens from the skin, but there are no studies to measure their effectiveness. There is weak but not statistically significant evidence that probiotics may help with eczema. Sea water baths, and topical sulfur have been used to treat eczema, but there are no scientific studies done to measure their effectiveness. Protective clothing might help with the itching, scratching and peeling associated with eczema. There is some evidence that some traditional Chinese medicine can help with eczema, but sometimes there are severe side effects.

Anecdotal evidence suggested that soft water could have therapeutic effects for people with eczema currently using hard water. However, a trial involving 336 children with eczema showed no objective difference in outcomes between the children whose homes were fitted with a water softener and those without.

There is a case study about chiropractic spinal manipulation and exzema, but since the study was tiny and not blinded it is not significant scientific evidence. Another eczema remedy without scientific evidence is acupuncture.

Sauna

A sauna treatment induces sweating which clears some allergens from the skin and clears the skin pores. For an eczema patient, sauna treatment two to three times a week is recommended. It is important to be on a regular schedule so that the eczema does not relapse and the skin gets time to heal. The patient should shower or bathe before a sauna treatment to wash off oils which would block the pores, also the patient should drink a lot of water, or better yet a carbohydrate and electrolyte drink, to counter the water and electrolyte loss through sweat. After the sweating stops and the patient is completely dry, then a moisturizer should be applied.

A side effect of a sauna treatment is that while the patient is hot and sweating the kidney and liver function slows down. Also some women find saunas unpleasant while they are menstruating. In general, saunas have a powerful effect on the body and should be used with caution.

If you want to try a sauna treatment, make sure to drink beforehand, start with just a five minute session, and see if there are any side effects. If there are no problems, then you may slowly increase the length of the sessions to fifteen minutes. There is no need to push yourself to discomfort.

It is possible to get a mild version of the effect of a sauna by drinking beforehand, taking a shower to clear the skin, then soaking in a really hot bath of around 47 Celcius as measured with a bath thermometer. Even though this is the mild version, you should still be cautious, start with short sessions and see if there are any side effects, before going to longer sessions up to fifteen minutes or slightly higher temperatures (up to 49 Celcius).

Other ways to sweat without a sauna include exercising with lots of clothes, drinking warm tea in a hot room, and eating cayenne pepper. Whatever technique is used to sweat, it should be done cautiously.

Probiotics

Probiotics are live microorganisms taken orally, such as the Lactobacillus bacteria found in yogurt. Some research points to some strains of beneficial microorganisms having the ability to prevent the triad of allergies, eczema and asthma, but the evidence is weak but not statistically significant. In rare cases they have a very small risk of infection in those with poor immune system response.

Sulfur

Sulfur has been used for many years as a topical treatment in the alleviation of eczema, although this could be suppressive. It was fashionable in the Victorian and Edwardian eras. Sulfur baths, and other forms of sulfur applied to the skin, seem to help treat eczema, however, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema.

Sea Water

There is some anecdotal evidence that salt water baths may help some children with atopic eczema. One reason might be that sea water has antiseptic properties. The Dead sea is popular for alleviating skin problems including eczema. The benefit of this treatment must be weighed against the extreme discomfort and burning sensations suffered as the salt water contacts raw skin.

Protective Clothing

Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.

Traditional Chinese medicine

According to American Academy of Dermatology, while certain blends of Chinese herbal medicines have been proven effective in controlling eczema, they have also proven toxic with severe consequences. In Chinese Medicine diagnosis, eczema is often considered a manifestation of underlying ill health. Treatment aims to improve the overall health of the individual, therefore not only resolving the eczema but improving quality of life (energy level, digestion, disease resistance, etc.). A recent study published in the British Journal of Dermatology describes improvements in quality of life and reduced need for topical corticosteroid application. Another British trial with ten different plants traditionally used in Chinese medicine for eczema treatment suggest a benefit with herbal remedy, but reviewers noted that the blinding was not maintained, leaving the results invalid.

Disclaimer

The information presented is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.


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