Wet to Dry Dressings for Eczema
During particularly intense eczema flares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. Face wraps use gauze and surgical netting, and are made and applied by nurses trained in this treatment.
Outpatient phototherapy is a safe, effective, and low-cost treatment modality for moderate to severe psoriasis. Barriers to outpatient phototherapy including patient inconvenience, patient co-pays, decreased physician compensation, and insurance disincentive structures have led to decreased use and underutilization of phototherapy. Home phototherapy can potentially overcome many of the barriers associated with outpatient treatment but is not widely used because of concerns over safety and efficacy, lack of resident and physician education, and lack of insurance coverage.
Marius Rademaker practices dermatology in Hamilton, New Zealand.
He has been at the forefront of research into the use of isotretinoin for acne and other disorders as well as the treatment of atopic dermatitis with methotrexate.
Here are notes from his presentations at Hot Spots in Dermatology
August 17 - 19, 2018, Kahuku, Hawaii
Key References:
1. Download Isotretinoin- Dose Duration Relapse
2.We do not have a pdf. Here is the citation + the abstract:
Methotrexate for treatment of atopic dermatitis in children and adolescents
Marius Rademaker et. al.
Int. J. Dermatoil 2014 https://doi.org/10.1111/ijd.12314 (06 March 2014)
Abstract: Low‐dose methotrexate is becoming established as a second‐line treatment for atopic eczema in the adult population, but there has been a paucity of data to support its use for this indication in the pediatric population.
Methods A retrospective review was undertaken of patients aged 18 years and under started on methotrexate between January 2005 and April 2010, at a hospital‐based dermatology department in New Zealand.
Results: Thirty‐one patients (17 females, mean age 10 years, range 3–18 years) were reviewed. Methotrexate was found to be effective or very effective in 75% and ineffective in 25%. The mean duration of treatment for those who responded to methotrexate was 14 months (range 2–38 months), 74% of patients were still on treatment at the time of last review. The most common adverse effect was minor nausea in four patients (14%) and non‐significant elevation of liver enzymes (four patients). No serious adverse effects were noted.
Conclusion: In our experience, methotrexate has a good safety/tolerability profile when used in low dose for the treatment of atopic dermatitis in children and adolescents and appears to be effective. Formal comparative studies are needed.
Eczema: Therapeutic Apparel
Eczema entrepreneurs are often driven by personal experiences that they or their family members have had with the skin condition. Joe Paulo, for example, created Smiling Panda clothing after he had eczema as a teenager. But he and others, including Elizabeth Scott, the founder of AD Rescue Wear, have found that the path to a winning eczema product is not short or easy, in large part because there is no official testing process to get approval.
See: July 2017 NY Times article: Search for Eczema Relief leads to Business Opportunities.
For decades researchers have argued that some of the skin’s microscopic residents are partly to blame for certain disorders, such as acne and eczema. Now, it seems, bacteria may be part of the treatment, too. This NY Times article by Ferris Jabr is an introduction to this emerging field of research.
An article by Richard Gallo on Antimicrobials and Skin Disorders describes early research into this area. Practical applications are still a ways off, but this may prove to be an effective approach for patients with acne and atopic dermatitis.
Abstract of Gallo article:
The microbiome can promote or disrupt human health by influencing both adaptive and innate immune functions. We tested whether bacteria that normally reside on human skin participate in host defense by killing Staphylococcus aureus, a pathogen commonly found in patients with atopic dermatitis (AD) and an important factor that exacerbates this disease. High-throughput screening for antimicrobial activity against S. aureus was performed on isolates of coagulase-negative Staphylococcus (CoNS) collected from the skin of healthy and AD subjects. CoNS strains with antimicrobial activity were common on the normal population but rare on AD subjects. A low frequency of strains with antimicrobial activity correlated with colonization by S. aureus The antimicrobial activity was identified as previously unknown antimicrobial peptides (AMPs) produced by CoNS species including Staphylococcus epidermidis and Staphylococcus hominis These AMPs were strain-specific, highly potent, selectively killed S. aureus, and synergized with the human AMP LL-37. Application of these CoNS strains to mice confirmed their defense function in vivo relative to application of nonactive strains. Strikingly, reintroduction of antimicrobial CoNS strains to human subjects with AD decreased colonization by S. aureus These findings show how commensal skin bacteria protect against pathogens and demonstrate how dysbiosis of the skin microbiome can lead to disease.
A landmark study reported in the New England Journal of Medicine highlights the efficacy of a new biologic drug, Dupilumab, for the treatment of atopic dermatitis. This may be heralding a new era for patients with moderate to severe atopic eczema.
The New York Times had a glowing article on October 1, 2016, and the NEJM's article was published the same day.
This is likely to be a great breakthough for many who suffer moderate to severe atopic dermatitis, but the drug company that makes is will likely play hardball with the pricing. Most biologics today run ~ $50,000 a year. Since Dupilumab may only be taken for four months, the price will be determined by a drug maker keen to maximize its profits. The drug will only be affordable to patients with good insurance. It will not be available to the uninsured or poorly insured.
An American physician and his wife visiting Turkey find themselves with their infant experiencing a flare of eczema. In desperation, at the suggestion of his mother-in-law, they visit a Greek Orthodox church to consult a priest with the reputation of a healer. This is a fine piece about faith and illness.
"My 9-month-old son’s first time on a plane — a 10-hour journey from J.F.K. to Istanbul — was a disaster. The dry air of the cabin, the confinement and possibly some allergen on the in-flight menu all contributed to an unprecedented eruption of his eczema. It was demoralizing. His skin had been cracking and inflamed for months, but we had taken such pains with it — daily applications of heavy cream and austere dietary restrictions — in anticipation of introducing him to his relatives in Turkey."
Twenty-five years ago, I saw a similar patient. He was an infant of a service woman who was stationed in Germany, but whose family lived in Hawaii. All the child knew was his crib in Munich. His mother took him from his familiar surroundings, half a world away to Hawaii. By the time they arrived, the child, who previously had had mild to moderate eczema, was experiencing a major flare. It was my feeling that the stress of travel was an important trigger to the eczema's exacderbation. Imagine what an infant must feel when removed from the only surrounding he knows, We seek for physical or microbial trigger -- but sometimes the psyche plays a role as well. Who knows the mind and emotions of a nine month old?
"The medical name for eczema is atopic dermatitis, which reflects the immunological nature of the condition. It is more common among children living in cities than those in rural areas. According to the so-called hygiene hypothesis, exposure to infectious agents early in life offers protection against allergic diseases. The more hygienic a child’s environment, the greater the risk." This is an extract from a good article by Jane Brody who writes the Personal Health section for the NY Times. I don't agree with everything, but it's a good starting point.
For full text see: Download Eczema NYT
A good guie to eczema for patients and parents is:
Your Guide to Eczema by Sarah Wakelin which can be ordered from ABE books for ~ $4 (includes shipping)
A trial of oolong tea in the
management of recalcitrant atopic dermatitis.
Uehara M, Sugiura H, Sakurai
K. Arch Dermatol. 2001 Jan;137(1):42-3.
Department of Dermatology,
Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu 520-2193, Japan.
Abstract
BACKGROUND: Mild cases of
atopic dermatitis (AD) generally improve with standard treatment. However,
standard treatment fails many patients with recalcitrant AD skin lesions. Study
results in animal models have demonstrated that the administration of tea (ie,
green, black, or oolong) has suppressed type I and type IV allergic reactions.
OBJECTIVE: To test the
effectiveness of oolong tea in the treatment of recalcitrant AD.
PATIENTS: Although 121
patients with recalcitrant AD were enrolled in the study, 118 patients
completed the open study.
METHODS: Patients were asked
to maintain their dermatological treatment. However, they were also instructed
to drink oolong tea made from a 10-g teabag placed in 1000 mL of boiling water
and steeped for 5 minutes. This amount was then divided into 3 equal servings
and 1 serving was drunk daily after 3 regular meals. Photographs of 2 or 3
representative lesion sites were taken at baseline and at 1 and 6 months and
the severity of pruritus was assessed on a 6-point Lickert-like scale ranging
from markedly improved (>50% improvement) to worsened.
RESULTS: After 1 month of
treatment 74 (63%) of the 118 patients showed marked to moderate improvement of
their condition. The beneficial effect was first noticed after 1 or 2 weeks of
treatment. A good response to treatment was still observed in 64 patients (54%)
at 6 months.
CONCLUSION: The therapeutic
efficacy of oolong tea in recalcitrant AD may well be the result of the
antiallergic properties of tea polyphenols.
Download Oolong Tea Atopic
In the Well section of the NY Times there is an excellent article on "Waking Up With Eczema" (December 25, 2011). This essay will appeal to patients with "atopic dermatitis" as well as those who itch for other reasons. There are well over a 100 comments, and some are very good, as well. Itching, eczema, and atopic dermatitis are frustrating to live with and diffiuclt to treat. This is a valuable introduction.