Available treatment options On Eczema

Local therapy (in alphabetical order):
Antifungal
Superficial fungal infections usually speak well to therapy with topical antifungal agents to. In the case of eczema are topical antifungal agents such as ketoconazole for the reduction of a mostly secondary fungal colonization (Pityrosporum ovale = Malasezia furfur), when seborrhoeic dermatitis a pathogenetic role. Systemic antifungal agents are usually only for extensive infestation and immunocompromised patients in need. Ketoconazole is a cream or shampoo (1% or 2%) available. Possible side effects may be skin irritation, burning, pruritus and his swelling.

Antimicrobials and antiseptics
These substances are responsible for such forms of eczema, by a bacterial infection accompanied superpower. They range from bacteriostatic drugs such as metronidazole, clindamycin, erythromycin to bactericidal drugs such as bacitracin. Possible side effects may include burning, stinging, pruritus, redness, irritant and allergic contact dermatitis be. The topical application of clindamycin is known in patients with ulcerative colitis or antibiotic-associated colitis contraindicated. As with all topical dermatological have allergies prior to elements of the Externums and may be considered a relevant presence of allergies not be applied.
Doxepin
Doxepin is a tricyclic antidepressant with antihistaminerger, antimuscarinerger and antiserotoninerger effectiveness. As Doxepinhydrochlorid (5%) it can be applied topically. It can be used to treat diseases eczematous we atopic dermatitis (AD), nummular eczema, contact dermatitis, and particularly to the symptomatic treatment of pruritus. The problem is the induction of a contact allergy with Doxepin. According to a systematic review for the treatment of AD, was not sufficient proof of efficacy of Doxepin in AD are provided.
Tanning
These are not available in all countries and established. In Germany, they are an essential part of eczema therapy They can be used as cream, fat ointment, gel, lotion, liquid or granular Bubble Bath applied. The latter two are part of implementing the baths affected region suitable. Entzündunghemmende have tanning and drying properties and are particularly dyshidrotic eczema and eczema associated with hyperhidrosis used.
Immunomodulators
Topical immunomodulators (Calcineurininhibitoren) for the treatment of atopic dermatitis (AD) admitted. Tacrolimus (FK 506) ointment is in a concentration of 0.03% and 0.1% and Pimecrolimus (ASM 981) than 1% cream available. Within the first days can apply itching, burning and irritation to the skin gets treated. During the treatment period, patients should not the natural or artificial sunlight (eg Solarium) suspended. In the presence of viral infections such as herpes simplex, herpes zoster, eczema Herpeticatum or varicella (chickenpox) topical immunomodulators may not be applied. From the current experience of view, the topical immunomodulators cause no long-term cortisone use possible atrophy. Additionally, you relapse and less likely to Tachyphylaxie. However, in this context must be noted that in the topical immunomodulators still no sufficient data concerning the assessment of side effects after long-term use exists.
Corticosteroids
There are a multitude of different potency topical corticosteroids. According to a new US-American division are seven different drug classes from Class 1 (very strong) to class 7 (weak) available. In Europe, is a 4-tier classification (mild to very severe effect) common.
Topical corticosteroids are often the first therapy of choice for moderate and severe forms of eczema. Weak corticosteroids such as Hydro cortisone or desonide should face Intertrigines (bars, armpits, submammäre region) and diapers should be applied.
Stronger corticosteroids (such as mometasone, methylprednisolone, Prednicarbat, triamcinolone acetonide) can be connected to other body regions. For lichenified plaques and regions such as hand and foot soles are very strong drugs (eg Fluocinonid, Desoximetason, Bethasonvalerat) needed. The uncontrolled long-term use of topical corticosteroids unreasonably strong can cause side effects such as skin atrophy, telangiectasia, Striae Distensae (equivalent to "Stretch"), hypertrichosis (increased hair growth), acne-like Hauteffloreszenzen and Tachyphylaxie lead. Very short periods of use can lead to a resurgence of the skin manifestations lead. The desire for a poor preparation possible side effects must be carefully weighed against the desire of the rapid symptom relief and control over the skin symptoms with a more effective drug. For the newer corticosteroids, the 4th Generation as methylprednisolone mometasone and the risk of skin atrophy diminished. Topical corticosteroids should not be in viral infections such as Herpes simplex, herpes zoster, varicella (chickenpox) and skin diseases such as rosacea, perioral dermatitis and open wounds should be applied.
Cooling lotions, menthol, camphor
Cooling measures such as the laying on of cold compresses are juckreizstillend and bring temporary relief, but long term can dry out the skin. Furthermore, they have no causal therapy It is different lotions with menthol, camphor and / or phenol, which have the same effect. They are eroded and aufgekratzte skin applied, this leads to burning. Schüttelmixturen also a chilling effect of the skin, but can apply for a longer drying effect and consequently to xerosis and asteatotic dermatitis (eczema dehydration) lead
Salicylic acid
Salicylic acid has keratolytic, bacteriostatic, fungicidal and photoprotective properties and can therefore strongly verhornenden hyperkeratotic eczema and forms used. Usually Externa concentrations of 10 to 40% used. Excessive application of salicylsäurehaltigen Topika on erodierter skin, in newborns and young children may increase the absorption and possible systemic symptoms of intoxication with neurological and gastrointestinal complaints.
Tar
In the field of dermatology three different Teerformen applied: Coal, Wood tar and Pflanzenteere. Tar preparations are as shampoo, cream or ointment available. They are effective in the treatment nummular eczema, hyperkeratotic eczema, chronic eczema and atopic dermatitis (AD). Among the side effects include folliculitis, akneiforme lesions and increased sensitivity to light. Teerpräparate should not in the genital area and the strips are applied, as there is a heightened risk of skin cancer formation exists.
Systemic therapy (in alphabetical order):
Antihistamines
There are currently three classes of antihistamines (H1, H2, H3). H1-antihistamines are used to treat certain urticaria and allergic diseases (eg rhinoconjunctivitis Allergica) were used. H1-antihistamines include three different categories: first-generation antihistamines (classically, additional sedative and anticholinergic effect), the second generation (slight sedation) and the third generation (minimal or no sedation). The sedierenden Antihistamininka (eg Hydroxycin, diphenhydramine) to help the Jucks-scratch cycle to prohibit and should preferably be administered in the evening. They are suitable for patients on the basis of pruritus can not sleep, or sleep during the night scratching like Patients with atopic dermatitis (AD). The efficacy of H1-antihistamines in the treatment of AD according to clinical trials is controversial and not yet proven.
Cyclosporine
There are two different formulations of the original substance (sand immune ®) and a micro emulsion (Neoral ®). The use of cyclosporine in atopic dermatitis (AD) is very well studied and a very large proportion of patients on this therapy is very good. A deterioration of the skin condition may occur discontinuation of cyclosporine. At best, it will be a short-term therapy (<6-12 months) in a dose of 2.5-5.0 mg / kg body weight. Among the side effects include hypertension, hypertrichosis and gingival. Taking less than 2 years in dermatological patients with an increased malignancy not expected. Cyclosporine is not teratogenic, taking cyclosporine during pregnancy should only be reserved for serious cases in which the therapeutic benefits outweigh the risk.
Corticosteroids
Systemic corticosteroids are highly inflammatory and can be used for the treatment of acute forms of allergic contact dermatitis, a phototoxic / photoallergic contact dermatitis and a exazerbierten atopic dermatitis (AD) will be necessary. As part of eczema treatment they are used for a Kurzzeitherapie (<4 weeks). Orally, they are usually as a single daily dose applied (such as prednisone). In severe cases, the gift to two or four individual doses to be made. The necessary daily dose depends on the severity of eczema and the body of the patient and is usually initially at 40-60 mg daily prednisone. If the mineralkortikoiden effects will be reduced, methylprednisolone should be preferred. The intravenous and intramuscular doses of corticosteroids is in very serious cases. Long Effective substances such as intramuscular triamcinolone acetonide should not be more than 4-6 times per year to be administered. In general, is an intravenous application for eczema patients is not necessary and should only be hardest forms of Dermatitis reserved. After an intravenous application will then oral corticosteroids continued. In the short-term use are usually no side effects. Possible side effects include gastrointestinal discomfort, weakness, muscle pain / - schäche, increased appetite, weight gain, mood swings, nervousness, akneiforme eruptions, infections, a derailment prior diabetes mellitus and delayed wound healing. The application for stomach ulcers, active tuberculosis, severe depression and psychosis, and known allergy to components of the drug is contraindicated.
Retinoids
They are structural and functional analogues of vitamin A with multiple effects on cellular differentiation and proliferation. As part of eczema treatment can be dermatitis them in the forms, accompanied with disorders such as severe forms of ichthyosis and the hyperkeratotic Fissured hand and foot, can be used. For the latter indication, the drug is not yet approved, but an application is under a therapeutic healing experiment possible. After completion of therapy, the skin symptoms occur again. The standard dosage depends on body weight and varies from 25 to 50 mg daily. Side effects may be dose-related mucosal symptoms such as dry lips, cheilitis, dryness of the nose and mouth, Xerophthalmie, Blepharo-conjunctivitis, corneal lesions, skin dryness, diffuse or localized hair loss and fat metabolism disorders be. Retinoids are contraindicated during pregnancy and may in women of childbearing age only in implementing an effective contraception to be administered. They are also in renal failure, liver dysfunction and lipid disorders contraindicated.
Others:
Tap-Iontophoresis
The tap-Iontophoresis is a physical therapy for the treatment of Dyshidrotic eczema (recurrent blistering) and the consequent with hyperhidrosis forms of eczema of hands and feet. Initial is a day for 10 to 15 minutes and then slowly symptom relief at two to three times per week reduced. In order to receive treatment success, should the application of the tap-Iontophoresis once a week even if symptom free continue. Possible side effects include tingling, stinging and burning during therapy. Should not be carried out when open wounds, fissures or metal implants in the body part to be treated, prior heart rhythm disturbances, patients with pacemakers and pregnancy.
Photodynamic therapy
Some patients already benefit from natural sunlight (atopic dermatitis, nummular dermatitis, eczema dyshidrotic, hyperkeratotic Fissured eczema), whereas others including deteriorate (eg seborrhoeic dermatitis, acute Kontaktekzeme). Different treatment regimes have been reported as successful. The photo-therapy includes UV-B, UV-A, combined UV-A/UV-B-Bestrahlung, UV-A1 long, narrow spectrum of UV-B and photochemotherapy with psoralens (PUVA), applied systemically, topically or as a bathroom. The implementation of a photo therapy is very promising, if the appropriate patients under professional guidance will be carried out. The success of therapy depends on the precise choice of therapeutic procedure for the corresponding indication. The selection of appropriate phototherapy should be developed by a dermatologist after consultation and in deference to the individual needs of the patient. Some patients can heat a UV phototherapy tolerate bad. The occurrence of side effects depends on the type of ultraviolet light, the Hautbräunungstyp of the patients (light sensitivity), the therapy duration and the number of UV-administered therapies from. Among the short-term side effects include dermatitis solaris (sunburn), erythema, skin dryness and an increased incidence of viral infections such as Herpes simplex infections. Long-term effects of UV exposure can be skin aging and the increased risk of occurrence of malignancies of his skin.
Miscellaneous:
About successes using acupuncture treatment for allergic contact dermatitis or persistent itching has been reported missing, however, controlled clinical trials.
Topical Capsaicintherapie: capsaicin, an ingredient of cayenne, has proved effective in the treatment of itchy dermatoses such as eczema showed (Lichen simplex, nummular eczema, Prurigoformen of eczema). An authorization is not before this, it can within the framework of a therapeutic healing experiment used. For a good efficacy is three to five times daily application. The Capsaicinkonzentration varies from 0.025% to 0.1%. It is recommended, with a low dosage to start and then all 3-5 days to increase. The face and the genital area should be omitted, since it propagated skin irritations may occur. Among the side effects, which usually from 3 to 5 days, suspend, include redness, burning, stinging and an initial increase of itch. These symptoms may include sweating and when in contact with hot water gets reinforced. Capsaicin should not be placed on open wounds and mucous membranes to be applied.
Chinese herbal medicine has been in controlled studies in atopic dermatitis (AD) with varying results reviewed, according to a systematic review for the treatment of AD was not sufficient evidence of efficacy was provided. Chinese herbs have non-steroidal, anti-inflammatory effects, some have additionally antihistaminerge and immunosuppressive effects. Thus they aim in their effect largely on the inflammatory component of the disease from. Side effects include hepatotoxicity and the need for a consistent and continuous medication.
Dietary supplements such as lipids with Nachtkerzensamenöl (linolenic and ?-linolenic acid) or fish oil showed corresponding double-blind, placebo-controlled trials and systematic reviews no significant efficacy in the treatment of AD. According to reports of clinical experience was acupuncture in the treatment of allergic contact dermatitis and difficult to control pruritus successfully, but this lack controlled clinical trials.
Psychological approaches: it has increased in recent years has become increasingly clear that psychological factors of the disease course of many diseases affect. Studies have shown that psychotherapy in groups, biofeedback and self-help, the quality of life of dermatology patients, in particular, the patients with AD improve.