eczema

Eczema is a general term for a variety of chronic inflammatory conditions of the skin. Eczematous skin often presents as a localized rash of itchy, red, dry, and scaly areas. Though poorly understood, the cause of eczema seems to be closely linked to heredity, and sensitization to one or many allergens. The mechanism behind the skin inflammation is an immune reaction that causes an increase in inflammatory cytokines. The condition is most often contracted in childhood, and diagnoses of asthma and hay fever often follow later in life¹. Though eczema is not traditionally thought of as a severe condition, the societal burden it creates is significant. Estimates show more than 15 million Americans are affected with eczema of one form or another, and payments from insurance companies to cover the costs of their patients with eczema amount to over 1 billion dollars per year².

In the course of treatment, clinicians will often discuss allergen exposure, and how to rule out various external allergens that may be exacerbating the condition. Lotions and emollients help to keep the skin hydrated and free of xeroses and may reduce the need for corticosteroids, but once an outbreak has begun, these topicals are often of little use. The medical standard of care most often recommended for eczema consists of topical corticosteroids used in short bursts to suppress symptoms while avoiding long-term use. This is due to the fact that long-term use of topical corticosteroids has been associated with skin atrophy, striae, and development of tolerance¹. Two new treatments, topical tacrolimus and picrolimus, have recently been approved for use on eczema, but the long-term effects of its use are unclear. Several studies have discovered an increased prevalence of skin cancer in animals treated with the compounds³. Presently, no treatment for eczema that has been deemed efficacious at suppressing outbreaks has been approved for long-term use without the possibility of side effects¹.

Reference

Williams H C. Atopic dermatitis. N Engl J Med 2005; 352: 2314-24
“Handout on Health: Atopic Dermatitis (A type of eczema).” National Institute of Arthritis and Musculoskeletal and Skin Diseases. April 2003. National Institutes of Health Department of Health and Human Services. 29 June 2005.
“Alert for Healthcare Professionals: Pimecrolimus (marketed as Elidel).” U.S. Food and Drug Administration: Center for Drug Evaluation and Research. March 2005. U.S. Food and Drug Administration. 29 Jul. 2005.
Fleming T Ed. PDR for Herbal Medicines. 2nd ed. Medical Economics Company, Montvale, 2000