Treatment of eczema

If the cause of eczema is known, every effort should be made to avoid contact with the cause. Otherwise treatment is symptomatic, there being no cure for eczema. 

If the eczema is dry, emollients can be used to soothe the skin and restore hydration. Emollients are made from liquid paraffin, soft paraffin and various fats and oils formulated into creams, ointments and bath oils with or without antimicrobials. 

If the eczema is wet, mild astringents such as dilute potassium permanganate may be useful in the short term. 

In many cases of eczema, the use of emollients or astringents may not be sufficient to relieve the symptoms. Topical corticosteroids may then be required to reduce the inflammation. Corticosteroids come in different potencies and the potency of the preparation chosen should be appropriate to the severity of the condition. One percent hydrocortisone cream or ointment, which is available as a pharmacy medicine is usually effective. Long-term application of topical steroids can cause damage to the skin. The aim is to use the lowest effective concentration of corticosteroid for the shortest period. However, it is preferable to use a high potency steroid for a short period rather than a low potency steroid for a longer period. This minimizes the damage to the skin structure and reduces the possibility of systemic adverse effects. (See Chapter 7 page 119 and Table 7.1 for adverse effects of corticosteroids.) 

Oral antihistamines that have a sedative effect may be useful at night to reduce nocturnal itching, which can cause skin damage and secondary infection. Antihistamines are discussed in Chapter 5. 

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About 120 chemical constituents have been identified in chamomile as secondary metabolites, including 28 terpenoids, 36 flavonoids and 52 additional compounds [4]. A substantial part of drag effects are determined by the essential oil content. Oil is collected from flower heads, either by steam distillation or solvent extraction, for yields of 0.24-1.90% of fresh or dry plant tissue. Among the essential oil constituents the most active are /-/-a-bisabolol and chamazulene. /-/-a-bisabolol has demonstrated anti-inflammatory, antispasmodic, antimicrobial, antiulcer, sedative and CNS activity. Chamazulene is also anti-inflammatory. Topical applications of chamomile preparation have shown benefit in the treatment of eczema, dermatitis and ulceration [5]. 

Cornbleet, T., Use of maize oil (unsaturated fatty acids) in the treatment of eczema, Arch. Dermatol. Syph.,31,224, 1935. 

In 1951-1952, Sulzberger et al. showed that systemically - but not topically -applied cortisone acetate was effective in the treatment of eczema and other der-matitides, whereas hydrocortisone was effective with both routes of administration [8,9]. Because the topical route promised a relative freedom from troublesome systemic side effects (e.g., salt retention). Schering recognized the need for an effective synthesis of the latter. 

Anionic emulsifying wax (3-30%) may also be mixed with soft and liquid paraffins to prepare anhydrous ointment bases such as emulsifying ointment BP. A preparation of 80% anionic emulsifying wax in white soft paraffin has been used as a soap substitute in the treatment of eczema. 

Armstrong NC, Ernst E. The treatment of eczema with Chinese herbs a systematic review of randomized clinical trials. Br J Clin Pharmacol 1999 48 262-264. 

Some alkaloids are active in a- and p-adrenergic receptors (e.g., ephedrine), a receptors (e.g., ergotamine), uterine a2 receptors (e.g., ergometrine), and presynaptic a2 adrenoreceptors (e.g., yohombine). Ephedrine increases blood pressure by elevating cardiac output. It is also known to have some stimulant activity on the respiratory center. Ephedrine may be applied in the treatment of eczema in insulin-dependent diabetics. Clonidine stimulates tt2 receptors in the brain. As the effect of this, the cardiac output is smaller and blood pressure is lowered. Clonidine as an 0(2 adrenergic receptor agonist improves endothelial function and modulates inflammation during reperfusion." ... 

Plants from the Rutaceae have been used in folk medicine in the treatment of eczema, rheumatism, stomachache, dysentery, herpes etc. 29 presently, none of these effects have been correlated to any carbazole alkaloid. Some Rutaceae carbazole alkaloids have however been screened for antibiotic activity, and cytotoxic activity has been found for koenoline (Figure l).i 20... 

Traditional use An infusion is used to treat stomach ailments, common colds, and gynecological problems. It is used externally as a lotion, compress, and in bathes for the treatment of eczema, infected skin diseases, and to wash wounds (Gammerman et al. 1990). 

Warner, J. O., and Hathaway, M. J., 1983, Dietary treatment of eczema due to food intolerance, in Proceedings of the Second Fissons Food Allergy Workshop (R. R. A. Coombs, ed.), pp. 105-108, Medicine Publishing Foundation, Oxford. 

As an example, fluocinonide is a prodrug that contains an acetal moiety, and is sold in a cream used for the topical treatment of eczema and other skin conditions. 

MA-MVE esters with alcohols with different chain length hydrocortisone (treatment of eczema and dermatitis) 139, 155... 

Based on a wide range of pharmacological effects and its history, and safety, curcumin has significant potential for use in cosmetic products. As an anti-inflammatory, it has been used in antiaging products. It is commonly used as a natural colorant (27), but has also found numerous uses as an antiseptic, in the prevention of dry skin, in the treatment of eczema and acne and the slowing down of wrinkles and aging. Turmeric and curcumin are found in facial masks, washes, lip balms, and sunscreens. Clinical supports of these label... 

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