Moisturizers- Moisturizers or emollients including bath oils, soap substitutes can be applied to the dermatitis as frequently as required to relieve itching, scaling and dryness. Emollients should also be used on the unaffected skin to reduce dryness. Emollient therapy helps to restore one of the skin's most important functions, which is to form a barrier to prevent bacteria and viruses getting into the body and therefore help to prevent a rash becoming infected. Emollients are safe and rarely cause an allergic reaction. Occasionally, products with lanolin may cause a reaction. Ideally, moisturizers should be applied three to four times a day. Apply in a gentle downward motion in the direction of hair growth to prevent accumulation of cream around the hair follicle (this can cause infection of the follicle).
Coal Tar- Coal tar has been used to treat the itching and inflammation caused by skin conditions for hundreds of years. The tar contains chemicals that soothe the skin. Crude coal tar is a byproduct of oil production. It makes the skin more sensitive to light. In its natural state it is a thick, brownish-black substance that is messy to apply to the skin. Refined coal tar preparations, many of which are available over the counter, may be more cosmetically acceptable. Coal tar has been used for many years to treat psoriasis and it has few side effects. However, it does not work for everyone. In addition to being messy to use, it has a strong odor and can stain skin and clothing. It can cause sun sensitivity, and may irritate acute dermatitis. Tar creams or bath emulsions can be helpful for mild inflammation of atopic dermatitis. The smell may be offensive to some people.
Corticosteroids / Topical steroids – Topical steroid medications are one of the most common treatments for mild to moderate psoriasis. They reduce redness (inflammation) and itching and stop the rapid build-up of dead skin cells. They come in varying strengths, from weak to highly potent. They are available as creams, gels, lotions, ointments, or solutions. A steroid mousse is now available to treat scalp psoriasis. Topical steroids can become less effective if used repeatedly for a long time. This is called resistance. The best outcome may be achieved when topical steroids are combined with other medications applied to the skin. Steroids in the form of pills or injections are generally not used to treat psoriasis because they have too many serious side effects. Also, psoriasis can come back worse than ever when treatment stops. Long-term use of potent topical steroids on large areas of skin can produce side effects such as stretch marks, thinning and reddening of the skin, and the appearance of small blood vessels through the skin. These medications should not be put on the face or on areas of the body where the skin folds, such as the armpits, groin, and webs of the toes. Use of steroid ointments and creams requires good judgment and careful supervision. They come in various strengths from mild to super-potent. Ask the doctor about potency and side effects of prescribed corticosteroid medicines. Corticosteroid medicines are prescribed for atopic dermatitis to calm the inflamed skin. Avoid combination topical steroid/antifungal cream in the treatment of diaper rash.
Topical Immunomodulators- Topical immunomodulators (TIMs) are a new type of non-steroidal anti-inflammatory drug for the treatment of eczema. Mild burning sensations have been reported when applying TIMs. In general, however, TIMs have fewer side effects than corticosteroids. TIMs are topical drugs that modulate the immune response (alter the reactivity of cell-surface immunologic responsiveness). Studies have shown that this class of drugs will improve or completely clear eczema in more than 80 percent of treated patients, with a side-effect profile comparable with topical steroids.
Antibiotics- Damaged skin is susceptible to bacterial infection. People living with eczema tend to develop more skin infections than others. Antibiotics, topical or oral, may be required to treat eczema. Oral eczema treatments are not used as frequently as topical therapies. However, oral medication may be required to treat complications, or especially severe cases of eczema. Many different types of antibiotics are available. Consult your medical professional to find out about the side effects of antibiotics prescribed to you. Oral or topical antibiotics reduce the surface bacterial infections that may accompany flares of Atopic dermatitis. In the treatment of stasis dermatitis, oral antibiotics are useful when cellulitis is present; topical antibiotics are useless and often cause contact dermatitis.
Antifungal agents - Indicated for suspected candidiasis or proven candidal infection by a medical practitioner. Commonly used topical antifungal agents are nystatin cream or ointment and econazole nitrate cream.
Antihistamines- Antihistamines are occasionally prescribed to control itching and help the eczema sufferer sleep. Their effectiveness as anti-itch medication is limited, however, as histamines are not important components of eczema-associated itching. Antihistamines can make you very drowsy. Driving while on antihistamines is not recommended.
Phototherapy- involves the use of light to treat a medical condition. Ultraviolet light therapy improves eczema symptoms in some people. Phototherapy may only use ultraviolet light, or may combine the use of ultraviolet light with psoralen, a drug that increases light sensitivity. While ultraviolet rays occur naturally in sunlight, excessive sun exposure causes sunburn, which can make symptoms worsen. Phototherapy uses carefully measured amounts of ultraviolet light; a safety measure that cannot be duplicated by simple exposure to the sun. A side effect of this is photo damage or increased risk of skin cancers.
Natural sunlight contains ultraviolet (UV) light. UV light kills T cells in skin, reducing redness and slowing the overproduction of skin cells that causes scaling. This is why brief, regular periods of sun exposure can help to clear psoriasis. Exposing the skin to UV light in carefully controlled doses is called phototherapy. Sunlight contains two kinds of UV light, known as UVA and UVB. Both can be used to treat psoriasis. In phototherapy, the affected person sits or lies inside a "light box," a booth fitted with special light-emitting tubes. Usually, people go to a doctor's office to receive phototherapy. Sometimes a light box can be purchased with a doctor's prescription for use at home.
UVB therapy: Treatment with UVB light is the safest form of phototherapy for widespread psoriasis or psoriasis that has not responded to medications applied to the skin. Usually 3 to 5 treatments a week are recommended, with a gradual increase in UV exposure depending on skin type. Significant clearing of psoriasis can be expected in 1 to 3 months. Exposure to UVB light must be carefully monitored to prevent sunburn. During treatment, the eyes must be shielded with goggles to guard against the possible formation of cataracts. Skin aging may be a side effect of UVB treatment. Large long-term studies have found no evidence of an increase in the risk of skin cancer as a result of UVB treatment. UVB phototherapy may be combined with tar, anthralin, topical steroids, or other medications applied to the skin. The Goeckerman regimen, developed at the Mayo Clinic, uses crude coal tar, tar baths, and UVB treatment to treat widespread psoriasis. The Ingram regimen uses coal tar baths, anthralin paste, and UVB therapy.
PUVA: This treatment combines a medication called psoralen with exposure to UVA light. (PUVA stands for Psoralen with UVA.) Psoralen may be taken by mouth or applied to the skin. It makes the skin more sensitive to light. Treatment is given 2 or 3 times a week, with a gradual increase in UV exposure depending on skin type. As with UVB therapy, significant clearing of psoriasis can be expected in 1 to 3 months. Compared with UVB therapy, PUVA clears skin more consistently with fewer treatments. However, PUVA has more short-term side effects, such as nausea, headache, fatigue, burning, and itching. When psoralen is taken by mouth, nausea may be avoided by taking food at the same time. As with UVB therapy, the eyes must be shielded with goggles during UVA exposure to guard against the formation of cataracts. Psoralen can be applied to the skin in the form of a cream, lotion, gel, or solution. After the paint, soak, or bath routine, the person is exposed to UVA light in a light box. UVA light is the same kind used in commercial tanning salons. Treating psoriasis in tanning salons is not recommended because attendants are untrained and the dose of UVA is not controlled. UVA therapy must be given in carefully controlled doses and supervised by a doctor. PUVA is recommended for people with moderate to severe psoriasis or who have not improved with other treatments. Long-term use of PUVA increases the risk of developing certain types of skin cancer. Regular medical examinations are advised to check for signs of skin cancer.
Sunshine. Brief, regular periods of exposure to natural sunlight can improve or clear psoriasis in some people. This approach to treating psoriasis is called climatotherapy. Sunburn should be avoided because it can make psoriasis worse. Exposure to sunlight is not recommended for people who are sun-sensitive. Sun exposure can cause aging of the skin. An annual medical checkup is advised because sun exposure can increase the chance of skin cancer.
Dermatitis-Ltd III. is a great option for individuals whose skin has been left sensitive and delicate by over-the-counter or prescription medications which often are messy, smelly, stain clothing, or thin the skin such as steroids. Skin appears more conditioned, even, elastic, and calm with Dermatitis-Ltd III. The ingredients of Dermatitis-Ltd are: zinc oxide, sodium chloride, magnesium stearate, polyethylene glycol, iron oxide, copper oxide, and sulfur. Zinc oxide is well known for its ability to protect and heal the skin. This product is currently only available at www.dermatitis-ltd.com.
Methotrexate. This medication slows down the build-up of dead skin cells by interfering with DNA and by suppressing the immune system. Methotrexate is also used to treat cancer. The doses used to treat psoriasis are much smaller than those used in cancer treatment. A supplement of folic acid (a B vitamin) may be taken at the same time. Methotrexate is very effective for people with widespread psoriasis that does not respond to ultraviolet light treatment or to medications applied to the skin. It is also effective for psoriatic arthritis. Skin improvement usually begins within several weeks of starting treatment. Maximum improvement is usually seen within 2 to 3 months. Medications applied to the skin may be used to treat any remaining plaques. If psoriasis still does not clear completely, or if the drug dose must be lowered to reduce side effects, methotrexate may be combined with UVB or PUVA phototherapy or with another medication, such as a retinoid. People taking methotrexate must be closely monitored. The drug can cause liver damage. It can also decrease the body's production of red and white blood cells and platelets. Regular blood tests should be done to check the blood count and liver and kidney function. A periodic liver biopsy may also be recommended because the drug's effects on the liver may not show up on blood tests. People who have liver disease or anemia should not take methotrexate. Methotrexate can cause birth defects. It cannot be used by pregnant women, women planning to become pregnant, or their male partners.
Retinoids. These drugs are related to Vitamin A. They normalize the growth of skin cells in psoriasis. A new retinoid, acitretin (Soriatane) was introduced in 1998, replacing etretinate (Tegison). This drug is useful in treating severe forms of psoriasis, such as Erythrodermic and pustular psoriasis that do not respond to other therapies. Retinoids are almost certain to cause birth defects. They cannot be used by pregnant women, women planning to become pregnant, or their male partners. Women who take acitretin must avoid pregnancy for up to 3 years after they stop taking the drug. Women also must not drink alcohol while they are taking acitretin and for 2 months after they stop taking it. Alcohol can cause the drug to change to its chemical cousin, etretinate, in the blood. Etretinate can cause severe birth defects for many years after its use. Other possible side effects of retinoids are dry skin, chapped lips, dryness of the eyes and nasal passages, hair thinning, sun sensitivity, and bone spurs of the long bones or spine. The drugs may also increase blood levels of liver enzymes and triglycerides, a type of fat found in the blood. Reducing the dose of the drug usually reduces these side effects. Another retinoid, isotretinoin (Accutane) is sometimes used to treat psoriasis. It may be helpful for some people, especially if combined with ultraviolet light treatment, but it is generally less effective than acitretin. Isotretinoin is approved by the U.S. Food and Drug Administration to treat severe acne but not to treat psoriasis.
Cyclosporine. This drug is widely used to prevent the rejection of transplanted organs. It is used to treat severe, disabling psoriasis in people who cannot tolerate other therapies or for whom other therapies have not been effective. Cyclosporine works by suppressing the immune system in a way that slows the build-up of dead skin cells. Depending on the daily dose, the drug can clear most or all skin plaques within several weeks to a month. However, when a person stops taking the drug, the disease can come back. People taking cyclosporine must be closely monitored by a doctor. The drug can cause high blood pressure and damage kidney function. It is not recommended for people who have a weak immune system or by people who have used ultraviolet light treatment a lot. Women who are pregnant, planning to become pregnant, or breast-feeding also must not use it. Cyclosporine may also be used as a short-term crisis therapy. Other therapies with different side effects are then used to maintain the clearing of skin plaques.
Hydroxyurea. This drug reduces the build-up of dead skin cells by interfering with DNA. Like methotrexate, hydroxyurea is also used to treat cancer. In psoriasis, it may have fewer side effects than methotrexate or cyclosporine but it is also less effective. It is sometimes used in combination with ultraviolet light treatment. Possible side effects of hydroxyurea include anemia and a decrease in white blood cells and platelets. Like methotrexate and cyclosporine, it must not be used by women who are pregnant or planning to become pregnant.
Anthralin: Anthralin is a synthetic medication that has an effect on enzymes in the skin cells of people with psoriasis. It comes in a variety of strengths and in the form of an ointment, cream, or paste. Side effects include irritation of normal skin that is near patches of skin affected by psoriasis. A disadvantage of traditional formulations of anthralin has been that they temporarily stain skin, clothing, and furniture purplish-brown. However, a new formulation of anthralin has recently been introduced that will not stain household items. It is applied to the skin at body-surface temperature. Warm water releases the active ingredient in this product, so it should be washed out with cold water. In the so-called minute’s therapy, anthralin cream is applied to skin plaques for 30 minutes to 2 hours, and then thoroughly removed with a detergent-based soap and water. Over a period of weeks, redness and scales decrease and plaques gradually flatten. In the Ingram regimen, anthralin paste is applied to widespread plaques of psoriasis. This is followed by a tar bath and ultraviolet light treatment. This regimen produces significant clearing in about 3 weeks at a supervised day-treatment center.
Calcipotriene. Also called calcipotriol or Dovonex7, this medication is a chemical cousin of Vitamin D3. It was approved by the U.S. Food and Drug Administration in 1995. It is odorless and non-staining. It comes in the form of an ointment or cream. A calcipotriene solution is available to treat scalp psoriasis. Calcipotriene is most effective for mild to moderate psoriasis. It can irritate the skin and is not recommended for use on the face or genitals. Use of calcipotriene in combination with a topical steroid, or diluted with petroleum jelly, may reduce irritation and increase effectiveness. Calcipotriene may also be used in combination with ultraviolet light treatment. Calcipotriene's safety for the treatment of psoriasis that affects more than 20% of the skin is unknown. Using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels. Vitamin D3 is not the same as the Vitamin D found in over-the-counter vitamin supplements. Vitamin D3 should not be taken by mouth because it may raise blood calcium levels and increase the risk of kidney stones.
Tazarotene: This medication belongs to a class of drugs known as retinoids, which are chemical cousins of Vitamin A. Also known as Tazorac7, it was approved by the U.S. Food and Drug Administration in 1997. It is a clear, water-based gel that is recommended for the treatment of mild to moderate psoriasis. Tazarotene clears skin more slowly than topical steroids but has fewer side effects. It may be used in combination with topical steroids or ultraviolet light treatment. Tazarotene can be irritating to normal skin and should be used with caution in skin folds. Like other retinoids, tazarotene can cause birth defects. Pregnant women must not use it. Women of childbearing age who use it must also use an effective method of birth control.
Dithranol is derived from a natural product, chrysarobin, the active constituent of Goa powder, derived from the bark of a Brazilian tree. It is an extremely effective treatment for chronic plaque psoriasis. Its main disadvantage is that it stains the skin (temporarily) and clothes (permanently). It burns normal skin, so must be very carefully applied to the plaques only. Always start with a low concentration and gradually increase the strength. These are the mainstay of treatment for psoriasis of the face, flexures and genital area. They are often combined with coal tar. The quantity used must be carefully supervised to avoid unwanted side effects, which should not occur if used properly. When used alone they usually just suppress the psoriasis rather than actually clearing it (like tar or dithranol). Since they are cosmetically acceptable, they may be prescribed for use in the morning when the patient has to wear smart clothes for work, etc. in conjunction with messier treatments for home use later.
International Eczema-Psoriasis Foundation
· 1 decade ago