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Difficult to treat eczema: a review of medications

Sometimes moisturizers and steroid creams aren’t enough. Many patients with severe eczema (atopic dermatitis, AD) require oral medications to keep their skin clear and itching under control. A recent article out of Amsterdam and Germany, reviewed the risks and benefits of several systemic therapies*. Here are the recommendations:
  • Cyclosporin A: first-line short term treatment option for moderate to severe AD. Higher doses (5 mg/kg/day) lead to a more rapid response and higher efficacy.
  • Azathioprine: second-line treatment option.
  • Methotrexate: third-line treatment option for adults.
  • IFN-γ: third-line treatment option.
  • Systemic steroids: not recommended.
  • Intravenous immunoglobulin: not recommended.
  • Montelukast (Singulair): not recommended.
  • Traditional Chinese herbal medicine (TCHM): not recommended.
  • [glossary slug=’mycobacterium-vaccae’ /]: not recommended.
  • Thympopentin-5 (an immunostimulant): not recommended.
What was not included: What needs to be stated:
  • All of these medications can have significant side effects.
  • It is important to maximize topical treatments, including moisturizers and medications.
  • It is important to identify and minimize exposure to triggers, including foods and contact allergens.
  * Roekevisch E, Spuls PI, Kuester D, Limpens J. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: A systematic review. Journal of Allergy and Clinical Immunology 2014; 133(2) 429-438.

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