New Medicine For Troublesome Eczema

Question: Our teenage son has had eczema all his life. His skin is very dry. The eczema is worst around his elbows, on his hands and feet. Dry air in winter usually makes it worse. Lately his eczema flared up after he was involved in sports. We have always used steroid cream to keep the eczema under control. A friend told us that there is a new cream which can help eczema. Can you tell us something about this new medicine?

Answer:

Before discussing about this new medicine for eczema, it would be helpful for other parents and readers if I start off by explaining about eczema first.

Eczema is an allergic condition of the skin. It is a genetic condition, so one is born with the tendency for eczema. However, this allergic tendency may not be limited to the skin, but can involve other allergic conditions like hayfever and asthma.

There are many triggers for eczema. In young children, food allergy is a common trigger. Some of the foods that have been implicated include cows’ milk, wheat, eggs, peanuts, and even soy.

One of the hallmarks of eczema is itchiness. Those who have eczema would know how difficult it is to try to stop scratching. However, the more one scratches, the worse the eczema gets. A good part of the problem of eczema is scratching itself. That is why eczema is so difficult to treat in young children—you just can’t tell them not to scratch!

The skin in eczematous children is often dry. The rash of eczema is usually red, swollen, and bumpy. Sometimes the skin may crack and leak out clear to yellowish fluid. Secondary bacterial infection is very common. Over time, the skin over the eczema can become much thicker than normal, this is called lichenification.

Eczema in infants often involves the cheeks, the chin, behind the ears, in the armpits, as well as at the elbows and behind the knees. The itchy skin frequently makes these children very irritable, and many of them cannot sleep through the night. Their parents quickly learn that this condition tends to be worse in winters when the air is dry.

However, it is not uncommon that excessive heat and sweating can also make eczema worse. This is evidently the case in your teenage son. Involvement in sports can also increase the chance of skin trauma, which may be partly responsible for his recent flare-up of eczema.

Topical steroids have been the standard treatment of eczema for the last few decades. It is very useful and highly effective. However, excessive use of steroids can induce unwanted side effect, especially thinning of the skin over the face.

In recent years, research has focused on the immune system’s role in a number of allergic conditions, including eczema. Although we still do not fully understand how the immune system affects eczema, it is safe to say that certain specialized immune cells called T-lymphocytes play a key role in development and persistence of eczema.

Because of this understanding, extensive research was dedicated at finding chemicals that can alter the functions of these T-lymphocytes. These chemicals are called immuno-modulators. The first one that was approved for use in Canada for the treatment of eczema is called Tacrolimus (Protopic). It is available in 0.03% ointment for children, and 0.1% for adults.

Research has shown that this ointment is very effective in controlling eczema without some of the side effects of topical steroids. Mild irritation is often experienced during the first few days of treatment. Fortunately, no serious side effect has been reported thus far. One significant drawback is the high cost of Tacrolimus ointment, although only a small amount is sufficient for each application.

Whether your son should try this new medicine, or he should continue to use the topical steroids he has used for many years, should be decided with your family doctor. One thing is certain: this new class of immuno-modulators offers another avenue in the management of eczema. It is very likely that further research will show similar benefits for other allergic conditions where the immune system plays an important role.

[Note to Readers: Another similar medicine called Elidel 1% was also approved in Canada for treatment of eczema.]