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The treatment of eczema is complex and involves a total management programme. There is no one cream or treatment that will cure the problem. Prevention constitutes the most important aspect of eczema therapy, especially the avoidance of aggravating factors as mentioned above.
Moisturizing creams Moisturizing creams are the mainstay of treatment for children with eczema. It is important that children are bathed daily in a bath containing oil, for example Aveeno Bath Oil, Hamilton’s Bath Oil or QV Bath Oil, and that this is followed by the use of a good moisturizing cream. Over-the-counter moisturizing creams such as Aquatain, E45 cream, QV cream, 10% glycerol in sorbolene cream, 5% peanut oil in aqueous cream and 10% olive oil in sorbolene cream are just a few of the excellent preparations available.
Anti-itch creams Over-the-counter anti-itch creams should be avoided as they do not treat the underlying eczema and often cause severe allergic reactions. These include topical anesthetic and topical antihistamine creams.
Topical cortisone creams Topical cortisone creams are essential in the management of active eczema. Unfortunately, they have acquired an undeservedly bad reputation, yet cause very few problems or side effects. Topical cortisone creams are not absorbed into the circulation in significant amounts.Strong topical cortisone creams should not be applied to the face as they can lead to thinning of the skin, but they may be used intermittently on other parts of the body. Mild cortisone creams, such as hydrocortisone cream, can be safely used on the face and body.Cortisone creams are often used too sparingly and infrequently to be very effective. This can result in the eczema actually becoming more uncomfortable and itchy. Secondary infection may then develop from constant scratching.
Tar creams Although tar-based creams are still used in mild cases of eczema, they have largely been superseded by topical cortisone preparations. The effectiveness of tar creams varies enormously, depending on the source of the particular batch of tar. Their effect is therefore difficult to predict.
*9/150/5*
Sun damage, as has been mentioned, is cumulative over the years. In this aspect it is like alcohol and cirrhosis of the liver, or smoking and lung cancer. For many years nothing appears to be happening, and then after a certain latent period, which depends on your skin type and the amount of exposure received, the damage appears.
Certain degenerative changes of the pre-cancerous type can be treated. These changes include patchy pigmentation (‘liver spots’), early wrinkling, and dry, scaly patches or keratoses.
Cryosurgery, or freezing, with either carbon dioxide snow or liquid nitrogen, is one of the commonest methods used. This selective destruction of damaged skin is induced by the extremely cold temperatures of these substances. Following their careful application, either to selected lesions or to a larger damaged skin area, blistering is induced. Once the blisters heal, smooth normal-looking skin remains.
Electrodessication has a similar effect to cryosurgery but is induced by the heat of an electric cautery. This is usually carried out under local anaesthetic, and has the advantage of being very accurate, therefore useful for small lesions. It can also be used with curettage, enabling deeper lesions to be removed.
Chemosurgcry, using chemicals such as 5 Fluorouracil, has become more common in recent times. This chemical is applied to both normal and abnormal skin for a period of about three weeks. It is able to inflame and subsequently destroy certain superficial malignant lesions and the latent pre-malignant ones. It is also able to uncover and destroy lesions that are clinically undetectable. The major disadvantage of this method is the severe skin inflammation it induces.
Peeling techniques, using either trichloracetic acid or phenol, are another form of treatment. This procedure destroys living tissue, and may be used on small lesions or larger skin areas. Recently it has been advocated for the treatment of more extensive sun damage, including wrinkling, particularly about the mouth, where it is often used in conjunction with a facelift. Great skill is required to perform this procedure satisfactorily.
Finally, dermabrasion may be used. Here the skin is snap-frozen to anaesthetize it, and a rapidly rotating brush is stroked across the skin to remove the damaged upper layers. Swelling and extensive crusting develops in 48 hours, and disappears gradually over the next ten days, leaving the underlying skin thinner, smoother, and pinker than before. It resumes a normal, undamaged appearance anywhere between six weeks and six months later.
All these procedures destroy the damaged epidermis and upper dermis, allowing regeneration of undamaged skin from below to occur.
If It were no longer fashionable to be tanned and people realized that tanning was by no means a harmless procedure, then dermatologists would lose at least a quarter of their patients and beauty salons more than half their clients.
*102\44\4*