Eczema Oral Treatment

Possible oral treatments for eczema are antibiotics, antihistamines, corticosteroids, and cyclosporine A (Neoral).

Antibiotics

The use of oral antibiotics to reduce bacterial load is certainly helpful in difficult cases. Frequently this can be used with benefit even though there are no obvious signs of infection. There is normally a colonization of staph aureus even in normal looking skin in atopic individuals. The use of topical antibiotics such as Bactroban® (click here to view the A-Detail™ on Mupirocin (Bactroban®)) or Fucidin have shown some benefit but are not as easy to use compared to the systemic approach when the eczema is extensive.

Cloxacillin, erythromycin or cephalosporins may be needed for a few weeks.

Antihistamines

Oral antihistamines have been helpful in reducing itch. The sedating antihistamines appear to give the best effect. These are usually used at bedtime. They will also help with any urticarial component of eczema. Hydroxyzine has been used with good effect. Doxepin also has a sedating value. (Klein PA, Arch Derm 1999;135:1522-5)

The importance of stopping itching is to reduce scratching, especially at night. This is an important component of therapy.

Non-sedating antihistamines do not appear to be as effective as the traditional sedating drugs.

Corticosteroids

Short courses of oral prednisone are occasionally used in severe intractable cases. Rebound of eczema is a concern as well as long-term side effects in those who demand or are unable to quickly wean off the medication.

Systemic steroids in the form of IM Triamcinalone can be very effective in stubborn cases. Potential serious side effects including possible avascular necrosis of the hip must be discussed before starting systemic corticosteroids.

Cyclosporine A (Neoral)

This is restricted for severe cases. It allows significant improvement. It is often started at a dose of 3mg. per kg. per day and is used to a maximum of 5mg. per kg. per day. Concerns about hypertension and renal problems are important concerns for this drug.

Cutivate^® (Fluticasone propionate)

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INTRODUCTION
A synthetic fluorinated corticosteroid recently introduced to Canada but has been available in the U.S market for a number of years. Fluticasone propionate is classified as a medium potency topical corticosteroid... | Read more ...

CLININCAL EXPERIENCE
Topical corticosteroids are extensively used. Atopic eczema will be used as a model for discussing this new topical corticosteroid. A concern with the use of any long term medication is the potential for... | Read more ...

INDICATIONS
Used for all inflammatory and pruritic conditions that are corticosteroid responsive e.g. eczema, psoriasis and dermatitis. It should not be used in rosacea, acne, or perioral dermatitis... Read more ...

PATIENT PROFILE
4 double blind randomized controlled studies in 772 adults and children showed the once the acute episode of moderate to severe eczema had been treated effectively that twice weekly... | Read more ...

DOSING
For the acute stage of eczema daily application of Cutivate is recommended. New evidence guides us to apply Cutivate twice a week to maintain control of eczema... | Read more ...

EFFICACY
Although not indicated for use on children in Canada, studies have shown that once daily application is safe and effective in children with atopic eczema... | Read more ...

COMPLIANCE
Daily application in the acute phase and thereafter twice weekly maintaince should help with compliance ... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Approx 270 million packs sold since 1990 in US ... | Read more ...

COST OF TREATMENT
Cost of this drug is in line with other potent topical corticosteroids. Cost effectiveness is seen if effective clinical response is realized. The utilization of a twice a week regimen significantly reduces costs... | Read more ...

View the entire Cutivate® (Fluticasone propionate) presentation.