Eczema - Patient's guide

Treatment of Eczema Complications

There are a number of complications associated with eczema:

Bacterial Infections

Bacterial infection is almost inevitable in atopic eczema. This may cause a flare up of symptoms and signs of eczema. Most patients with active eczema will carry Staphylococcus aureus on the skin. Sometimes yellow crusting is seen as with impetigo but more frequently the skin only shows erosions. This bacteria may cause a flare up of itching and inflammation.

Treating the colonization helps with the control of eczema. The use of Bactroban cream in the nose and perineum at night for 5-7 days will suppress staph carriage for some time. If involvement of the skin is localized topical antibiotics such as Mupirocin (Bactroban) or Fucidic acid (Fucidin) are useful. Systemic antibiotics are best if there is extensive skin involvement.

See also:  Bacterial Infections

Viral Infections – Herpes Simplex

Infection with herpes simplex in atopic dermatitis is called Kaposi’s varicelliform or eruption of eczema herpeticum. This occurs when there is active atopic dermatitis. There is a sudden outbreak of small pustules and vesicles. They frequently erupt. There is often secondary crusting. There are hemorrhagic areas that become eroded and painful. There are punched out ulcers that are quite distinctive. At times this outbreak can be very localized although it may spread to involve the whole face, chest or arms. Very occasionally it can become generalized. Secondary staphylococcus is very common. When this is extensive it can be potentially life threatening.

Treatment:

Treatment of this involves discontinuation of topical steroids. Tepid water compresses on the affected area can be helpful. Treating the secondary staphylococcus infection with antibiotics such as cloxacillin is vital. The use of oral anti-viral medications such as Acyclovir and Famciclovir or Valacyclovir is also beneficial.

See also:  Herpes

Molluscum Contagiosum

This is a pox virus infection. It is much more common in eczema and is often more extensive that in non-atopics. Cryotherapy with liquid nitrogen is preferred treatment by some.

Warts

Warts are more common in people that have eczema.

See also  Warts

Fungal Infections

Fungal infections are also common in patients that have eczema.

Allergy to Topical Treatments Including:

• Medication
• Topical steroid creams
• Perfumes
• Preservative

Alternative Therapy Complications:

The risk of hepatotoxicity is documented. There is a case reported of a dilated cardiomyopathy with this.

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 ...

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