Topical steroids have been both extensively used and found to be very effective for the treatment of eczema. Concerns about side effects both on the skin and systemically has increased acceptance of the new steroid free alternative. Worries about long term use of a cortisone cream making the skin less responsive to treatment is a potential risk and is occasionally a concern. This may not occur with the topical immunomodulators but longer term studies will be needed to confirm this.
The new topical immunomodulators (TIMS) provide a significant new choice in the treatment of atopic eczema. They are used as a steroid-sparing medications. There is a discussion whether the immunomodulators should be used alone as monotherapy. Good evidence is available to show that using a potent topical cortisone twice a week only will reduce and may prevent eczema flares. If this was combined with intermittent use the immunomodulators this might further reduce flares. However some TIMs may reduce flares on their own.
For locations such as the face, folds and anterior upper chest the topical immunomodulators seem to be effective, well tolerated and free of significant side effects other than initial and minimal burning.
The following charts simplify some of the anti-inflammatory options:
Seborrheic dermatitis is a common, chronic, inflammatory skin condition that frequently affects the scalp, scalp margins, eyebrows, base of eyelashes, chest, upper back, nose and ears. It can cause patches of white or yellow scales over greasy skin, redness, rashes, and dandruff. The yeast Malassezia , genetic and environmental factors are believed to play a role in seborrheic dermatitis. In infants, seborrheic dermatitis affects scalp and forehead and often called “cradle cap.” Adolescents and adults of all ages are susceptible, particularly those with a coexisting neurologic disease or who are HIV positive.
My doctor sent me to a dermatologist-he took one glance and declared I had perioral dermatitis. Put me on a course of antibiotics. It would clear up, and then start coming back. The dermatologist keep saying don’t worry we have more antibiotics to try. I tried 3 different kinds with the same results and decided to go off completely. Went to a naturopath-was prescribed a bunch of extremely expensive stuff-didn’t work. Decided to live with PD. Tried every natural remedy known to man. Would flare up and subside, but never go away. Then I became pregnant and after my baby was born I decided I had to do something about this as the flareups were getting worse and leaving scars. During my pregnancy I’d met a girl in my friends clothing shop who had claimed to have had PD, even though her skin was beautiful, and said she had gone to so and so at WellSpring health Vitamin shop and taken what he prescribed. Now I had a Homeopath for a sister-in-law who couldn’t help me and also a good friend who worked in a vitamin store who had not been able to help me either. I was decided it was worth it anyway. This person listened to me, asked me my blood type and heard all my symptoms. He said I need to be on high doses of B5-pantothenic acid. Combined with New Chapter breast feeding formula vitamins 3 x’s a day, fish oil, high dose probiotics and magnesium plus NAC-N-acetyl Cysteine. So we are taking about 1000mgs of B5 3x’s a day. NAC before bed. Magnesium 3 x’s a day, probiotics 3 x’s a day, fish oil once and breast feeding vitamins 3x’s a day. Well, within 12 hrs that familiar burning inflammatory skin feeling went away. Then 24 hrs later the PD started to fade, just fade away. Within a week-it was gone. I was on this cycle of vitamins for 6 months-then lowered the doses of B5. Now, years later, I take this combo to maintain when I’m feeling stressed or I notice one or two tiny red bumps-which always appear around my period.