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Dx Itching Treatments:

Atopic Eczema/ Atopic Dermatitis

N.H.S. Choices
"Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can continue into adulthood. Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term, or chronic, condition.

Atopic eczema commonly occurs in areas with folds of skin, such as:
*behind the knees
*the inside of the elbows
*on the side of the neck
*around the eyes and ears

Atopic eczema can vary in severity and most people are only mildly affected. Severe symptoms include cracked, sore and bleeding skin. People with atopic eczema usually have periods when symptoms are less noticeable, as well as flare-ups when symptoms become more severe, needing additional treatment.

The exact cause of atopic eczema is unknown. However, it often occurs in people who get allergies ("atopic" means sensitivity to allergens). Atopic eczema can run in families and often occurs alongside other conditions, such as asthma and hay fever.

Atopic eczema clears up or significantly improves in many children as they get older. In about 53% of cases, atopic eczema clears up by the time a child reaches 11 years of age, and in 65% of cases it clears up by 16 years of age.

Many different types of treatment can be used to control symptoms and manage eczema, including medication and self-help techniques.
The main treatments are:
*emollients (moisturizing treatments) – used all the time for dry skin
*topical corticosteroids – used to reduce swelling and redness during flare-ups

About one in five children in the UK has eczema. In 8 out of 10 cases, atopic eczema occurs before a child reaches five years of age. Many children develop it before their first birthday.The number of people diagnosed with atopic eczema has increased in recent years. This could be because of changes in lifestyle or environmental factors ...Males and females are affected equally.

*[Editor]There are a number of more severe 'itching' states for which the potent medications may be necessary. For most cases of dermatitis, treatment starts with emollients and progresses to low dose inexpensive topical steroids[once daily].

Medications Used in Treatment:
1. Corticosteroids: prednisone, Cutivate®/fluticasone, Kenalog®/triamcinolone, Clobex®/clobetasol; Solu-Medrol®/methyprednisolone sodium succinate, Depo-Medrol®/methyprednisolone acetate;
2. Skin Barrier Emollients: Epiceram®, Neosalus®, Prumyx®
3. CNI Immunosuppressants: Protopic®/tacrolimus, Elidel®/pimecrolimus
4. Keratolytics: X-Viate®/urea
5. Tricyclic Antidepressants: Zonalon®, Prudoxin®/doxepin (Creams)
6. Antiprotozoal: Alcortin® Aloquin®/aloe polysaccharide-iodoquinol

Suggested Links:
*Merck Manual Home Edition

*[Editor] The doxepin creams Prudoxin®, Zolalon® are proven to reduce pruritis (hives) "while topical antihistamines are widely prescribed for the treatment of pruritus, the evidence to support their use is mixed.

Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy (thin skin) from topical corticosteroids.

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