While antihistamines relieve itching from hives, which are caused by histamine release, the underlying cause of the itching from atopic eczema is quite different from that of hives and involves mechanisms other than histamine. AntihistaminesĪlthough classical antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax or Vistaril) have frequently been prescribed for atopic eczema, studies hav atopic eczema. and Europe have taken exception to the implication of those warnings and emphasize the effectiveness and safety of the TCIs for use when intermittent use of appropriate topical corticosteroids are not adequate for control or require more frequent use or higher potency products than are safe. Although the FDA has placed a “black box” warning on the labeling of the TCIs, major allergy and dermatologic societies in the U.S. While not necessarily having greater effectiveness that the more potent topical corticosteroids for clearing eczema, their ability to be used continuously with safety makes them useful as maintenance therapy for eczema that tends to flare shortly after a topical corticosteroid is stopped An appropriate topical corticosteroid can be applied for limited periods in addition to the regular application of the TCI for breakthrough eczematous flares. Studies of continuous use in children for periods longer than a year have been associated with no adverse effects. A major advantage of these agents is the absence of the potential for thinning of the skin and cosmetic changes associated with the topical corticosteroids. They are not a replacement for skin care but may provide an alternative to topical corticosteroids when those are not effective or require excessive use. They currently are indicated primarily for atopic eczema that does not respond to conventional therapy with skin care and low potency topical corticosteroids. They are in a new class of drugs called “topical immunomodulators” or more commonly “topical calcineurin inhibitors” (abbreviated as TCIs). These are the newest medication for atopic eczema. Protopic (tacrolimus) and elidel (pimecrolimus) Apply the medication to the affected area.Īmount of cream or ointment to use on affected area (in fingertip units):.Squeeze out a line of medication from the tip of your finger to the first skin crease.How to measure the amount of cream or ointment to apply: In general, it is best to avoid sustained use of topical corticosteroids for periods longer than 2 weeks at a time, although resumption is likely to be needed when inflamed areas return. Topical corticosteroids should be stopped in areas that become clear. Nothing more potent than 1% hydrocortisone cream should be applied to sensitive areas such as the face or genitals, since sustained use of higher potency topical corticosteroids can cause thinning of the skin with permanent cosmetic changes. Occasionally, a medium potency steroid such as triamcinolone may be required. The use of a relatively low potency topical steroid, such as 1% hydrocortisone is usually sufficient for most children. Topical corticosteroids are classified by their level of potency. Never apply the moisturizer just before the steroid. The steroid should always be applied to the skin first and the emollient moisturizer applied after to all of the skin. One of the applications should be applied immediately after the evening bath, while the child's skin is still wet. Topical corticosteroids should be applied once to twice daily specifically to the areas of inflammation, that is the areas that are red, pink, and itchy. Ointments are reserved for more resistant areas where the skin is thick and dry. Ointments are like Vaseline and tend to feel somewhat oily or greasy for a while after they are applied. Creams are white and not very oily or greasy once applied. The judicious use of an appropriate topical steroid is a safe and essential part of treatment. A topical corticosteroid cream or ointment
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