There may be more relief on the horizon for the millions of children who suffer from eczema, a chronic affliction that leaves them so itchy that they sometimes scratch until they bleed.
Researchers believe an ointment version of tacrolimus, a drug widely used for transplant patients, may be a good alternative to the mainstay treatment for eczema–corticosteroid creams. Meanwhile, researchers have discovered that massage may ease the anxiety of children with eczema as it reduces symptoms.
A recent study published in the New England Journal of Medicine reported that tacrolimus doesn’t share the side effects caused by regular use of potent prescription corticosteroid creams, also known as topical steroids. The creams control inflammation and severe itching but also can discolor and destroy layers of skin, making it vulnerable to open wounds and infections.
Researchers discovered that eczema disappeared after three weeks in three-quarters of the patients using tacrolimus, with the only apparent side effect a burning sensation.
The drug now is given to transplant patients to depress the immune system and increase chances the body will accept the organ.
More research is needed to determine the safe dosage and duration of treatment for pediatric eczema. The drug’s manufacturer, Fujisawa, plans to seek approval from the federal Food and Drug Administration next year, says Eileen Jaracz, a company spokeswoman.
An alternative to current treatments would be good news for patients with severe eczema. About 5 percent of the roughly 5 million children nationally with eczema are severely affected.
“For those patients who need something better than what we are doing now, this gives us some hope,” says Dr. Stuart Sobel, a dermatologist in Hollywood, Fla.
In most cases, eczema first appears in infancy, but most children outgrow it by age 8. For about 10 percent of sufferers, the eczema returns in adulthood. The cause is a mystery, but factors such as stress, allergies, changes in temperature and lack of sleep can trigger the itching and redness.
For some, those symptoms can be downright miserable.
Three-year-old Catie Kezar of Plantation, Fla., has eczema on 90 percent of her body.
“She doesn’t know what it’s like not to be in pain or itchy,” says her mother, Catharine. “She itches and scratches until she has open wounds.”
Catie takes a battery of medications every day to fight the eczema, including steroid ointments, an oral antihistamine before bed to relieve the itching and help her to sleep, a teaspoon three times a day of an oral steroid to stop the itching and antibiotics three times a day to fight infection in the wounds. Sometimes, she gets a yeast infection from the antibiotics.
“You have to be constantly changing the medicine because it becomes ineffective,” her mother said.
The anxiety and sense of rejection experienced by many young eczema sufferers can be almost as challenging as the treatment.
“Massage therapy may reduce a child’s sense of not wanting to be touched, while allowing parents the chance for positive bonding activity,” says Dr. Lawrence Schachner, a professor of pediatrics and dermatology who also is director of the division of pediatric dermatology at the University of Miami.
In a comparative study at Miami’s Touch Research Institute, a research arm of the University of Miami Medical school, Schachner found that, when a parent massaged a child 20 minutes a day in addition to giving the standard emollient and anti-inflammatory treatment, the child experienced less redness, scaling and hardening of the skin than did those in a group given standard therapy alone.
Parents massaging their children noticed that the children were more relaxed at the end of the study. And massage therapy has benefits for the parents as well.
What can you do for eczema? Doctors offer this advice: Don’t use soap; it dries and irritates the skin. Better choices are non-soap cleansing or moisturizing agents, such as Aveeno or Emulave. Whatever you use, it should be fragrance-free and labeled safe for sensitive skin.
Children should take a daily bath or shower for no more than 10 minutes in warm, not hot, water. This allows the skin’s top layer to become full of water but doesn’t deplete the skin’s natural moisturizers.
After bathing, pat away excess water and, within two minutes, apply a thick moisturizer or any special skin medication onto damp skin. Dr. Ana M. Duarte of Miami Children’s Hospital recommends Cetaphil. This helps re-establish the skin’s barrier function and control infection.
