23 years
Hello, Due to stress eczema appeared in my hands. I asked a doctor and he gave me cutivate but it didn't work. So is there any treatment for it, Regards.
Aug 16, 2015
Management of atopic dermatitis requires the elimination of exacerbating factors, restoration of the skin barrier function and hydration of the skin, patient education, and pharmacologic treatment of skin inflammation.
- Exacerbating factors in atopic dermatitis that further disturb the already abnormal epidermal barrier include excessive bathing not followed by adequate moisturization, low humidity environments, emotional stress, xerosis (dry skin), overheating of skin, and exposure to solvents and detergents Avoiding these tirggers is helpful for acute flares as well as for long-term management.
The role of environmental or food allergies in exacerbating atopic dermatitis remains controversial. Hypersensitivity to house dust mites (eg, Dermatophagoides pteronyssinus, D. farinae), animal danders, molds, and pollens is linked with flares of atopic dermatitis. However, reduction of house dust mite antigens in the atopic patient's environment did not yield significant disease control.
Individuals with atopy are are more prone to develop allergic contact dermatitis (ACD) to nickel as well as many components of topical treatments (eg, fragrances, preservatives etc.) ACD should be suspected when patients do not show good response to appropriate topical therapy or when affected areas continue to spread beyond the usual flexural locations.
Skin hydration is vital for the overall management of patients with atopic dermatitis. Lotions, which have a high water and low oil content, can worsen xerosis via evaporation and induce a flare of the disease. In contrast, thick creams (eg, Eucerin), which are low in water, or ointments (eg, petroleum jelly, Vaseline), which have zero water content, better protect against xerosis, but are greasy. To maintain skin hydration, emollients should be applied at least two times per day and immediately after bathing or hand-washing.
Atopic skin is known to be deficient in lipids (especially ceramide), so using moisturizers that contain those ingredients may be beneficial.
The association between atopy and frequency of bathing, and whether showering or bathing is preferable in patients with atopic dermatitis, is a debatable subject. Most authorities recommend a hydrating bath followed by immediate emollient application, but others recommend a shower of short duration.
Antihistamines may aid in controlling itchiness.
For the optimal management of eczema, disease severity is an important factor:
●Mild – Areas of dry skin, infrequent itching (with or without small areas of redness); little impact on everyday activities, sleep, and psychosocial wellbeing
●Moderate – Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening); Moderate impact on everyday activities and psychosocial wellbeing, frequently disturbed sleep
●Severe – Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation); severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep.
Topical steroids, and emollients are the mainstay of therapy. The choice of the steroid potency is determined based upon the patient’s age, body area involved, and degree of skin inflammation. Topical calcineurin inhibitors may be an alternative to topical corticosteroids, in particular for the treatment of the face, including the eyelids, neck, and skin folds.
Topical corticosteroids:
For patients with mild atopic dermatitis, a low potency corticosteroid cream or ointment, like the one you’re using (like Cutivate, generic fluticasone propionate) is recommended. Application once or twice per day for two to four weeks. Emollients should be abundantly used multiple times per day in conjunction with topical corticosteroids.
For patients with moderate disease, medium to high potency steroids (eg, triamcinolone 0.1%, betamethasone dipropionate 0.05%) are recommended. In patients with acute flares, topical steroids (can be used for up to two weeks and then replaced with lower potency preparations until the lesions resolve.
The face and skin folds are areas that are at high risk for atrophy with corticosteroids. Initial therapy in these areas should start with a low potency steroid (such as desonide 0.05% ointment. High potency topical corticosteroids are generally avoided in skin folds and on the face.
Maintenance therapy: after induction of remission, intermittent therapy with moderate to high potency topical steroids applied once daily to previously affected skin areas for two consecutive days per week (ie, weekends) for up to 16 weeks is recommended, in parallel with emollients many times per day.
You may want to shift to a more potent topical steroid such as a Betamethasone-based cream (e.g. Betnovate®) to control the eczema, then back to Cutivate for maintenance therapy.
Topical calcineurin inhibitors
These are nonsteroidal agents that locally (on the skin level) modulate the response of the immune system. Unlike steroids, they do not lead to skin atrophy. They can be used as an alternative to topical steroids for the treatment of mild to moderate atopic dermatitis involving the face, including the eyelids, neck, and skin folds. The most widely used and effective topical calcineurin inhibitors are Tacrolimus ointment and pimecrolimus cream are applied twice a day. Tacrolimus comes in two strengths; the 0.1% formulation is appropriate initial therapy for adults. In patients who do not tolerate tacrolimus because of burning or stinging, pimecrolimus may be better tolerated.
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First try to avoid getting exposed to irritant products sometimes even by wearing gloves, you will need to use moisturizing soaps when washing your hands and to apply on daily basis at least once to twice per day a moisturizing handcream, whether the eczema is active or not as long as you have dry skin. Cutivate is a very mild treatment for eczema of the hands and I won't expect it to help except in mild cases. If your eczema is moderate to severe you will need a stronger treatment cream. However the strength of the cream should be defined upon evaluation and I would advise you to get back to your dermatologist to change the treatment cream for you.
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