Other therapies and treatments
Phototherapy
There are two types of phototherapy, both involving exposure of the skin to light for a short period, usually on an outpatient basis. UVB light therapy involves exposing the skin to UVB light and PUVA involves exposing the skin to UVA light after taking a drug called psoralen. The side effects of these treatments include sun burn type immediate reactions, potential long term side effects include premature skin aging and skin cancers. Because of concerns about long term side effects it is only likely to be used in children with severe eczema.
Systemic therapy
This means the use of oral drug treatments to control eczema. These include oral steroids and immunomodulating drugs such as ciclosporin and mycophenolate mofetil. These drugs work by damping down the immune system and so improving eczema. Steroid drugs do this very effectively but their use is limited by their side effects which in children includes growth retardation. Often other immunomodulating drugs are used to control eczema and limit the amount of steroid drug a child is exposed to. These too can have serious side effects and may require regular monitoring for toxicity. All of these drugs impair the immune response to infection. Systemic therapy is reserved for the most serious cases of eczema.
| Drugs used for systemic therapy of eczema | ||
|---|---|---|
| Name of drug | Type of drug | Side effects and monitoring |
| Steroids e.g. Prednisolone | Immunosuppressant | Usually used in short courses to minimise side effects, which include osteoporosis, high blood pressure, diabetes, adrenal suppression, psychiatric problems and impaired growth. |
| Ciclosporin | Immunomodulating drug | May cause kidney damage – regular blood monitoring is required. |
| Azathioprine | Immunomodulating drug | May cause bone marrow suppression – regular blood monitoring required. May cause impairment of liver function and jaundice. |
| Mycophenolate moftetil | Immunomodulating drug | May cause bone marrow suppression – regular blood monitoring required. Increased risk of skin cancer. |
Other treatments used
There are other treatments used for eczema that are not part of the step treatment process that may be used at any stage -:
Antihistamines
These are oral drug treatments that can reduce itching particularly when itching is severe and where there is associated urticaria (a rash often caused by contact with something to which a person is allergic). There are two types of antihistamines used in eczema. Sedating antihistamines promote sleep in addition to reducing itch and can be used at night to aid sleep. Non-sedating antihistamines can be used during the day the day to reduce itch.
| Names of Antihistamine medication | |
|---|---|
| Non-Sedating | Cetirizine, Desloratidine, Fexofenadine, Levocetirizine, Loratidine, Mizolastine |
| Sedating | Alimemazine, Chlorpheniramine (Piriton), Hydroxyzine, Promethazine |
