Atopic Dermatitis (Eczema)
Many Canadian children have atopic dermatitis , which can last into adulthood. Eczema can have a lasting adverse effect on people’s lives, both physically and psychologically. Among the current treatment options for atopic dermatitis are topical calcineurin inhibitors, also known as topical immunomodulators. In Canada these topical medications are available as either Elidel ® cream or Protopic ® ointment. These topical agents can be used alone or in conjunction with other medication.
To ensure safety, clinical studies have been done on 38,000 people, including 14,000 children under the age of 17. Two cases of non-lymphoma cancer were discovered. There were no cases in children. Scientists usually expect to find three lymphomas among such a large group.
In North America, nearly seven million patients are safely using Elide ® or Protopic ® products. In the spontaneous reporting program (which means that companies making medications and other treatments must report to government if there is an adverse affect in people taking their products), there were 25 cases of malignancy, four of them in children 2-16 years old, out of the nearly seven million patients on these medications (13 lymphomas). Normally, in a group of this size, the companies would expect to learn about 61 cases of lymphoma.
This means that not only were there fewer cases of cancer and lymphoma in both children and adults than scientists were expecting to find but also external experts have assessed these as unlikely to be linked to the use of Elidel ® cream or Protopic ® ointment.
Please feel free to discuss the contents of this fact sheet with your dermatologist – your skin expert.
The Canadian Dermatology Association’s mission is to promote the highest quality standards of dermatologic care in Canada. Part of this mission is to help ensure that patients are prescribed safe and effective medications.
A person with eczema has very sensitive skin. Itch results in scratching, making the eczema worse. Conditions which sometimes aggravate everybody’s skin often result in outbreaks of eczema in persons with this sensitive skin; eg:
- Dryness from exposure to dry winter air and excessive soap and water
- Extreme heat which produces sweating
- Irritating clothing and chemicals
- Stress and emotional upset
- Rarely, allergies to foods
- Staphylococcal secondary infection
- Use lukewarm water for shower or bath, sometimes 2 or 3 times per day.
- Short duration, less than 5 minutes, may bath daily.
- Use a mild skin cleanser such as Dove, Oilatum, Petrophylic Bar, Spectro Jel, or Cetaphil Cleanser.
- Apply creams or ointments to the wet skin and pat dry.
- Apply to damp skin daily, e.g., Ciiniderm, Schering Base, Moisturel, Aveeno, Glaxal Base, Vaseline Creamy, Petroleum Jelly, Aquaphor. Avoid products containing urea and alpha hydroxy acids.
- Avoid wool and rough clothing, cotton is better.
- Wear loose light appropriate clothing during the warm weather.
- Two pairs of boots for winter so that one is always dry.
- Wear leather shoes.
- Rubber gloves, preferably over cotton gloves for all wet work.
- Cut fingernails and toenails short and file smooth on a regular basis
- Such as mild products, eggs, chocolate, nuts, shellfish, and fruits may occassionally cause a flare of eczema in infants.
- Any suspicious foods should be avoided for several weeks and then reintroduced for confirmation.
- Vacuum bedroom carpet daily
- Use special mattress and pillow covers under a cotton liner or mattress cover (Vital Aire)
- Change furnace filters every 3 to 4 months
- Wash sheets and mattress cover frequently
- Prescription creams or ointments – if steroid (cortisone) creams are used, it is best to control the eczema with the weakest one possible, even though sometimes stronger ones are necessary for short periods of time.
- Antihistamines orally – very helpful when scratching leads to poor sleep.
- Antibiotics are sometimes necessary to treat secondary infection.
- Avoid contact with persons with cold sores.