For Eczema Sufferers, New Relief And Old Myths

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For Eczema

Sufferers, New Relief And Old Myths

New York Times News Service

Ask the millions of parents whose children have

had the hereditary skin condition eczema and many will report that the first

" trick " their babies learned was how to scratch the intensely itchy

lesions against the crib sheets. Some will even say that the itchiness kept

their babies from sleeping through the night.

Beyond such reports, you're likely to hear what

Dr. Herbert P. Goodheart, a New York expert on the condition,

might call a myth - that the baby is reacting allergically

to milk-based formula or some other food that must be eliminated from the

child's diet. Another common belief that he considers erroneous is that

exposure to water (as in baths) should be limited.

" There's been an overemphasis on specific

allergens, " said Dr. Lawrence Eichenfield,

chief of pediatric and adolescent dermatology at Children's Hospital in San Diego. " Although most

children with eczema may test positive for certain allergens, avoiding those

substances doesn't change the course of the disease. "

In other words, the baby may indeed be allergic

to various substances, but eliminating exposure to them is unlikely to clear

up the eczema. Rarely is eczema brought on by allergens, Eichenfield

said, though dust mites may occasionally be a trigger. Instead, he explained,

eczema, also known as atopic dermatitis, is

primarily a built-in hypersensitivity that goes along with other atopic conditions like asthma, hay fever and hives.

Like asthma, eczema appears to be on the rise.

And about half of the children with widespread eczema develop asthma by their

teen-age years.

Eczema tends to wax and wane. Although many

children outgrow it - some as early as age 5, some by 8 - it becomes a

lifelong problem for others, and it can be cosmetically distressing and

socially inhibiting, not to mention very annoying.

All told, 12 percent to 15 percent of American

children and an estimated total of 15 million children and adults are

affected.

TREATMENTS ARE IMPROVING

The good news is that there is a revolution brewing in how skin problems like

eczema can be treated. The standard treatment for four decades has been the

use of topical steroids - or oral ones for severe flare-ups - which have some

risks if used chronically. In December, the Food and Drug Administration

approved the first of a new class of drugs called topical immunomodulators,

which are highly effective in suppressing eczema even though they contain no

steroids.

The new drug, tacrolimus,

sold by Fujisawa Healthcare under the trade name Protopic,

is an ointment approved for use on adults and on children age 2 and older.

Coming along the regulatory process is a second topical immunomodulator,

pimecrolimus, by Novartis.

It appears to be safe to use on children as young as 3 months, which is when

eczema commonly starts in babies.

The main advantage of these drugs is that they

are skin-selective. That means that when applied to the skin they stay there,

as opposed to steroids, which are more penetrating and can be absorbed into

the bloodstream, potentially causing unwanted side effects.

Goodheart, whose photoessays on

eczema were published in the last four issues of the journal Women's Health

in Primary Care, called the new topical immunomodulators

" the most exciting thing in dermatology in decades. "

" Protopic ointment

is so safe it can be used on the eyelids of a 2 -year-old, " Goodheart said. And now, he added, doctors are using it

for inflammatory skin disorders like psoriasis, even though it has not been

specifically approved for those conditions.

Protopic and pimecrolimus also

appear to be safe for intermittent long-term use, whereas long-term use of

steroids, even topical ones, can be hazardous.

The new drugs do not cure atopic

dermatitis; nothing does. Nor do they bring complete relief to everyone

affected. The three 12-week studies that formed the basis of FDA approval for

Protopic found that the drug resulted in 90 percent

improvement in about a third of patients, with lesser degrees of improvement

in others.

But, Eichenfield

pointed out, use of these drugs will allow more sparing use of steroids, and

the extra options will greatly enhance the safety of long-term treatments for

eczema.

Copyright 2001 New York Times

News Service. All rights reserved.

Hugs,

Deanna