EczemaNet Article
The Truth About "Other" Therapies for Atopic Dermatitis

Eczema therapies that “guarantee” clear skin or promise an “amazing breakthrough” can be appealing. The longer you have been treating atopic dermatitis, the more alluring these ads may seem.

The truth is nothing cures atopic dermatitis. What researchers have found is that some therapies, when added to a treatment plan prescribed by a dermatologist, can improve results. Others have no effect. A few can cause serious, even life-threatening, side effects. Here is what the research shows:

Behavior Modification + Topical Therapy: A Win-Win Approach
Adding a therapy called “behavior modification” to a treatment plan prescribed by a dermatologist may lead to clearer skin. Behavior modification is a technique used to help people change what they do so that they can get better results.

One behavior modification technique that has proven helpful for patients with atopic dermatitis is the combined approach. Used mostly in the United Kingdom, this approach teaches patients techniques that can help them avoid scratching. Patients also receive one-on-one training, usually from a nurse, on how to use moisturizer and their medications.

When tested in research studies, the combined approach produced dramatic results. Without the habitual scratching — people with atopic dermatitis may scratch their skin 500 to 1,000 times per day — and with proper use of topical therapy, even patients with severe long-term atopic dermatitis saw significantly clearer skin.

Bottom line: Avoiding scratching and using medication as directed allows the skin to heal. The combined approach is but one effective technique. To find tips that dermatologists tell their patients to help them reduce scratching, visit Preventing Flare-Ups.

Emotional Support Makes a Difference
A skin disease can diminish a person’s quality of life. Patients with atopic dermatitis often have low self-esteem. Many say their skin makes them feel isolated and embarrassed. A support group, camp, or conferences created for people living with a skin condition can help.

Support group. In June 2003, a hospital in Brazil began a support group for children younger than 12 years of age who had atopic dermatitis. The group met every 15 days. Initially, the children were insecure and kept to themselves. Once they recognized their similarities, they began to interact with each other. After 6 to 8 meetings, the doctors noticed several improvements. The children developed stronger bonds with the medical staff. They learned more about atopic dermatitis and how to better manage their symptoms. As their self-confidence grew, their symptoms lessened.

To provide families with this kind of support, the U.S. National Eczema Association (NEA) offers support groups and telephone support. For contact information, go to the NEA’s Support Group Leader and Telephone Support Contacts.

Camp. Operated by the American Academy of Dermatology, Camp Discovery offers children with skin conditions an opportunity to meet and develop bonds with others in their age group. Under the expert care of dermatologists and nurses, campers can go fishing, boating, swimming, and water skiing — even if they never previously participated in these activities. They can enjoy arts and crafts and just have fun with kids like themselves. By the end of the week, it is common to hear kids say, “The best thing about camp is that it gives you self-confidence for the whole year.” To learn more, visit the Camp Discovery Web site.

Conference. The NEA offers an annual conference for people of all ages who have atopic dermatitis/eczema or care for someone who does. During the conference, participants have the opportunity to share experiences with others who face similar challenges and to learn more about eczema. In this relaxed setting, kids can enjoy a camping experience with other children who have eczema. Adults can join support sessions and attend medical presentations. Everyone has an opportunity to meet dermatologists and ask questions. For more information about this annual conference, send an e-mail to info@nationaleczema.org.

Bottom line: The emotional support gained by participating in a support group, camp, or conference created for people living with a skin disease can significantly improve the quality of life for someone who has atopic dermatitis.  

Stress Busters Can Spell Relief
For many living with atopic dermatitis, stress triggers a flare-up. Studies confirm that when stress begins, the skin often starts to itch.

To help people with atopic dermatitis reduce stress, researchers continue to study the safety and effectiveness of several stress-reduction techniques. Biotherapy, progressive muscle relaxation, and massage are just a few of the stress-reduction techniques that have been studied. While the results from these preliminary studies are encouraging, the studies are too small to draw conclusions.

What the studies have shown is that keeping calm and having a positive outlook may be one of the best ways to keep eczema under control. To learn some stress-busting tips recommended by dermatologists, visit Stress Reduction Techniques.

Bottom line. Finding ways to relieve stress can have a positive effect on your skin — and your life. Before trying a new stress-reduction technique, talk with your dermatologist.  While stress-reduction techniques seem harmless, some can have a powerful effect. Biofeedback can change a diabetic’s need for insulin. Massage can do more harm than good if the person giving the massage does not know how to treat someone who has a skin condition.

Probiotics: More Research Needed
A few studies indicate that taking a dietary supplement containing probiotics (live bacteria) — when used along with topical therapy — may help reduce the severity and extent of atopic dermatitis in children. While these findings are promising, more research is needed. Each study tested a different blend of probiotics. The appropriate blend and dose for treating atopic dermatitis have not been determined. The long-term effects are not known.

Most of this research has been conducted in Europe and Australia. Researchers do not know if supplements now available in the United States can be beneficial for atopic dermatitis.

Bottom line: Before taking a supplement containing probiotics or giving one to a child, speak with a dermatologist. Ask if a supplement containing probiotics might help and if it is advisable to take this supplement. Some dietary supplements can trigger an allergic reaction; others can interact with medication. If the dermatologist believes probiotics may help, be sure to get a product recommendation. Dietary supplements are not regulated as strictly as medications.

Other Dietary Supplements: No Proof These Help
Borage oil, evening primrose oil, vitamin B6 (pyridoxine), vitamin E, and zinc — each has been promoted as a safe and effective treatment for eczema. To find evidence for these claims, researchers have been studying these supplements.

Two studies investigated borage oil supplements. Researchers found that while patients did not experience side effects, the patients’ overall response to borage oil was not significant. The most noticeable effect was seen in a study in which adults with moderately severe atopic dermatitis were given a capsule that contained 500 milligrams of borage oil every day for 24 weeks. The patients taking the borage oil supplement noticed a slight improvement. Those given the placebo did not experience this slight improvement.

Evening primrose oil also has not proven effective in treating atopic dermatitis. In one study, 58 children with atopic dermatitis participated in a 16-week trial. All of the children received topical therapy. They also received either capsules containing evening primrose oil or a placebo. At the end of 16 weeks, all 58 children showed significant improvement. There was no difference between the children given the evening primrose oil and those taking the placebo.

Studies show that adding zinc, vitamin E, or vitamin B6 supplement also has not proven effective in treating atopic dermatitis. 

Bottom line: Research studies find that supplementing the diet with borage oil, evening primrose oil, vitamin B6, vitamin E, or zinc does not prove effective in relieving signs and symptoms of atopic dermatitis.

Teas: The Right Blend May Help
Studies suggest that tea — whether green, black, or oolong — can prevent some allergic reactions. To find out if tea could benefit patients with atopic dermatitis, researchers in Japan recruited patients with atopic dermatitis who had not respond to other treatment. The patients were instructed to continue following their treatment plan and to drink one liter of oolong tea every day. The liter was to be divided into thirds so that one-third of it was drunk after each of three meals. Of the 118 patients who completed the study, 63% showed marked to moderate improvement after one month. This effect was first noticed after one or two weeks.  

It should be noted that green, black, and oolong teas contain caffeine, which can increase restlessness, anxiety, and sleeplessness. Having atopic dermatitis produces these feelings in many patients, and caffeine may intensify these feelings.

Some people swear by a tea that does not contain caffeine. While chamomile is used worldwide to treat many conditions including atopic dermatitis, there is not enough reliable research in humans to support its use as a tea, essential oil, or in any other form.

One reason may be that too many cases of people developing an allergic reaction after eating or coming into contact with the chamomile plant have been reported.
A few cases of anaphylaxis, a severe and potentially life-threatening allergic reaction, have occurred. Anaphylaxis makes blood pressure drop suddenly. Breathing becomes difficult. Some people loss consciousness and some die.

Bottom line: Limited research suggests that drinking oolong tea may help patients with atopic dermatitis when used along with treatment prescribed by a dermatologist. Chamomile has been shown to cause an allergic reaction, which in a few cases has been life threatening.

Chinese Herbal Medicines Can Be Toxic
Blends of Chinese herbs have proven effective in controlling atopic dermatitis. For some patients, these medicines also have proven toxic. Two children participating in a long-term research study not only saw clearer skin after taking a Chinese herbal medicine, they developed abnormal liver function.

Liver toxicity has been detected in others taking Chinese herbal medicines. One poison unit in London reported 21 cases of liver toxicity in patients taking Chinese herbal medicine to relieve skin conditions.

Kidney failure is another possible side effect. Two patients who used Chinese herbal medicine to treat their eczema developed end-stage kidney failure and needed kidney transplants. Heart disease is another condition linked to the use of Chinese herbal medicine.

Applying an herbal remedy to the skin also can cause side effects. Chemical analysis shows that several over-the-counter herbal creams sold for the treatment of eczema and psoriasis contain potent corticosteroids. This is the reason they work so well. Long-term use of potent topical corticosteroids can cause thinning skin, dilated blood vessels, stretch marks, infection, and excess body hair. Many patients who use herbal creams to treat atopic dermatitis develop allergic contact dermatitis — another type of eczema.

Bottom line. While some blends of Chinese herbal medicines and topical herbal creams may effectively treat eczema, these therapies are not regulated. The possibility of serious side effects exists, so be sure to speak with a dermatologist before using any herbal medicine.

Partner with a Dermatologist
New ways to treat atopic dermatitis can be appealing. Before trying another therapy, be sure to consult a dermatologist. Over-the-counter products and alternative therapies should not be a substitute for a dermatologist’s care. These should not be tried before seeking medical care for atopic dermatitis. If side effects occur after trying any treatment for atopic dermatitis, be sure to tell your dermatologist.

References:
Behavior Modification
Staughton R. et al. “Psychologic approach to atopic skin disease.” Journal of the American Academy of Dermatology. 2001. Jul;45(1 Suppl):S53-S54.

Emotional Support
American Academy of Dermatology. “Camp Discovery.” Web site available at: www.campdiscovery.org (last accessed October 13, 2006).

Cestari Tania et al. “Support Group for Patients with Atopic Dermatitis: Proposal for a New Approach.” Journal of the American Academy of Dermatology. 2005. Mar;52(3 Suppl):p72.

National Eczema Association. “The 3rd Annual Eczema Patient Conference Registration Booklet.” 2006.

Stress Busters
Garg A et al. “Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders.” Archives of Dermatology. 2001. Jan;137(1):53-59.

Hanifin JM et al. “Guidelines of care for atopic dermatitis.” Journal of the American Academy of Dermatology. 2004. Mar;50(3):391-404.

McMenamy CJ et al. “Treatment of eczema by EMG biofeedback and relaxation training: a multiple baseline analysis.” Journal of Behavior Therapy and Experimental Psychiatry. 1988. Sep;19(3):221-227.

Schachner L et al. “Atopic dermatitis symptoms decreased in children following massage therapy.” Pediatric Dermatology. 1998. Sep-Oct;15(5):390-395.

Williams HC. “Atopic Dermatitis.” The New England Journal of Medicine. 2005. Jun 2;352(22):2314-2324.

Probiotics
Rosenfeldt V et al. “Effect of probiotics Lactobacillus strains in children with atopic dermatitis.” The Journal of Allergy and Clinical Immunology. 2003. Feb;111(2):389-395.

Vilijanen M et al. “Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial.” Allergy. 2005. Apr;60(4):494-500. 

Weston S et al. “Effects of probiotics on atopic dermatitis: a randomized controlled trial.” Archives of Disease in Childhood. 2005. Sep;90(9):892-897.

Williams HC. “Two ‘Positive’ Studies of Probiotics for Atopic Dermatitis. Or Are They?” Archives of Dermatology. 2006. Sep;142(9):1201-1203.

Other Dietary Supplements
Ewing CI et al. “Failure of oral zinc supplementation in atopic eczema.” European Journal of Clinical Nutrition.” 1991. Oct;45(10):507-510.

Hederos CA et al. “Epogam evening primrose oil treatment in atopic dermatitis and asthma.” Archives of Disease in Childhood. 1996. Dec;75(6):494-497.

Henz BM et al. “Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema.” British Journal of Dermatology. 1999. Apr;140(4):685-688.

Mabin DC et al. “Pyridoxine in atopic dermatitis.” British Journal of Dermatology. 1995. Nov;133(5):764-766.

Takwale A et al. “Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomized, double blind, placebo controlled, parallel group trial.” British Medical Journal. 2003. Dec 13;327(7428):1385-1359.

Teas
Uehara M et al. “A trial of oolong tea in the management of recalcitrant atopic dermatitis.” Archives of Dermatology. 2001. Jan;137(1):42-43.

U. S. Library of Medicine and the National Institutes of Health (NIH), “Chamomile (Matricaria recutita, Chamaemelum nobile).” MedlinePlus. Available at www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html. Last accessed November 27, 2006.

Chinese Herbal Medicine
Ernest. E. “Adverse effects of herbal drugs in dermatology.” British Journal of Dermatology. 2000. Nov;143(5):923-929.

Sheehan MP et al. “Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year.” Clinical and Experimental Dermatology. 1995. Mar;20(2):136-140.

Sheehan MP et al. “One-year follow up of children treated with Chinese medicinal herbs for atopic eczema.” British Journal of Dermatology. 1994. Apr;130(4):488-493.

Sheehan MP et al. “Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis.” Lancet. 1992. Jul 4;340(8810):13-17.


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An alternative therapy replaces treatment prescribed by an MD.

When a patient chooses complementary therapy, the non-conventional therapy is added to a treatment plan prescribed by an MD.

 

 

 
 

 

 

 

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Page last updated 12/15/06

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