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Counter-irritants and topical anti-pruritics Apart from systemic antihistamines, topical moisturisers and corticosteroid creams and ointments, there is occasional place for traditional remedies in reducing pruritus in atopic skin disease. Counter-irritation of the skin with 0.5% menthol in aqueous cream, and the use of preparations containing lauromacrogols (p. 155), can be useful soothing additions to a particular treatment programme. Oatmeal bath preparations can have similar effects.

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Evening primrose oil

Fig 2.24 Evening Primrose Oil • A popular complementary remedy • Uncertain effectiveness in atopic eczema • Discontinue if unhelpful after thorough trial • Beware epileptogenic property

Evidence for the therapeutic value of evening primrose oil in atopic skin disease remains inconclusive. Based on evidence that some children with atopic dermatitis show reduced levels of the essential fatty acid gamma linoleic acid (GLA) in their blood, the provision of supplements in the form of evening primrose oil is thought by some to improve the clinical symptoms of atopic eczema. As a natural treatment, it is often popular. To assess its effectiveness for an individual patient adequate doses need to be given for three months. If no benefit is then noted, it is unlikely to be helpful. Sometimes taken by adults as well as given to children, GLA may have a potential to manifest undiagnosed temporal lobe epilepsy. This can occur when epileptogenic drugs such as phenothiazines are also being prescribed (Fig 2.24).

Systemic steroids Few clinicians regard systemic steroids as a sensible long-term option for the treatment of atopic skin disease. Side-effects emerge sooner or later, including growth retardation, diabetes mellitus, osteoporosis, hypertension and the exacerbation of infection. The dramatically beneficial effects seen when they are used in the management of urticaria, angio-oedema, asthma and allergic rhinitis are much less obvious in atopic eczema. This may be explained by the time required for the resolution of skin lichenification and dermal inflammation. Locally applied corticosteroids have a much superior therapeutic ratio (effect/side-effect) compared with systemic steroids. In addition, with eczema of differing severity at

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Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients