Why It's Hard to Find Eczema Treatments That Work Consistently
Eczema is a chronic and life-long condition that can prove very tricky to treat, despite there being a variety of options—both over-the-counter and prescription—widely available now. That being said, medicine and skin-care technology is advancing more and more every year, thus begging the question: Why *is* it still so hard to find eczema treatments that actually work effectively and consistently?
Here, we take a look at a few of the most common treatment options currently available for eczema—plus, why they’re far from perfect.
For those unfamiliar, topical corticosteroids are synthetic or man-made medications with potent anti-inflammatory properties that are used for treating skin conditions such as eczema, psoriasis, and more. According to Dr. Peter Lio, topical corticosteroids can be tempting to use as they generally work quickly and provide great relief, but it’s sadly not sustainable because the results are short-lived and dependent on consistent use, which isn’t safe. “People do great while they're using them, but then can flare right back up,” explains Lio. Additionally, they come with pretty alarming side effects. “The problem is, if you overuse topical corticosteroids, you can risk thinning the skin and permanently damaging it, or even worse, absorbing enough to cause systemic problems which is a major issue.”
Topical calcineurin inhibitors like tacrolimus and pimecrolimus are nonsteroidal, immunosuppressive treatments for eczema that can help to minimize itch, inflammation, and dryness (especially when used in ointment form). That being said, Lio says they come with a far-from-comforting warning label on them, which is off-putting for many people. “It's called the black box warning and talks about the potential cancer risk,” he explains. “While we think that it is an extremely low likelihood to have anything like that occur from these, the fact is it’s still there and can be nerve-wracking to patients and families.” Additionally, they still pose a risk for infection and can be extremely costly (more than $60 for a 30-g tube), which isn’t ideal for those who don’t have the funds to afford it.
Nonsteroidal anti-inflammatories such as crisaborole, which is sold under the brand name Eucrisa, can be very helpful and fast-acting but also doesn’t come without a slew of issues. For instance, according to Lio, a percentage of patients experience burning and stinging when they apply the medication, and it can also be very costly. Moreover, some people have adverse reactions, including hives, redness, and swelling. “Ultimately, there is a huge, huge need for new innovative therapies and approaches to eczema,” Lio says.
Topical antihistamines such as Benadryl’s Extra Strength Itch-Stopping Cream are nice in that they provide immediate relief, but only serve as a short-term solution and aren’t without their fair share of risks. For instance, some people can actually develop contact dermatitis from using them often—there, and there’s the fear of absorption, too.
While oral antibiotics can be helpful at treating eczema that’s flaring due to an infection in the skin, they work by killing off all bacteria, including the good types that we need in order to have a balanced skin microbiome. Lio calls this “collateral damage.” Moreover, we know that people can develop a resistance to many commonly used antibiotics if they’re used too often or in excess. “Any antibiotic that has a mechanism will find a way around that over time,” explains Lio. Antibiotics are also only effective at treating eczema if an infection is present, so if that’s not the case, they won’t be helpful.
Phototherapy, also called light therapy, is defined as the “controlled delivery of ultraviolet light for anti-inflammatory purposes.” In other words: It uses UVB rays to stop the immune system from overreacting and can thereby have a healing effect on eczema. Because UV rays can cause serious health problems such as cancer, as well as premature skin aging, treatments are typically administered in super short time periods (as little as 15 seconds) and done over a long period of time. Unlike most of the aforementioned treatment options, phototherapy isn’t a quick fix and is usually done over the course of five months or more. Additionally, because everyone responds to UV light differently, it can be difficult to pinpoint who’s most likely to benefit from phototherapy.