Oct 18, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Eric wants to start mining in his bedroom. He is going to be soooo rich. He will be able to buy mountains of candy and wheel barrows full of video game accessories. Eric has watched the YouTube tutorials and he too is going to be a bitcoin miner. Bitcoin is a type of electronic money. The reason why Eric, and everyone else, has recently gotten so excited about bitcoin is because its value rose to over $5000. But wait.... There's more! With your own computer and a small computer program, you can create bitcoins (or more accurately tiny fractions of bitcoins) in your own home. This is called bitcoin mining and this is Eric's vision for creating his untold riches.

Eric is just scratching the surface of the cryptocurrency world with his interest in bitcoins. If you have been scratching a rash that has been going away and coming back since childhood, you might have eczema. Eczema is a skin condition that can affect up to 20% of children and up to 10% of adults. It usually begins childhood and in some people it continues on into adulthood. It is also possible that the first flare up of eczema starts in adulthood. The eczema rash often goes away and comes back in the same individual. Eczema often runs in families and often the patient with eczema also has asthma and allergic rhinitis.

The rash in eczema is often red and itchy. It can be dry, scaly or oozy. The location of the eczema rash changes as the patient ages. In infants the rash tends to be on the face and the outside of joints like the outside of the elbow. In older children, eczema tends to be on the neck and the inside of joints like the inside of the elbow. In adults, it tends to stay on the inside of joints but can also appear on the hands.

The first line of treatment for eczema is moisture. People with eczema should liberally apply moistures after a bath or shower daily. The shower puts the moisture into the skin and a good moisturizer can hold it in. Showers should be warm, not hot and relatively short. During the shower, try to use as little non-irritating soap or cleanser as possible. The best moisturizers are the greasy ones. Vaseline or the more cosmetically appealing Vaseline Creamy are fantastic at keeping moisture in the skin, but many people don't like the greasy feeling. So, the best moisturizer is the one the patient will agree to use liberally everyday.

After staying moisturized, the next step is avoiding things that can irritate the skin and trigger an eczema flare up. Irritants will vary person by person but can include things like wool clothing, excessive heat or various perfumes.

Even after we've kept the skin moisturized and avoided eczema triggers, there still will be flare ups. Eczema flare ups are going to vary person to person, but when they happen we will probably reach for a cream that reduces inflammation first. The first line treatment is still the topical steroids. They have names like hydrocortisone, betamethasone and mometasone. They work well, but we have to be careful to use each in the right places. Hydrocortisone is a low potency steroid, so that makes it a good choice for the sensitive skin on the face. Betamethasone is too strong for the face, but would be a good choice for the thicker skin on the palms of the hands. Mometasone is interesting. It was marketed as being gentle enough for the face, but strong enough to work well on other parts of the body. I think this makes mometasone closer to a one size fits all cream for eczema.

Topical calcineurin inhibitors with names like pimecrolimus and tacrolimus are alternatives to topical steroids. They affect some of the white blood cells in the immune system called T cells and some of the immune signaling chemicals called cytokines. When the topical calcineurin inhibitors modulate the immune system, they reduce inflammation in the skin. They work about as well as a mid-potency topical steroid. However, they don't run the risk of thinning the skin like steroids. In that way they are considered safer. But they also are much more expensive than steroids.

If a person has moderate to severe eczema for which the anti-inflammatory creams aren't working, there are other options. These options are usually done under the supervision of a skin specialist or dermatologist. One treatment option isn't a medication at all. Eczema can be treated with light. Narrow band ultra violet B light two to three times per week can safely treat moderate to severe eczema. It has similar risks to that of sun exposure including aging of the skin and a possible increase in risk of skin cancer.

If light therapy doesn't work or is unavailable, the skin specialist might pull out the big guns. These are pills that suppress the immune system. They have names like prednisone, cyclosporin, methotrexate, azathioprine and mycophenolate. As they suppress the immune system of the whole body, not just in the misbehaving rash, they have a bunch of potential side effects and should be used with caution.

Instant bitcoin multi-millionaire-dom may not be quite as easy as Eric thinks. Yes, bitcoin value is now over $5000, but it has recently been down at the $300 level. And bitcoin mining with your computer, while possible, might be beyond Eric and I's expertise. Over the summer we bought a raspberry pi kit, which is basically a few chips to make a mini computer. While we did get it to turn on, we failed to get it to make a string of LED lights to flash, which was one of the basic early projects. And even if we did get a computer to create fractions of fractions of a bitcoin, there is a good argument that we might spend more on electricity than we'd ever get back in bitcoin. Now, I just have to convince Eric that his path to multi-millionaire-dom should probably include finishing Grade 7.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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