Sep 14, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Yeah I'm jealous of Eric's hair. Let's start with the fact he has hair. Mine is not quite all gone, but let's say my forehead has a high reflective index. Eric has blond curly hair. And lots of it. In fact he is probably over due for a back to school hair cut. I told him he should just keep growing it. I said he was in grade 8 and should rebel against society and just grow his hair out. Although I suppose if you listen to your Dad and that's why you grow out your hair you aren't really a rebel at all. I told him to never cut his hair because like Samson his hair was the source of his strength. Eric asked who Samson was. Doris said, "You know like Samson and Delila from the Bible?" Blank stare from Eric. You see, Doris grew up in the Baptist Church. Aside from an occasional wedding, our kids have never stepped inside a church. Was lack of Church attendance, yet another way we were failing our children?

A longing for a more pious life is kind of a spiritual itch. If you have been scratching a physical itch and have 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.

Yes, our kids might not have the moral and spiritual education that Doris got when she was growing up. Yes, we might be failing as parents because our kids didn't go to Church. Yes, Eric may have no idea who Samson and Delila are. But that doesn't mean Eric shouldn't strive for the purely superficial glory of lots and lots of hair for those of us who can't. Balderdash. Apparently, I've lost the battle for the superficial as well. Eric just booked a hair cut.

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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