Blended creams for treating eczema

A blended cream is a careful mix of the main ingredients required for treating eczema. All dry skin requires an emollient or moisturiser, as the base. When skin is inflamed it also requires steroid cream, diluted into the base emollient. When skin is flared and has not responded well to steroid cream, it requires antibacterial cream added. This makes a blended cream of three key ingredients for control of eczema.

During skin recovery process, the dry skin needs to be repaired, and any remaining bacteria which aggravate the skin removed. This requires smaller doses of steroid well diluted in the base, and ceramides and natural products, which heal the skin gradually.

The healing phase takes much longer than people think, and it is important to continue moisturising and healing skin which has been prone to eczema for many months.

Especially formulated creams for treating Eczema in young people and adults

What is a blended cream, or compounded cream? A blended cream or compounded cream is a careful mix (known as an alligation) of the two, or three essential components of agents used in infected eczema, namely antibiotic specific to staph aureus, steroid to act on inflammation, and moisturizer to repair and protect the skin barrier against further invasion by germs and foreign matter. Moisturiser also keeps the skin moist or hydrated by keeping tissue fluid in the skin layer. Once Staph infection is controlled and no longer a problem, the compounded or blended cream is a careful mix of steroid and moisturizer, in lower dose, to prevent further flares while the skin barrier is completely renewed, and the immune system slowly adjusts.

Blending antibiotics and steroids in creams for the treatment of eczema

The doses of both antibiotic and steroid components must be very carefully measured and mixed to ensure appropriate dilution so as to ensure both safety, and effectiveness. Safety is ensured by blending creams available on prescription, (which are already safe to use in their own right, and licensed for use), but to a greater dilution, so that they can be used more frequently over the course of a day, or over a longer period. Frequency of use is essential in the early stages to gain rapid control.

The dilution is increased, and in other words, the strength or potency is reduced, as the eczema heals, superficially at first, and then as the deeper systemic immune problems can be addressed. The dilution and strength are therefore bespoke to the individual severity and duration of the eczema. The length of time one has had the eczema is critical to the strength or potency, since over time inflammatory changes thicken the skin and generate more fibrous collagen.

Strength or potency of the steroid depends first on the molecule chosen for treatment, and then secondly on the dilution. So clearly Betnovate RD (which stands for ready diluted) is weaker as a 1 in 4 dilution, than plain Betnovate. (Betnovate is the trade name for betamethasone, a moderate potency steroid, made weaker by diluting it to 1 in 4). While of course O.5% hydrocortisone cream is a 1 in 2 dilution of 1% hydrocortisone cream. These are two examples of ready diluted creams which are available on prescription. While both creams will work, it is clear that twice as much of the 1 in 2 dilution cream can be applied, or 4 times as much 1 in 4 dilution, provided that absolute doses are not exceeded. Diluting the steroid allows for more of the cream to be applied, and ensures that the active steroid molecules are evenly distributed in the carrier base.

Applying the blended cream method

Use of the blended cream approach, allows for mixing of three creams or ingredients (or more) together, which would occur anyway when three different creams are all applied to the skin.The advantage of dilution  allows more generous application of cream, more frequent use, and longer duration. Staph aureus, the bacteria which usually colonises eczema, is also more effectively dealt with by adding the third component. This approach may be a more effective manner than by using the traditional medical approaches of bleach baths, or wet wraps. Such are the advantages to the approach of compounding creams, that it allows for greater patient satisfaction in the results of treatment of moderate to severe eczema, while avoiding the need for more difficult treatment measures.

Patients are naturally at liberty to mix their own prescribed creams themselves once given instruction on this, or to continue to use creams prescribed separately if they choose to continue with traditional methods. However, using creams separately does still require one to use emollient creams often to ensure proper healing of the barrier layer, and there is no getting around frequent application of creams.

In fact the blending of creams is perfectly safe to do at home, and of course while applying to the skin. While the fingertip measure is commonly advocated for dosing of steroid or antibiotic creams, patients are often given advice on how many ‘teaspoons’ of moisturizer, which fit in the palm of the hand to use. With such separately prescribed creams being applied to the same area of eczema several times a day, the cream is effectively blended ‘in situ’.

Lastly it should be noted that some premixed creams are available on the NHS and licensed for use in UK, and these are sometimes prescribed on the NHS. You will see these prescribed as a brand name such as Fucidin H (containing the antibiotic fucidin, and Hydrocortisone 1%, a common topical steroid that is generally safe to use on any area of the body, and in most age groups). There have been other combinations of antibacterials such as neomycin, clioquinol, and gentamycin with betamethasone, and also chlortetracycline with the steroid triamcinolone.

There are various reasons why many of these are not often used, some relating to resistance, some to sensitization, and some are cost reasons.

The premixed creams I advocate are only used while it remains common expert opinion that the ingredients are both safe, and effective, and not part of those suspected of causing any sensitization reactions, or prone to antibiotic resistance. Premixing is done in the safe and careful manner as taught to Masters degree pharmacy students by the process of alligation.

Please contact me to learn more about my methods, or request an appointment if you are ready for a consultation.