How I treat eczema

A holistic approach to treating eczema

I treat eczema using the Aron regime of blended dilute steroid, antibacterial and moisturiser, and holistically. This means that I treat the skin as an organ which is part of a child’s developing immune defence system, and a young child may be prevented from developing other atopic disease like asthma and food allergies.

Atopic conditions start with eczema and progress to asthma, food allergies, and environmental allergies such as to pets, dust, or pollens. I recognise that the skin and the gut are getting used to germs in the environment and must be able to defend the child from unhealthy germs by reducing the risk.

The increase in allergies in western countriesPreventing Atopic cascade in eczema patients

My aim is to substantially reduce the risk of what is known as atopic march or cascade, from atopic eczema, to food allergies, and then respiratory allergies such as asthma and allergic rhinitis. We now know there are risk factors for these conditions, based on both genetic and environmental factors, both on the skin, and in the gut. These are well described in scientific literature, by Alduraywish, and many others since 2015.

Treatment of Atopic Eczema with Blended CreamsThe science is overwhelming that a germ known as Staph aureus is implicated in moderate and severe eczema, and that it causes severity by releasing delta toxins beneath the skin surface. So part of my approach is to treat the Staph at the same time as the eczema, in the same cream, until after the flare has settled. Then the staph must be kept in check, by using other measures to keep the skin clean, and well hydrated, and protected from further attack. It is possible also to repair the damage to the skin barrier, using appropriate compounds in the emollient cream, such as ceramides, and natural anti-bacterials, which over time, can fully repair the skin.

Using compounded creams

I use therefore use compounded, or pre-mixed creams which contain well diluted and safe steroid levels, anti-bacterial or antibiotic components, in an  emollient base free of any allergens, and with anti-itch properties. The elements of the compounded or pre-mixed cream will vary depending on the extent and severity of the eczema, and the areas affected, as well as age of the child.

One must be very careful to ensure that the steroid component is properly diluted so that the cream can be both emollient and anti-inflammatory, as well as safe to use over a longer period to ensure proper healing of the skin surface. Although such creams have widespread use as individual agents, I have found that many patients experience difficulty adhering to regimes which require first one cream, an emollient, and then another, a steroid, and sometimes a third, an antibacterial. It is therefore extremely common to find parents or eczema sufferers finding convenient shortcuts, which eliminate one or other essential components. It certainly makes sense to have a single cream which can be applied twice a day or even more frequently, containing all the elements of the treatment.

One also finds that people who have suffered with eczema in the past eventually find certain skin products that they favour, and choose from products containing natural ingredients such as shea butter, or naturally derived vitamin E rich oils. So it really does become possible to mix up a cream based upon known preferences which also contain diluted prescribed medications.

The bespoke cream offers anti-inflammatory, anti-itch, moisturizing and hydrating properties, as well as anti-bacterial or bacteria controlling ingredients to reduce unhealthy germs from becoming dominant on the skin surface.

While the child is growing quickly, I also introduce dietary tips and advice on probiotic eczema prevention, prebiotic foods to introduce, and advice on exposure to healthy environments for skin bacteria to become more diverse too.

Bathing and eczema

As far as bathing is concerned, I am not a fan of bleach baths to reduce staph, as the bleach itself can be very drying to the skin, and it is difficult to do properly if one does not have a bath and a shower head attached to rinse off the bleach and water mixture. I am also not convinced that bathing using the base moisturiser as a cleanser is a good idea, since there is nothing there that reduces unhealthy germs from the skin. However, I do have a regime I recommend for bathing, and drying after a bath, and a regime for clothing and fabrics.

I do not as a rule, use antibiotics by mouth to combat staph aureus, since it is readily treated topically, and I do not wish to disrupt the emerging healthy bacteria from the gut microbiome. If patients require antibiotics for other infections from their GP, I advocate using extra doses of probiotic to protect the healthy bacteria.

Three phases of treatment

I have three distinct phases of treatment in the programme; the first is intense to get control of the flare, or of the neglected eczema. The second phase is interval treatment of skin and gut, to prevent further flare in the same season or year. The third phase is maintenance of the healthy skin and gut for the year or years while the immune system is maturing, to prevent atopic march or cascade to further associated medical problems.

All bespoke creams are made up in a safe and clean manner, using only materials and medicines licensed for use in UK, and available either on prescription or over the counter. Where prescription medicine is provided in the form of creams, a prescription will be issued to provide replacement stock, as is usual in NHS practice by GPs who provide medicines as required immediately by patients.

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