What are the holistic approaches to managing severe eczema?

From the Guidelines

Holistic management of severe eczema requires a comprehensive approach that prioritizes patient education, lifestyle modifications, and medical treatments to minimize morbidity, mortality, and improve quality of life. According to the most recent guidelines 1, the management of atopic dermatitis in adults should consider phototherapy and systemic therapies for severe or widespread cases.

Key Components of Holistic Management

• Patient Education: Providing adequate patient education is essential, including discussing avoidance of irritants and known triggers, stressing the importance of adherence, optimizing topical therapy, addressing topical steroid phobia, and considering structured educational interventions like eczema school 1.
• Lifestyle Modifications: Daily skin care is crucial, using fragrance-free, gentle cleansers like Cetaphil or CeraVe, moisturizing immediately after bathing with thick emollients like petroleum jelly or ceramide-rich creams, and taking lukewarm showers limited to 5-10 minutes.
• Trigger Avoidance: Identifying and avoiding triggers through an elimination diet and environmental modifications is important, as common triggers include dairy, eggs, nuts, dust mites, pet dander, and harsh fabrics like wool.
• Stress Management: Stress management techniques such as meditation, yoga, or deep breathing exercises can help reduce flares, as stress hormones can worsen inflammation.
• Medical Treatments: For acute flares, prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05% can be used, followed by maintenance therapy with non-steroidal alternatives like tacrolimus (Protopic) or pimecrolimus (Elidel). For severe cases, systemic medications such as dupilumab (Dupixent, 300mg subcutaneous injection every two weeks) or oral immunosuppressants like cyclosporine (2.5-5mg/kg/day) may be necessary, as recommended by recent guidelines 1.

Considerations for Real-Life Clinical Practice

• The decision to initiate advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.
• Concomitant use of topical anti-inflammatory medications with phototherapy and systemic therapies is common in clinical practice, and most patients will use evidence-based topical therapies concomitantly with these treatments 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Holistic Approaches to Managing Severe Eczema

• Dietary changes: Some studies suggest that dietary supplements may not be effective in managing eczema 2. However, eliminating allergenic foods from the diet may be beneficial, particularly in infants and patients with elevated immunoglobulin E levels and/or multiple food sensitization 3.
• Phototherapy: Phototherapy, particularly narrow-band UVB, may be effective in reducing symptoms of atopic eczema 4, 5. However, the evidence is not conclusive, and more research is needed to determine its safety and effectiveness.
• Topical treatments: Topical corticosteroids and calcineurin inhibitors are commonly used to manage atopic dermatitis 6. Moisturizers and soap substitutes can also help improve the condition of the skin.
• Lifestyle changes: Avoiding trigger factors, such as stress and environmental allergens, may help manage atopic dermatitis 6.
• Alternative therapies: Some studies suggest that alternative therapies, such as bleach baths and wet dressings, may be effective in managing atopic dermatitis 6. However, more research is needed to determine their safety and effectiveness.

Key Considerations

• It is essential to work with a healthcare professional to develop a personalized treatment plan for managing severe eczema.
• A comprehensive approach that incorporates dietary changes, topical treatments, lifestyle modifications, and alternative therapies may be more effective than relying on a single treatment option.
• More research is needed to fully understand the effectiveness and safety of various holistic approaches to managing severe eczema.