1. What is eczema? Is there anything that might make my symptoms worse?
Eczema is also called atopic dermatitis. It is a chronic, inflammatory skin disease that occurs most frequently in children, but also affects many adults. It is mainly characterized by itching. Ezcema may be made worse by using products that are allergenic. You can ask your doctor if the products you use may be worsening your condition.
2. What are the best treatment options for moderate to severe eczema?
The best treatments for moderate to severe eczema are phototherapy, oral cyclosporine, and the new injection therapy, dupilumab (Dupixent). All people with eczema will benefit from maximizing their skin care routine, taking short showers, applying sensitive skin moisturizer, and taking antihistamines during flares.
We also try to minimize skin superinfections because extra bacteria on eczema patients makes their skin flare. Sometimes we advise bleach baths to reduce the amount of bacteria on the skin. In addition, sometimes oral antibiotics help control the extra bacteria on the skin.
3. What are some common side effects of treatment?
High dose steroids can sometimes lead to steroid atrophy of the skin, which means that the skin thins out. Stretch marks may also be seen. Phototherapy treatment carries a slight increase in skin cancer risk if used over time.
One relatively well-tolerated medication is cyclosporine. The most common side effects of cyclosponrine are headaches and diarrhea, but these usually only last a few weeks.
Dupixent is an injection for severe cases of eczema. The most common side effects is pain and swelling at the injection site. It may also cause long-term effects, including inflammation of the eyes and increased cold sore outbreaks.
4. What are some signs that I need to consider switching my treatment regimen?
If you experience increased itching and more frequent breakouts while using the same therapy, it’s a sign that you may need to consider switching your treatment regimen.
5. How long does it usually take for a new treatment to start working?
Topical steroids work pretty quickly —usually in a few weeks. Cyclosporine take a little longer. Phototherapy also takes longer, although some patients have a reduction in itching right away.
6. Are there any lifestyle practices that can help me manage my eczema?
All eczema patients have different triggers. Sometimes sweating is a trigger, sometimes the dry indoor heat of winter is the trigger, or sometimes certain clothing will trigger eczema. Even getting a cold can trigger eczema. Anything that you can do to minimize the trigger is helpful in reducing breakouts.
7. Are there any activities I need to avoid if I have eczema?
Not at all! You can do all activities! If you find a particular activities seems to trigger eczema symptoms, speak with your doctor.
8. Is there any new research or breakthrough treatments that might help moderate to severe eczema?
The newest and latest treatment that has been revolutionary in helping patients with moderate to severe eczema is an injectable therapy called Dupixent. Dupixent is administered as an injection under the skin. Dupixent’s active ingredient is an antibody called dupilumab that binds to a protein — specifically the protein “interleukin-4 (IL-4) receptor alpha subunit (IL-4Ra)” — that causes inflammation. By binding to this protein, Dupixent is able to inhibit the inflammatory response that plays a role in the development of atopic dermatitis.
Dr. Morgan Rabach is a board-certified Dermatologist with expertise in cosmetic procedures such as neuromodulators (Botox® and Dysport®), dermal fillers (Juvederm®, Restylane®, Radiesse®, and Sculptra®) and the full spectrum medical dermatology. In addition to her private practice, she is Assistant Professor in the Department of Dermatology at Mount Sinai Hospital. After graduating from Brown University with Honors in Biology, Dr. Rabach earned her medical degree from New York University School of Medicine. She completed her medical internship at Yale New Haven Hospital and her dermatology residency at SUNY Downstate Medical Center where she served as chief resident. Dr. Rabach’s practice encompasses medical, surgical, and cosmetic dermatology, and she tailors her treatments to the individual needs of each patient.