Clinical Studies Summary

Exorex (=Linotar) superior to conventional coal tar lotion

Exorex (Linotar) is superior to a conventional coal tar lotion (5%) for treatment of mild to moderate psoriasis, and may be preferred as a first-line topical treatment according to a study published in the 2003 issue of the Journal of Dermatological Treatment.

These are the key results of this clinical study:

  1. Exorex (Linotar) is superior to a conventional coal tar lotion in treating psoriasis.
  2. Exorex (Linotar) may be the preferred option for first-line topical treatment.
  3. Doctors’ and patients’ assessments showed a preference for using Exorex.
  4. Exorex (Linotar) is well tolerated and produced fewer skin reactions.
  5. Exorex (Linotar) was cosmetically acceptable to patients.

Conclusion:

Based on these results the study concluded that Exorex (Linotar) is significantly more effective than a conventional coal tar lotion in mild to moderate psoriasis and may be preferred for first-line topical treatment.

Reference: Journal of Dermatological Treatment (2003) 14, 1-9.


Exorex as effective as Dovonex (Daivonex)

Exorex has been found to be as effective as Dovonex (Daivonex) in treating psoriasis in a study published in the August 2003 issue of the British Journal of Dermatology.

These are the key results of this clinical study:

  1. Exorex is as effective as Dovonex in treating psoriasis.
  2. Exorex provided the same length of psoriasis remission as Dovonex.
  3. The cosmetic properties of Exorex were greatly improved over other coal tar products.
  4. Exorex is several times less expensive than Dovonex (Daivonex).

Conclusion:

Based on these results the study concluded that Exorex is a very useful topical treatment for chronic moderate-to-severe plaque type psoriasis.

Reference: British Journal of Dermatology 2003; 149: 350-353

Clinical Study Exorex vs. Dovonex

Observer-blind, randomized, intrapatient comparison of a novel 1% coal tar preparation (Exorex®) and Calcipotriol Cream (Dovonex®) in the treatment of plaque type psoriasis.

Authors: S. Tzaneva, H. Hönigsmann, A. Tanew.

Division of Special and Environmental Dermatology, Department of Dermatology,
University of Vienna Medical School, Austria.

Summary

In a recent pilot study a novel, patented fatty acid-based 1% coal tar preparation (Exorex®)
has been found to be similar in efficacy to Calcipotriol Cream in the treatment of psoriasis.

Objectives

Our aim was to investigate the therapeutic efficacy, safety and cosmetic acceptability of the new
1% coal tar preparation Exorex®, in comparison with Calcipotriol Cream in a larger patient cohort.

Patients and methods

Forty patients with chronic plaque type psoriasis were included in this randomized, observer-blind,
intrapatient comparison trial. In each patient two comparable target plaques were treated twice
daily with 1% coal tar preparation or Calcipotriol Cream. At the onset of therapy and at weeks 2, 4,
6 and 8, the response to treatment was determined by the psoriasis severity index (PSI) that assesses the degree of erythema, infiltration and scaling of the psoriatic lesions on a five-point scale.

In addition, all treatment-related side-effects were recorded and cosmetic acceptability of both
treatments was rated every second week by the patients. After complete or near complete clearing the patients were followed up until relapse or for a maximum period of 18 months.

Results

Thirty-eight patients completed the study. At termination of the trial the mean ± SD baseline PSI
score of 9·2 ± 1·5 was reduced to 3·0 ± 2·9 by 1% coal tar preparation and to 2·8 ± 2·7 by Calcipotriol Cream.

The mean PSI reduction between baseline and final assessment did not differ significantly between 1% coal tar preparation and Calcipotriol cream (P = 0·77). The mean intraindividual difference in reduction of PSI score between 1% coal tar preparation and calcipotriol was 0·1 score points (95% confidence interval -0·84 to + 0·63). No difference between either preparation was observed with regard to time until relapse. Itching was caused by 1% coal tar preparation in four patients and by Calcipotriol Cream in one patient. Unpleasant odour or staining of the 1% coal tar preparation was reported by six patients, whereas one patient complained about the smell of the Calcipotriol Cream.

Conclusions

The novel 1% coal tar preparation was found to be comparably as effective as Calcipotriol Cream in treating psoriasis. Tolerability and cosmetic acceptability was better for Calcipotriol Cream. Taking into consideration that the coal tar preparation is considerably less expensive than Calcipotriol Cream this new product appears as a very useful topical medication for chronic plaque type psoriasis.

References

Valk, P.G.M. van der, E. Snater, Verbeek-Gijsbers, P. Duller, P.C.M. van der Kerkhof.
Out patient treatment of atopic dermatitis with crude coal tar. Dermatology 96; 193: 41-44.

Veronikis, I.E., Malaban, A.O., Holick, M.F. Comparison of calcipotriene (Dovonex) with a
coal tar emulsion (Exorex) in treating psoriasis in adults: a pilot study. Arch Dermatol.
1999; 135: 474-475.

Source: British Journal of Dermatology. Volume 149 (2003), Pages 350-353.

Web link to full text: https://pubmed.ncbi.nlm.nih.gov/12932242/

Clinical Success

  • Clinical experience has shown that Exorex (Linotar) is a safe, effective and cosmetically acceptable treatment for psoriasis.
  • More than 700 patients have been enrolled in controlled clinical trials.
  • There has been more than 16 million patient days of usage over the last 9 years.
  • The unique delivery system ensures a highly effective transdermal carrier of coal tar.
  • Exorex (Linotar) is approved in more than 10 countries around the world.

Coal tar shown to be safe

No Increased Risk of Cancer after Coal Tar Treatment in Patients with Psoriasis or Eczema

Abstract

Coal tar is an effective treatment for psoriasis and eczema, but it contains several carcinogenic compounds.

Occupational and animal studies have shown an increased risk of cancer after exposure to coal tar.

Many dermatologists have abandoned this treatment for safety reasons, although the risk of cancer after coal tar in dermatological practice is unclear.

This large cohort study included 13,200 patients with psoriasis and eczema.

Information on skin disease and treatment, risk factors, and cancer occurrence was retrieved from medical files, questionnaires, and medical registries.

Proportional hazards regression was used to evaluate differences in cancer risk by treatment modality.

Patients treated with coal tar were compared with a reference category of patients treated with dermatocorticosteroids (assumed to carry no increased cancer risk).

The median exposure to coal tar ointments was 6 months (range 1–300 months).

Coal tar did not increase the risk of non-skin malignancies (hazard ratio (HR) 0.92; 95% confidence interval (CI) 0.78–1.09), or the risk of skin cancer (HR 1.09; 95% CI 0.69–1.72).

This study has sufficient power to show that coal tar treatment is not associated with an increased risk of cancer.

These results indicate that coal tar can be maintained as a safe treatment in dermatological practice.

Authors: Judith H J Roelofzen, Katja K H Aben, Ursula T H Oldenhof, Pieter-Jan Coenraads, Hans A Alkemade et al.

Source: Journal of Investigative Dermatology (2010) 130, 953–961; doi:10.1038/jid.2009.389; published online 17 December 2009

Web link to full text coal tar safe: https://www.jidonline.org/article/S0022-202X(15)34771-0/fulltext

How to Use Linotar?

Main Body:

Lightly apply the Linotar Gel 1% to the affected areas. The Linotar Gel 1 will dry within 2 to 3 minutes. LinoCream Moisturizing Cream can now be applied to those affected areas. Repeat 2 to 3 times daily.

Scalp:

Towel dry hair after it has been washed with a hypo-allergenic shampoo. Apply Linotar Gel 1 to affected areas and allow to dry for 2 to 3 minutes. Apply LinoScalp leave-in Scalp Conditioner to affected areas on the scalp. Blow dry or let hair dry naturally. Linotar Gel 1 and LinoScalp leave-in Scalp Conditioner can be applied without washing hair. Repeat 2 to 3 times daily.

Fingernails:

Cut the nails as short as possible. Apply the Linotar Gel 1 under the nail as far as possible and around the nail bed. Allow to dry for 2 to 3 minutes, then apply the LinoCream Moisturising Cream to the same areas. Avoid peeling potatoes, tomatoes, onions etc. Wear cotton gloves when working with chemicals.

Notes:

  • If the skin becomes increasingly sensitive to the Linotar treatment, call the Linotar Helpdesk (Canada & US toll-free:1-888-604-4561, or consult a physician.
  • Soaps and shampoos should be mild, hypo-allergenic and deodorant free. Ask your pharmacist or Help Line for suggestions.
  • Coal Tar is a photosensitizer. Avoid overexposure to sunlight.

Linotar Gel 1 Penetrating Emulsion:

Distilled Coal Tar, 10 mg/g (1% w/w) Topical emulsion for the treatment of psoriasis of the skin and scalp

Directions for use:

For adults and children over 12 years of age:
Make sure that all areas of the affected skin are clean.
Apply a thin layer of Linotar Gel 1 Penetrating Emulsion two to three times per day to these areas. Massage gently and leave to dry.

For use in children under 12 year of age and the elderly:
Linotar Gel 1 can be diluted in the palm of the hand by mixing with a few drops of freshly boiled water.

Make sure to keep the bottle closed after use and stored out of sight and reach of children!

In the morning:

Clean the affected area. Sparingly apply a thin layer of Linotar Gel 1.
After Linotar Gel 1 Emulsion has dried (2-3 minutes), apply a thin layer of LinoCream Moisturising Cream.

In the afternoon:

Sparingly apply a thin layer of Linotar Gel 1 onto the affected area, including the scalp.
After Linotar Gel 1 Penetrating Emulsion (2-3 minutes), apply at thin layer of LinoCream Moisturising Cream.
Treatment of the scalp: after Linotar Gel 1 Penetrating Emulsion has dried, gently rub in LinoScalp leave-in Scalp Conditioner and leave to dry.

In the evening:

Repeat the treatment of the afternoon.
Along with the recommendations given in the brochure to adapt to an appropriate life-style,
this treatment regimen is the optimal Linotar therapy for psoriasis sufferers.
Any deviations from this scheme may lead to a longer duration of treatment.

Directions for use on the scalp: apply LinoScalp leave-in Scalp Conditioner after washing the hair and rub gently when hair is still wet and leave to dry.

Linotar Gel 1 – how does it work?

Coal tar is mildly antiseptic and relieves itching.
It also acts as a ‘keratolytic’, which works to break down a protein which forms part of the skin structure called keratin.
Skin thickening occurs due to the deposition of keratin.
Coal tar helps to reduce the excessive hardening, thickening and scaling of the skin.

What is Linotar Gel 1 used for?

Psoriasis of the skin and scalp

Warnings!

– Avoid exposure to sunlight or sunlamps.
– If exposure to sunlight cannot be avoided, use protective measures such as sun-creams or protective clothing.
– This medicine will stain skin, hair and fabric.
– Avoid contact with eyes, mucous membranes, genital and rectal areas.
– This preparation is for external use only.

Use Linotar Gel 1 with caution:

– Avoid contact with eyelids and all other mucosal surfaces
– Avoid direct contact with the eyes

Linotar Gel 1 is not to be used in:

Acute psoriasis (is sudden, severe outbursts of psoriasis).

Linotar Gel 1 should not be used if:

– You are allergic to one or any of its ingredients (see below).
Please inform your doctor or pharmacist if you have previously experienced such an allergy.

– If you feel you have experienced an allergic reaction,
stop using Linotar Gel 1 and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding:

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding, provided the benefits to the mother outweigh the risks to the unborn baby.
Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
No Linotar Gel 1 safety information is available in pregnancy. Seek medical advice.
No safety information is available in breastfeeding. Discuss with your doctor.

Side effects:

Medicines and their possible side effects can affect individual people in different ways.
The following are some of the side effects that are known to be associated with this type of medicine (coal tar).
Because a side effect is stated here, it does not mean that all people using this medicine will experience that particular, or any, side effect.

– Abnormal reaction of the skin to light, usually a rash (photosensitivity)
– Staining of skin and clothes
– Skin irritation

The side effects listed above may not include all of the side effects reported by the drug’s manufacturer. For more information about any other possible risks associated with this medicine, please read the patient information provided with the medicine, or consult your doctor or pharmacist.

How can Linotar Gel 1 affect other medicines?

No known interactions, when applied to unbroken skin.

Composition:

Active substance: Distilled Coal Tar, 10 mg/g (1% w/w Gel 1)

Other ingredients:

Complex of esterified essential fatty acids; PEG-40 hydrogenated Castor Oil; Sodium Propyl Paraben 0.05 %; Vitamin E (DL-Alpha Tocopherol); Methyl Paraben 0.1%; Polysorbate 80; Xanthan Gum; Industrial Methylated Spirits; purified Water.

John’s Story

My name is John and my body was more than 85% covered with Psoriasis. I started using the Exorex treatment by using the Exorex Penetrating Emulsion followed by the Exorex Stabilizing Cream.
During the healing process, the flaking and scaling disappeared and the red lesions began to fade.
I was relieved and thankful that 95% of my psoriasis lesions cleared up.
And now, years later my psoriasis still remains under control.

Linotar / Key Benefits

The LINO-range treatment method has been developed to control the symptoms of psoriasis and eczema.

The success of Linotar is based on a unique trans dermal delivery system containing a mixture of natural essential fatty acids first identified from the skin of the banana.

This unique base:

    • Acts as an anti-inflammatory agent and

 

    • Enhances the deep delivery of a low concentration of emulsified coal tar to the deepest layers of the skin with very effective results.

See John’s Story…

8 Key benefits:

 

  1. Clinically proven to control the symptoms of psoriasis.
  2. Easily applied and quickly absorbed into the skin.
  3. Colorless and virtually odorless after proper application.
  4. Contains NO cortisones.
  5. NO side-effects observed as are often associated with other treatments.
  6. Will not stain clothing when properly applied.
  7. No evidence that resistance to the product occurs.
  8. The full range of Linotar Gel 1% and the compatible LinoCream Moisturising Cream and LinoScalp leave-in Scalp Conditioner ensures a complete body treatment.

Linotar Psoriasis Medication

Linotar Gel 1%: Product Profile

Linotar Gel 1%, also known as Exorex Lotion 5% v/w (UK) or Exorex® Gel 1% penetrating emulsion (US), is a highly innovative topical dermatological preparation indicated for the treatment of Psoriasis and Eczema. The active ingredient is distilled coal tar. In addition, Linotar Gel 1% features a sophisticated vehicle consisting of a specific combination of free essential fatty acids. Linotar, as a result, has been successfully applied without most of the burdens that are usually associated with the use of more conventional, coal tar preparations.

Contrary to most traditional coal tar preparations, Linotar Gel 1% produces an extremely rapid and almost complete penetration (1). The excipients have a transdermal carrier function, bringing coal tar much more efficiently through the affected skin. Thanks to this special feature and due to the general physical properties of Linotar, the product does not provoke as much of the yellow staining that is common to coal tar products, nor does it produce the traditional strong coal tar smell: The product “disappears” within minutes.

Linotar has been developed by Meyer Zall Laboratories of South Africa and was first launched in 1993 in its home market, South Africa, for both the indications Psoriasis and Eczema, as part of a complete treatment method.Since 1993, Its equivalent, Exorex®, has been successfully introduced in Australia, New Zealand, and in a number of African and Asian countries, as well as in the U.S.A., Canada, Israel, Ireland and the United Kingdom. In 1996 Exorex® 1% was registered in Austria, Greece, The Netherlands and Luxembourg.

Exorex® 1% has been shown to be clinically and statistically equally effective as the vitamin D derivate calcipotriol (also known as Daivonex®, Dovonex® or Psorcutan® Creme) and superior to any coal tar in the treatment of psoriasis, through objective parameters and in patient preference scores. Results of a recently completed Austrian (University of Vienna, 2001) 40-patient clinical trial proves this point (2). These results closely match those of an earlier 18-patient US pilot study in which Exorex® is compared with the vitamin D derivate Dovonex (calcipotriene) (3).

References

(1) Saunders James C J, Davis Henry J, Coetzee Linda, Botha Susan; Kruger Ansie E, Grobler, Anne. A Novel Skin Penetration Enhancer: Evaluation By Membrane Diffusion And Confocal Microscopy. J Pharm Pharmaceut Sci (https://www.cspscanada.org/) 2(3):99-107, 1999.

Web link to Exorex / Linotar trans dermal carrier: https://sites.ualberta.ca/~csps/JPPS2(3)/J.Saunders/microscopy.htm

(2) Tzaneva S, Hönigsmann H, Tanew A. Observer-blind, randomized, intrapatient comparison of a novel 1% coal tar preparation (Exorex) and calcipotriol cream in the treatment of plaque type psoriasis. British Journal of Dermatoly 2003 Aug;149(2):350-3.

Web link to Exorex 40-patient clinical study: https://pubmed.ncbi.nlm.nih.gov/12932242/

(3) Veronikis, Irini E, Malabanan, Alan O, Holick Michael F. Comparison of calcipotriene (Dovonex) with a coal tar emulsion (Exorex) in treating psoriasis in adults: a pilot study. Arch Dermatol 1999 Apr;135(4):474-5.

Web link to Exorex 18-patient pilot study: https://pubmed.ncbi.nlm.nih.gov/10206065/

Veronokis/Exorex vs Dovonex

clinical study Exorex and Dovonex control

observers do not know the grouping situation, random, compare a new type of 1% coal tar preparation (Exorex®) and calcipotriol cream (Dovonex®) Plaque psoriasis treatment.

Authors: S. Tzaneva, H. Hönigsmann, A. Tanew.
Special Environment Dermatology, Dermatology,
Vienna Medical School, Austrian University.

Summary

In a recent trial, a new, patented base fatty acid, 1% coal tar preparation (Exorex®)
has been found to be as effective as calcipotriol cream in the treatment of psoriasis.

Objectives
Our objective is to explore a new cosmetics with its efficacy, safety and acceptability,
1% coal tar preparation Exorex®, and compare it with calcipotriol cream in more patients.

Patients and methods
Forty patients with chronic plaque psoriasis were included in this randomization, and the observers did not know the grouping situation.
In the comparison test, two comparable target plaques in each patient were treated twice daily with 1% coal tar preparation or calcipotriol cream. At the beginning of treatment, and at 2, 4,
6 and 8 weeks, the response to the treatment of Psoriasis Severity Index (PSI), the degree of erythema, infiltration, and the size of the psoriatic skin damage, are performed on a five-point scale. Determination.

In addition, all treatment-related side effects and cosmetic acceptability of the two
treatments are also recorded. The treatment is evaluated by the patient every second week. After complete or nearly complete clearance, the patient will be tracked until there is a relapse or the maximum period of 18 months.

result

38 patients completed the study. In the PSI based on the average ± SD of the trial results, the
coal tar penetrating emulsion was tried, and the original 9.2±1·5 was reduced to 3.0±2.9, and the calcipotriol cream was reduced to 2.8±2· 7.

The average PSI reduction between the baseline and the final assessment, there was no significant difference between the 1% coal tar penetrating emulsion and the calcipotriol cream (P=0.77). The average intra-individual difference in PSI score between 1% coal tar penetrating emulsion and calcipotriol cream was a score of 0.1 (95% confidence interval -0.84 + 0.63). There is no difference between observing relative to time until relapse. The pruritus was caused by 1% coal tar penetrating lotion in 4 patients, and one was caused by calcipotriol cream. Six patients pointed out that the 1% coal tar penetrating emulsion had an unpleasant odor, or stained with the 1% coal tar formulation, while one patient complained of the smell of calcipotriol cream.

Conclusion The

new 1% coal tar emulsion is considered to be as effective as calcipotriol cream for the treatment of psoriasis. Tolerability and cosmetic acceptability are better than calcipotriol cream. Considering that coal tar permeable milk is cheaper than calcipotriol cream, this new product has shown to be a very useful topical medicine for chronic plaque psoriasis.

Refer to

Valk, PGM van der, E. Snater, Verbeek-Gijsbers, P. Duller, PCM van der Kerkhof.
My patients with allergic dermatitis are treated with coal tar lotion. Dermatology 96;193:41-44.

Veronikis, namely Malaban, AO, Holick, MF.
A preliminary study comparing calcipotriol (Dovonex) and coal tar emulsion (Exorex) in the treatment of psoriasis in adults. Arch Dermato.
1999; 135: 474-475.

Source: British Journal of Dermatology. Volume 149 (2003), pages 350-353.

What is Eczema?

What is Eczema? What causes Eczema?

Eczema is also known as atopic dermatitis, or atopic eczema (the most common form of eczema). Atopic eczema mainly affects children, but it can continue into adulthood or start later in life. The word eczema comes from the Greek word ekzein meaning “to boil out”; the Greek word ek means “out”, while the Greek word zema means boiling.

Eczema is a chronic skin condition in which the skin becomes itchy, reddened, cracked and dry. Approximately 30% of all skin-related GP visits in Western Europe result in a diagnosis of atopic eczema. It affects both males and females equally, as well as people from different ethnic backgrounds. Most GPs (general practitioners, primary care physicians) in Western Europe, North America and Australia say the number of people diagnosed each year with eczema is has been rising in recent years.

Atopy is the hereditary predisposition toward developing some hypersensitivity reactions, such as hay fever, asthma, chronic urticaria, and some types of eczema. Atopic eczema, therefore, means a form of eczema characterized by atopy – in other words, inherited eczema.

Approximately 80% of atopic eczema cases start before the age of 5, and a sizeable number develops it during their first year of life.

What are the symptoms of eczema?

As atopic eczema is a chronic disease symptoms are generally present all the time. A chronic disease is a long-term one; one that persists for a long time. However, during a flare-up symptoms will worsen and the patient will probably require more intense treatment.

Below are some common symptoms of atopic eczema (without flare-up):

The skin may be broken in places.
Some areas of the skin are cracked.
The skin usually feels dry.
Many areas of skin are itchy, and sometimes raw if scratched a lot.
Itching usually worse at night.
Scratching may also result in areas of thickened skin.
Some areas of skin become red and inflamed.
Some inflamed areas develop blisters and weep (ooze liquid).
The skin has red to brownish-gray colored patches.
Areas of skin may have small, raised bumps.

Although the patches may occur in any part of the body’s skin, they tend to appear on the hands, feet, arms, behind the knees, ankles, wrists, face, neck, and upper chest. Some patients have symptoms around the eyes, including the eyelids. Scratching around the eyes may eventually lead to noticeable loss of eyebrow and eyelash hairs. Babies tend to show symptoms on the face.

When there is a flare-up the previous symptoms still exist, plus some of the ones below:

The skin will be much more itchy.
Itchiness and scratching will make the skin redder, raw and very sensitive.
Many of the affected areas will feel hot.
The skin will be much more scaly and drier.
The raised bumps will be more pronounced and may leak fluid.
Blisters will appear.
The affected areas may be infected with bacteria.

Flare ups can last from a day or two to several weeks.

Patients with mild atopic eczema will generally have only small areas of dry skin which may itch sometimes. When symptoms are severe large areas of skin become very dry and the itching is constant. Many areas will ooze fluid.

A vicious circle can set in. It starts with unpleasant itching, then scratching which makes the itching worse, which makes the patient scratch more – eventually the skin can bleed. Children who get into this cycle can suffer serious sleep disruption and may find concentrating at school extremely challenging.

The following may worsen the symptoms of atopic eczema:

Prolonged hot showers or baths.
Allowing the skin to stay dry.
Mental stress.
Sweating.
Rapid temperature changes.
Dry air.
Certain fabrics for clothing, such as wool.
Cigarette smoke.
Dust.
Sand.
Some soaps, solvents, or detergents

A Swedish study found that linalool, the most common fragrance ingredient used in shampoos, conditioners and soap is a powerful allergen for a significant number of people.

What are the causes of atopic eczema?

Experts say that people with eczema are born with it – it is a genetically inherited condition. It can be worsened with exposure to external or environmental factors such as pollen or pet fur, and internal factors such as hormone levels and stress.

In 2006, scientists from the University of Dundee, with collaborators in Dublin, Glasgow, Seattle and Copenhagen, discovered the gene that causes dry, scaly skin and predisposes individuals to eczema.

In 2009 a study carried out by scientists at the University of Edinburgh concluded that the defects in a particular gene known as the filaggrin gene are linked to a considerably amplified risk of developing allergic disorders such as eczema, rhinitis, and asthma.

The oily (lipid) barrier of skin is usually reduced in people with atopic eczema, compared to other people. The lipid barrier helps prevent water loss. If your barrier is reduced you will lose water faster and your skin will be drier. Several studies have been confirming this, including this one.

The immune system cells of people with atopic eczema release chemicals under the skin’s surface which may cause inflammation. Experts are not 100% sure why this happens. They just know that it is an immune system overreaction.

Even though scientists are fairly sure genetics are the primary cause, they do not yet know what the exact genetic cause is. The above-mentioned studies are giving us a better idea – but a great deal of further research is needed. 60% of children with atopic eczema have one parent with the same condition. Studies have shown that children run an 80% risk of developing eczema if both their parents have the condition.

Eczema linked to gut bacteria in children – children who have eczema have a wider range of bacteria in their gut compared to kids without the condition, researchers from the University of Turku, Finland, reported in the journal BMC Microbiology. The scientists noticed that the bacteria in the gut of children with eczema were more like those found in adults than other kids.

Recent studies are starting to reveal a picture of early life lifestyle habits that may reduce the risk of developing eczema later on, either during early childhood or later on in life. An infant diet that includes fish before the age of 9 months curbs the risk of developing eczema, a Swedish study reported.
Environmental factors that make atopic eczema symptoms worse
Some scientists say that environmental factors are the ones causing the number of recent eczema cases in the developing world to rise. They argue that it is highly unlikely that genetic factors would change in such a short time.

Environmental factors are also known as allergens – they cause the body’s immune system to overreact; an allergic reaction.

The three most common allergens for atopic eczema are:

House dust mites (bed bugs)
Pollen
Pet fur

Children who are exposed to cats soon after birth may have an increased risk of developing eczema, according to a study carried out by researchers at the University of Arizona in Tucson, USA.

These three allergens are also the main ones that trigger asthma and hay fever.

Hard water

Several scientists have suggested that hard water may be bad for people with eczema. Scientists from the University of Portsmouth, England, are carrying out a study to find out whether installing a water-softener in the home might improve the symptoms of children with eczema. Results of their study should appear around the end of 2009.

Foods that may make atopic eczema symptoms worse

These are foods that typically cause allergic reactions in people with sensitive immune systems. These include:

Milk (cow’s)
Eggs
Nuts
Soya
Wheat

About 10% of children with atopic eczema are affected by food allergens. Foods rarely affect the symptoms of adults with eczema.

Hormones can worsen symptoms

A significant proportion of women with eczema report that their symptoms worsen during their menstrual cycle. 30% of women have flare ups during the days preceding their menstrual period. 50% of women with eczema say their symptoms got worse when they were pregnant. These are all periods when a woman’s hormone levels change.

Mental stress can make eczema symptoms worse

Doctors are not sure what exactly it is that causes a worsening of symptoms during mental stress. Atopic eczema patients commonly report that their symptoms are likely to get worse when they are mentally stressed. It is possible that a vicious cycle could develop – the symptoms of eczema stress the patient, the resulting stress exacerbates the symptoms, etc.

Winter is usually worse than summer

Most patient who do not live near the equator find that their symptoms are worse in the winter than the summer, even though pollen is an important trigger.
Diagnosis of eczema
No laboratory test or skin test currently exists which can diagnose atopic eczema.

A GP is able to diagnose atopic eczema after examining the patient and asking some questions about his/her symptoms and medical history – this will include questions about the presence of eczema in close family relative. The doctor will also ask about some other allergy-related conditions, such as asthma and hay fever.

A number of diagnostic criteria to confirm diagnosis

A doctor in the UK will assess the patient’s skin against a number of diagnostic criteria in order to confirm an eczema diagnosis. The criteria include:

A long period with itchy skin – the patient has had itchy skin for the last 12 months.

Plus at least three of the criteria below:

Itching and irritation – itchiness and irritation in skin creases, such as the front of elbows, behind the knees, front of ankles, around the neck, or around the eyes.

Asthma or hay fever – the patient either has asthma or hay fever or has had them in the past. If the child is under four, the doctor will ask whether a close relative (brother, sister, mother, father) has asthma or hay fever.

Dry skin – the patient’s skin has been dry for the last 12 months.

When it started – the condition started when the patient was two years old, or less. (If the patient is under four years of age this criterion is not used).

Joints – eczema is present either where skin covers the joints or the parts of the body that flex, such as wrists, knees, or elbows.

If the patient meets these criteria (the first, plus at least three of the others) the UK doctor will not usually have to carry out any further testing to confirm diagnosis.

Identifying trigger factors during diagnosis

The doctor will try to find out what triggers worsen the patient’s symptoms. He/she will ask the patient questions about lifestyle, soaps and detergents used, diet, home environment, pets, where exactly the house is, etc.

Some doctors will ask the patient to keep a diary – the patient will note down such data as eating habits, clothes worn, what time of day symptoms are better or worse and where the patient was during those times, etc. The aim here is to identify as many trigger factors as possible.
What is the treatment for atopic eczema?
There is currently no cure for atopic eczema – there is no treatment that gets rid of it for good, as might be the case with surgery to cure blindness caused by cataracts. However, there are a variety of treatments which focus on the symptoms, as well as strategies to avoid triggers, and may improve the patient’s quality of life considerably.

A significant proportion of children with atopic eczema will find that their symptoms will improve as they get older.

Self-care – What the patient can do

Avoid scratching

Itchiness is a common part of eczema, and scratching is a natural reaction to deal with itching. Unfortunately, scratching will invariably further aggravate the skin and make symptoms worse. Scratching also raises the risk of infection.

Getting an adult to control his/her scratching is hard enough – it is even harder for children. Children will often not be able to control the urge to scratch. It is important that nails are kept short and clean. Babies may benefit from anti-scratch mittens.

Avoid trigger factors

A good doctor will have established a list of factors that trigger eczema flares. The patient should try to avoid them as much as possible. Parents/guardians need to remind children of triggers and help them devise strategies to avoid them – younger children may need to be reminded frequently.

People with atopic eczema usually avoid clothes made of synthetic fibers and opt for natural materials, such as cotton.

We know that dust mites are likely triggers for many people. However, most studies have shown that trying to eradicate them from your home is very time consuming and does not seem to be very effective in reducing the frequency and severity of flare-ups. Several patients have written into Medical News Today saying that when they get up in the morning they pull their sheets right back and do not make their beds for several hours, allowing the bed to be ventilated – this has helped them (bear in mind this information is not a study, and must be taken as anecdotal).

Nutrition

It is important to check with your doctor before undergoing any large change in diet, especially if the patient is a child. Breastfeeding mothers whose babies have atopic eczema should check with their GP before embarking on any significant diet change. Milk, eggs, and nuts are common triggers. Researchers from King’s College London found no evidence that exclusive breastfeeding reduces the risk of a baby eventually developing eczema.

The German Institute for Quality and Efficiency in Health Care stresses that parents should be cautious about eliminating important foods like milk from their baby’s or child’s diet. In fact, their report says that avoiding foods may do more harm than good for children with atopic eczema, unless your child has a proven food allergy.

Regular fast-food consumption linked to eczema risk – children who consume fast foods at least three times a week are much more likely to have eczema as well as hay fever, researchers reported in the journal Thorax (January 2013 issue).

If you have identified the triggers you should avoid them. However, if a child’s trigger is milk he/she will need an alternative source of calcium. Always check with your doctor or a qualified nutritionist first before taking a major food source out of your or a child’s diet.

Complementary therapies

These are very popular among patients with atopic eczema. They include aromatherapy, massage, homeopathy, and some herbal remedies, to mention but a few. It is important to remember that although patients do report benefits, a lot of information one reads in books and on the internet is anecdotal. For therapy to be convincing, it should undergo proper clinical tests, usually carried out and compared to a placebo (dummy treatment). Before undergoing any complementary/alternative therapy, check it out carefully.

Researchers at Mount Sinai Hospital in New York reported that treatments consisting of Erka Shizheng Herbal Tea, a bath additive, creams and acupuncture, effectively treated patients with persistent atopic eczema. Their findings were presented at the 2009 Annual Meeting of the American Academy of Allergy, Asthma & Immunology.

Another study, carried out by Scientists at the Chinese University of Hong Kong, found that a traditional Chinese herbal concoction, consisting of Flos lonicerae (Japanese honeysuckle), Herba menthae (peppermint), Cortex moutan (root bark of peony tree), Atractylodes Rhizome (underground stem of the atractylodes herb) and Cortex phellodendri (Amur cork-tree bark) may help people with eczema and reduced their needs for medications.

Bleach baths

Researchers from the Northwestern University Feinberg School of Medicine reported that bleach baths offer an effective treatment for kids’ chronic eczema.

Emollients

An emollient is an agent that softens and smoothes the skin – it can be a cream, lotion or ointment. They keep the skin supple and moist. Emollients are an important part of atopic eczema treatment. The skin of people with eczema is usually dry; emollients help keep them moisturized, which helps prevent cracking and irritation.

Finding the right emollient may be a question of trial-and-error at first. The patient may have to try several different ones before hitting on a suitable one. Patients usually end up needing different types of emollients for different parts of their body.

Some emollients are specific for very dry skin, while others are aimed at less dry skin. Ointments are generally prescribed for drier skin, while creams and lotions are usually prescribed for other skin types.

It is not uncommon for patients to find that an emollient is not longer as effective as it used to be. Others may start experiencing skin irritation after long-term use. If either case happens to you or your child, you should see your GP.

Applying an emollient – apply smoothly to the skin, following the direction the hair grows. Do not rub it in as this may irritate the skin. Gently dry the skin after washing and apply the emollient as soon as the skin is dry. Emollients must not be shared.

Creams and lotions are generally used for red, inflamed areas.

Ointments are usually used for dry areas that are not inflamed.

Apply often – Frequency is the key for effective emollient use. Do not stop applying it when the skin seems to be clear. Frequent use on known affected areas will significantly reduce the number of flare-ups, as well as their severity. Patient’s whose skin is very dry should have repeat applications every two to three hours. During flare-ups frequency of use is paramount – this is when the skin needs the most moisture. Applications during a flare-up should be both frequent and generous.

If your child has atopic eczema it is important that you liaise with his/her school. In the UK it is common for a child to have emollient supplies at home and at school.

Emollient instead of soap – emollient treatments should be used in place of soap. Soap irritates the skin if you have atopic eczema. In many countries it is possible to purchase emollient bath and shower additives. This measure will make a significant difference in the patient’s frequency and severity of flare-ups.

Side effects of emollients – some patients may develop a rash with certain ingredients in a specific emollient. That is why people commonly have to try out different ones when they first start. Some emollients contain paraffin and can be a fire hazard – store them carefully and do not use them near a naked flame. Emollients may make the surface of the bath and the floor of the shower cubicle more slippery.

Topical corticosteroids

In medicine topical means “applied on to the skin”. Corticosteroids rapidly reduce inflammation. If the patient’s skin is very red and inflamed the doctor may prescribe a topical corticosteroid.

Many parents or adult patients react with alarm when the doctor utters any word with “steroid” in it. They imagine anabolic steroids that bodybuilders use. Corticosteroids are not anabolic steroids, and when used correctly, they are a safe and effective treatment for eczema.

Applying a corticosteroid – apply to the affected area sparingly. Follow the instructions on the leaflet carefully. You can also ask the doctor, and if you cannot remember, ask a qualified pharmacist.

Applying a corticosteroid during a flare-up – the corticosteroid should not be applied more than twice daily. Most patients will only require one application per day. After the flare-up has cleared up you should continue for another 48 hours.

If the patient is using corticosteroids on a long-term basis, he/she should check carefully with the doctor on how and when to apply it.

If you have tried corticosteroids and symptoms have not improved you should see your doctor.

Alitretinoin (Toctino)

Alitretinoin is used for patients with severe, chronic hand eczema who have not responded to other treatments. A specialist skin doctor (dermatologist) needs to supervise treatment with alitretinoin. Alitretinoin is a retinoid, a type of medication that helps lower levels of irritation and itchiness associated with eczema. Treatment usually consists of swallowing one tablet a day for 12 to 24 weeks.

Alitretinoin must NOT be taken by pregnant women or breastfeeding mothers. In most countries alitretinoin is not recommended for women of child-bearing age.

Side effects of alitretinoin include headaches, dry skin, flushed skin, joint pain, and muscle pain. The following extremely rare side-effects also exist: hair loss, blurred and distorted vision, and nose bleeds. Anybody who experiences blurred vision when taking this medication should contact the dermatologist immediately.

Antihistamines

This type of medication stops the effects of histamine, which our body releases when in contact with an allergen. If the effects of histamine can be stopped or reduced, symptoms of eczema, hay fever, and some other allergic conditions are often significantly reduced.

Sedating antihistamines can make some people feel drowsy and are generally prescribed for itchiness at night – their drowsiness side-effect will help some patients get a good night’s sleep. Sedating antihistamines are not usually prescribed for more than a couple of weeks at a time. They should be taken about one hour before going to bed. Sometimes drowsiness is still present the following day – it is important that the child’s school knows this. If the patient is an adult and feels drowsy the following morning he/she should not drive or operate heavy machinery.

Non-sedating antihistamines may be used on a long-term basis. They will help ease itching but will not make the patient feel drowsy.

Infection

If the eczema becomes infected the patient will probably need an antibiotic.

Oral antibiotic – An oral antibiotic will be prescribed if symptoms are very severe and infection has affected a large area. The most commonly prescribed antibiotic is flucloxacillin, which should be taken for seven days. If you or your child are allergic to penicillin a different antibiotic will be prescribed, perhaps erythromycin or clarithomycin.

Topical antibiotic – if symptoms are not so severe and the infection does not cover a large area the patient will most likely be prescribed a topical antibiotic – one that is applied directly onto the affected area. This will usually be an ointment or a cream.

The doctor may prescribe new supplies of topical medications in case your current ones have become infected.

Patients who have areas which are prone to recurrent infection may be prescribed a topical antiseptic, which is applied directly onto the targeted area of skin. Examples include chlorhexidine and triclosan.

Light Therapy (Phototherapy)

This involves the use of natural or artificial light. In its most simple form, all the patient has to do is expose himself/herself to controlled amounts of natural sunlight.

Other forms of phototherapy include using artificial ultraviolet A (UVA) or ultraviolet B (UVD) light, either on its own or in combination with drugs.

Light therapy is very effective. It is important that it is done with a qualified health care professional. Exposure to sunlight has many beneficial effects, but it does, however, also have risks if not controlled properly. Examples of risks include premature skin aging and a higher risk of developing skin cancer.

When to see a specialist

The GP may refer a patient to a specialist skin doctor (dermatologist) if:

The patient has not responded to treatment.
The GP is uncertain about what is causing the eczema.
The patient insists the GP refers him/her or the child to a specialist.
The GP thinks the patient would benefit from specialist treatment, such as ultraviolet light exposure, bandaging treatments (wet wraps), or calcineurin inhibitors.

Complications of atopic eczema

Infection

If the skin becomes dry and cracked there will be an opportunity for bacteria to penetrate. The likelihood of this happening is greater for people with eczema. Scratching the eczema increases the risk of infection further.

A bacterium called Staphylococcus aureus (S. aureus) commonly infects people with eczema. An infection with S. aureus will make the eczema much worse, causing increased redness, oozing of fluid and crusting of the skin, making it virtually impossible for the skin to heal naturally (without antibiotics).

Psychological effects

The mental stress of living with eczema can have a psychological impact on the sufferer, especially if it started very early in life. Children with atopic eczema are much more likely to have behavioral problems at school, compared to their peers who do not have it. Parents sometimes comment that their child with atopical eczema is much more clingy than their other children.

The stress can also come from other people. More than a quarter of patients with atopic eczema have been bullied or teased because of their skin condition, according to an international study.

Children with eczema frequently suffer from a lack of self-confidence. Family support and encouragement is a crucial factor in helping them overcome this. If your child’s self-confidence appears to be seriously undermined, talk to a health care professional, as well as the staff at his/her school.

Sleep problems

The majority of children with atopic eczema have sleep-related problems. Lack of sleep can have an impact on the patient’s physical and mental health.

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