How To Treat Eczema (Dermatologist Explains)

Summary

In this informative video, Dr. Osama Hamdy, a dermatologist known as the 'Real Skin Doctor,' discusses various treatment options for eczema, a common skin condition affecting millions worldwide. He outlines lifestyle interventions like moisturizers, humidifiers, and bleach baths to manage symptoms. Prescription treatments include topical steroid creams and non-steroidal options like tacrolimus and Eucrisa. For severe cases, phototherapy and new biologic medications like Dupilumab are explored. The video also mentions experimental JAK inhibitors for resistant cases, emphasizing the ongoing need for treatment due to eczema's chronic nature.

Takeaways

• 🌍 Eczema is a widespread skin condition affecting millions, causing itchiness, discomfort, and impacting sleep and quality of life.
• 👨‍⚕️ Dr. Osama, a dermatologist, offers evidence-based advice on eczema treatment options, including new life-changing methods.
• 🧴 Lifestyle interventions include using moisturizers like CeraVe or La Roche-Posay to reinforce the skin's barrier function.
• 💧 Humidifiers are recommended to reduce water loss from the skin, especially during winter months.
• 🚿 Reducing shower frequency and temperature can help retain skin moisture and reduce dryness.
• 🛁 Bleach baths can help control bacterial overgrowth on the skin, which contributes to eczema inflammation.
• 💊 Prescription treatments include topical steroid creams that are anti-inflammatory and can be used safely for up to two weeks.
• 🌿 Non-steroid creams like tacrolimus ointment and Eucrisa are safe for prolonged use and can be applied to sensitive areas.
• 🌞 Phototherapy involves exposure to specific light that reduces immune cells causing itchiness, and is covered by most insurances.
• 💉 Dupilumab is a biologic injection targeting a key immune driver of eczema, providing significant relief with regular use.
• 💊 JAK inhibitors are oral medications for resistant cases, offering potential but with more immune system impact.

Q & A

What is eczema?

Eczema is a common skin condition where the skin's barrier function is compromised, leading to dryness, itchiness, and irritation.

How does moisturizing help with eczema?

Moisturizing reinforces the skin barrier, reducing water loss and providing relief from dryness and itchiness associated with eczema.

Why is using a humidifier recommended for eczema patients?

A humidifier increases the water concentration in the air, reducing the gradient for water loss from the skin, which is beneficial for eczema-prone skin.

What is the significance of taking less frequent and less hot showers for eczema sufferers?

Less frequent and cooler showers help to minimize skin dehydration that can occur after showering, which can exacerbate eczema symptoms.

Can you explain the concept of bleach baths for eczema treatment?

Bleach baths involve using a small amount of bleach in a full bath to reduce bacterial overgrowth on the skin, which can contribute to inflammation in eczema.

What role do topical steroid creams play in eczema treatment?

Topical steroid creams are anti-inflammatory and are used to manage severe eczema symptoms. They are effective but should be used under medical supervision and with caution.

Why is it important to take breaks from using topical steroids?

Taking breaks from topical steroids is important to prevent potential side effects on the skin and to allow the skin to recover.

What are some non-steroid topical cream options for eczema?

Non-steroid topical creams such as tacrolimus ointment and Eucrisa ointment are safe for prolonged use and can be used on sensitive areas like the face.

How does phototherapy work for eczema treatment?

Phototherapy uses a specific type of light, most commonly narrow band UVB, to reduce the number of immune cells causing itchiness in eczema, leading to remission.

What is Dupilumab and how does it treat eczema?

Dupilumab is a biologic medication that targets a specific part of the immune system involved in eczema, reducing inflammation. It is administered through self-injections every two weeks.

What are JAK inhibitors and how do they relate to eczema treatment?

JAK inhibitors are a class of oral medications being experimented with for eczema treatment. They have a more significant effect on the immune system than Dupilumab but are considered less safe.

Outlines

00:00

🧴 Eczema Treatment: Lifestyle Interventions and Topical Therapies

The first paragraph introduces eczema as a common skin condition affecting millions, causing itchiness and discomfort. It emphasizes the importance of treatment options, including lifestyle interventions. The speaker, a dermatologist, discusses the use of moisturizers like CeraVe and La Roche-Posay to reinforce the skin barrier, the benefits of humidifiers, the recommendation to take less frequent and less hot showers to retain skin moisture, and the unusual but effective practice of bleach baths to reduce bacterial overgrowth. The paragraph also covers prescription treatments, highlighting topical steroid creams as the primary treatment for eczema, with a discussion on their varying strengths and the importance of using them safely and effectively. It concludes with a mention of non-steroid topical creams like tacrolimus ointment and Eucrisa ointment as alternatives for long-term use.

05:02

🌞 Advanced Eczema Treatments: Phototherapy and Biologics

The second paragraph delves into more advanced treatments for eczema that may be necessary when lifestyle changes and topical creams are not sufficient. Phototherapy is introduced as a treatment involving exposure to specific light, which reduces itchiness by targeting immune cells in the skin. Although effective, it requires regular visits to a dermatology office, which can be inconvenient. The paragraph also introduces newer treatments like Dupixent (dupilumab), a biologic medication administered through injections that targets a specific immune system component involved in eczema, leading to significant improvements. The speaker notes that while Dupixent is considered safe, it requires ongoing treatment as the body metabolizes the medication. Finally, the paragraph mentions experimental treatments like JAK inhibitors, which are oral medications used for severe cases of eczema that do not respond to other treatments, although they may have more side effects.

Keywords

💡Eczema

Eczema, also known as atopic dermatitis, is a common skin condition characterized by red, itchy, and inflamed skin. It affects millions of people worldwide and can significantly impact their quality of life. In the video, the dermatologist discusses various treatment options for eczema, making it the central theme of the discussion.

💡Skin Barrier Function

The skin barrier function refers to the skin's ability to retain moisture and protect against external irritants and allergens. When this function is compromised, as in eczema, the skin loses moisture, leading to dryness and irritation. The video explains how treatments aim to reinforce this barrier to alleviate symptoms.

💡Moisturizers

Moisturizers are topical products applied to the skin to help lock in moisture and prevent dryness. They are a key part of the lifestyle interventions for managing eczema, as mentioned in the video. Examples given include CeraVe and La Roche-Posay products, which are used to reinforce the skin barrier.

💡Humidifier

A humidifier is a device that increases the moisture content in the air, which can be beneficial for people with eczema, especially during dry winter months. The video suggests using a humidifier as a lifestyle intervention to reduce the skin's water loss and maintain its hydration.

💡Bleach Baths

Bleach baths involve adding a small amount of household bleach to a full bathtub of water and soaking in it for a short period. This treatment is mentioned in the video as a way to reduce bacterial overgrowth on the skin, which can contribute to inflammation in eczema sufferers.

💡Topical Steroid Creams

Topical steroid creams are prescription medications used to reduce inflammation and itching associated with eczema. The video discusses the阶梯 of potency in steroid creams, from mild over-the-counter options like hydrocortisone to stronger prescription options like clobetasol.

💡Non-Steroid Topical Creams

Non-steroid topical creams are alternatives to steroid creams for eczema treatment. They include medications like tacrolimus ointment and pimecrolimus, which are considered safe for prolonged use and can be used on sensitive areas like the face, as highlighted in the video.

💡Phototherapy

Phototherapy, as discussed in the video, is a treatment that involves exposure to specific wavelengths of light, most commonly narrowband UVB. This treatment reduces inflammation and itching by targeting immune cells in the skin and is often recommended for more severe eczema cases.

💡Biologics

Biologics are a class of medications that target specific parts of the immune system. Dupilumab, mentioned in the video, is a biologic used to treat eczema by dampening the immune response that contributes to skin inflammation. It is administered through injections at home.

💡JAK Inhibitors

JAK inhibitors are a newer class of medications being explored for the treatment of eczema. They work by inhibiting enzymes in the immune system that contribute to inflammation. Although they have a more significant effect on the immune system than biologics like dupilumab, they may be considered for cases that do not respond to other treatments, as discussed in the video.

Highlights

Eczema affects millions of people worldwide causing itchiness, discomfort, and loss of sleep.

Treatment options for eczema can be life-changing.

Eczema occurs when the skin's barrier function is compromised.

Lifestyle interventions are the first line of treatment for eczema.

Moisturizers help reinforce the skin barrier in eczema.

Humidifiers can be beneficial for eczema-prone patients.

Taking less frequent and less hot showers can help manage eczema.

Bleach baths can reduce bacterial overgrowth on the skin.

Topical steroid creams are a main treatment for eczema.

Steroids are anti-inflammatory and can be used safely for short periods.

Non-steroid topical creams like tacrolimus and pimecrolimus are alternatives to steroids.

Phototherapy can be an effective treatment for severe eczema.

Dupilumab is a new biologic treatment for eczema that targets a specific immune system component.

Dupilumab requires long-term use for sustained eczema control.

JAK inhibitors are a newer class of medications being tested for eczema.

Eczema has no one-time cure and requires ongoing management.

The video provides a comprehensive overview of eczema treatments.

Transcripts

eczema is an incredibly common skin

condition that affects millions of

people around the world it causes

itchiness discomfort loss of sleep and

it really affects the quality of lives

of so many people in a profound way most

extra sufferers just give up and decide

that they're going to have to deal with

it but in this video i'm going to tell

you about the treatment options

available for eczema including some

newer ones that i think are truly

life-changing my name is osama aka real

skin doctor and i am a dermatologist

living and working in new york on this

channel i give evidence-based skin care

advice as well as talking about some

common dermatology conditions like this

video here about eczema so if you're

interested in this content make sure to

hit that subscribe button so let's kick

things off with a really brief

explanation of what eczema is eczema is

basically when your skin's barrier

function is no longer working

effectively and so you lose too much

moisture and water and you get dry and

irritated skin left behind when it comes

to extra treatment options the first

category that i'm going to discuss are

known as lifestyle interventions the

first major lifestyle intervention are

things like moisturizers which i have a

few examples of here this is cerave

moisturizing lotion which i'm a big fan

of and this is a similar laroche per se

product which i also like these are not

paid features i just happen to have them

in my bathroom now a moisturizer as an

intervention makes sense when you think

about the introduction i gave where i

explained that in eczema your skin's

barrier function is not working like

it's supposed to what you're doing is

reinforcing that skin barrier using this

artificial external layer kind of like

cement filling in the gaps between

bricks in a building and therefore your

skin's barrier becomes more effective

you don't lose as much water and so you

no longer have as dry and itchy skin

another example of a lifestyle

intervention that i think is great is

actually having a humidifier and i

recommend it to all of my eczema prone

patients especially in the winter months

a humidifier as the name suggests

increases the water concentration in the

ambient air in your room and because of

that there is less of a gradient for you

to lose water from the surface of your

skin to the outside air another useful

intervention i think is to take less

frequent and less hot showers that might

sound counterintuitive because when we

take a shower we're actually putting

water onto our skin but when that

surface water dries off it actually

leaves our skin more dehydrated after a

shower than before now i'm not

suggesting you guys stop showering and i

take no responsibility for any weird

smells that begin to emerge as a result

of this video all i'm saying is trying

to minimize the length of those showers

and try not to shower more than once per

day the final lifestyle tip is going to

sound weird but bear with me you can

actually do something called bleach

baths which involves taking clorox like

actual bleach a small amount of it like

half of a cap and putting that into an

entire bath full of water you then soak

the entire body beneath the chin in that

bathtub for around five to ten minutes

and the reason why this is effective is

because eczema sufferers actually have

too much of a specific type of bacteria

known as staph aureus taking over their

entire skin it's normal for all of us to

have bacteria on our skin but usually we

have different combinations of bacteria

that help to keep each other in check in

eczema sufferers they tend to have what

we call a monoculture of staph aureus

and that staphorious overgrows takes

over every other type of bacteria and

this leads to more inflammation in the

skin with a bleach bath you basically

nuke the entire surface of the skin get

rid of all of the staph aureus and all

of the other type of bacteria and then

you hope that it regrows in more of a

balance now you shouldn't be doing

bleach baths too frequently and i would

say a maximum of once a week or once

every two weeks depending on how your

skin handles it so moving on to the next

level of eczema and that is prescription

treatments you could be doing everything

right when it comes to your lifestyle

moisturizing frequently having your

humidifier on 24 7 but maybe your eczema

is so severe that you are going to need

prescription strength treatments the

main weapon we have against eczema is

topical steroid creams and the reason

for that is that steroids are

anti-inflammatory within the family of

steroids you can have mild steroids like

hydrocortisone one percent which is

available over the counter and then 2.5

percent which is prescription and you

can work your way up to a medium

strength like triumph syndrome which i'm

holding right here and even all the way

up to something like clobatazol which is

a top strength topical steroid cream as

a reflex some people don't like the idea

of using topical steroids because they

associate it with having harms to the

inside of the body but the reality is

that if you use a topical steroid cream

twice a day for up to two weeks maximum

at any one point in time you can

actually do it safely and effectively

although as always this is not medical

advice and you should always speak to

your own dermatologist after that

usually two week limit of using a

topical steroid consecutively you would

then be advised to take a break to make

sure that there's no side effects on the

skin and at that point there are also

non-steroid topical cream options and

you would hope that after that

short-term steroid use your skin is

calmed down enough that you can just

switch over to using the moisturizers

and it will stay under control for a

period of time because eczema is a

chronic condition you might have to

cycle between these periods of using

steroids and then taking a break and

using it and taking a break and it can

be really frustrating there are also

other types of creams which are

non-steroid anti-inflammatory options

and the most popular of these are

tachronymous ointment and eucrisa

ointment both of these are seen as safe

to use for prolonged periods of time

beyond two weeks consecutively and they

can also be used on places like the face

where we're otherwise a bit more scared

to use a topical steroid so what happens

if these topical creams fail or maybe

there's too much of the body involved

for the creams to be able to keep it

under control one great treatment option

is known as phototherapy this involves

going to usually a dermatology office

and standing in something called a light

booth the light booth emits this really

specific type of light most commonly

narrow band uvb and over time this light

therapy reduces the amount of a specific

type of immune cell in the skin which is

actually the first domino in the cascade

that causes itchiness in eczema it's a

great treatment super safe and covered

by most insurances but the main downside

is that you have to go in two to three

times a week usually for around eight to

ten weeks in a row that is a huge hassle

to anyone's schedule but if you're able

to complete that treatment usually

you'll go into a state of remission for

your eczema for around three to four

months at least now let's talk about

some newer treatments for eczema once

again i'm going to caveat that this is

not specific medical advice and you're

going to need to speak about this with

your own dermatologist but there is a

new type of treatment out for eczema

known as a dupilu map japinimab is a

type of medication known as a biologic

what that means is that it targets a

really specific part of your immune

system that is found to be a key driver

in eczema and it helps to turn the

volume down on that it's an injection

medication that people give themselves

at home every two weeks and it can lead

to absolutely life-changing results it's

actually considered to be a really safe

treatment as well and most providers

won't even require you to do blood work

at the beginning or during your

treatment with dupiluma but keep in mind

that it's a treatment you would have to

keep up for the long term there is no

one and done cure when it comes to

eczema your body breaks down dupilumab

and if you stop injecting yourself with

it every two weeks you'll find that in

around four to six weeks most of it

would have been broken down by your body

and your skin will go back to being

however it would have been without any

intervention and finally for those few

really resistant cases that don't

respond to even dupilumab there are even

newer medications that are being

experimented with right now especially a

class that are known as the jack

inhibitors the jack inhibitors are

actually tablet medications although

they do have slightly more of an effect

on your immune system and so they're not

considered to be as safe as dupilumab

however in some really resistant cases

they can still be absolutely

life-changing and a great medication for

those people so that is the a to z on

all of the eczema treatments that are

out there right now if you enjoyed this

video please consider dropping a like or

a comment down below and make sure you

check out the rest of the channel

because there might be some other videos

you find interesting too thank you so

much for watching and i'll see you in

the next one