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 DENOMINATION
- Treatment of the dermatitis atopica.
TREATMENT
The treatment of the eczema atópico includes different measurements:
- Exclusion of the causes of allergy,
- Cosmetic treatment,
- Treatment of the stress,
- Pharmacological treatment for oral route,
- Treatment of the itch,
- Treatments antinflamatorios or of the sprouts,
- Treatments of the sobreinfecciones,
- Local pharmacological treatment,
- Phototherapy,
- New inmunomoduladores.
EXCLUSION OF THE CAUSES OF ALLERGY
In this case the food exclusion diets are contemplated to which the patient is sensitized by allergy mechanisms.
Also the measurements of environmental control to diminish the mites content in the domestic dust.
To see in: http://www.broadviewcare.org/temas/alergia_a_acaros.php". COSMETIC TREATMENT
The patient with eczema atópico has the dry skin and the tendency to suffer a very annoying itch due to the xerosis. An excellent way of dampening the skin are the corporal daily baths. Although the bath with water moderated relieves already of if the itching, the benefit is obviously better if they are added to him to the water, in solution or suspension, dust of oats or certain formulae with soft tars. The ideal hour of the bath is the evening. After the bath it is adapted to apply emollient corporal creams. The majority they contain urea or lactic acid to different concentrations.
TREATMENT OF THE STRESS
The eczema sprouts atópico can be provoked or be irritated by emotional tensions, the states of anxiety or of anxiety and stress. The doctor with aptitude to receive the situations and to value them, can help very much with a good psychotherapy. For this motive the use of tranquilizers is justified along with the antiallergic traditional ones.
PHARMACOLOGICAL TREATMENT FOR ORAL ROUTE
- a) Corticoids for systemic route: They are useful in the very sharp cases, to suitable doses, to break the cycle: itching, scratched, eczema, itch. They must be used in short periods, being always attended to the basic conditionings that are tied to the employment of the same ones. They must not be used like maintenance treatment.
- b) Antihistamines for systemic route: These medicines must never be used by local route. They can be used alone or combined. There are useful the combinations of an antihistamine of new generation (levocetirizina, desloratadina, rupatadina, etc...) in the daytime with a classic antihistamine (hidroxicina, clorfeniramina) at night.
- c) Antibioticoterapia: The antibiotics employment for general and local route is necessary in the eczemas sobreinfectados. The eczema atópico sobreinfecta seldom. If it does it especially it is for streptococcus betahemolítico. On the other hand, often, the golden staphylococcus colonizes the eczema badges.
- d) Inmunomoduladores: Ciclosporina A por oral route is active in the treatment of the eczema atópico of the adult and in the infancy. In general it is used to dose of 2,5-5 mg / kg / day in short time periods.
- e) Supplements lipídicos: The employment for oral route or transepidérmico of unsaturated essential greasy acids Omega-6, originated from the vegetable oil as that of evening primrose (evering rose occupies first place oil) or of other rich vegetables in ac. Linoleico and gammalineleico they help to improve the cutaneous dryness, relieve the itching and reduce the inflammation eccematosa.
LOCAL PHARMACOLOGICAL TREATMENT
- a) Humid compresses: They are used in open remedy, from two to four times a day. The physiological whey, the permanganate are advisable potásico.
- b) Baths: One or two baths a day, in finished bathtub and entire immersion during twenty minutes, are very effective for the dry skin and like tranquilizer of the itching. There are used colloids of oats or certain tars to dissolve in the water.
- c) Emollient: There are the ideal complement for after the bath, although they can be used also without, several times a day. They contain urea and lactic to different concentrations. The children do not tolerate well those who take urea. There are many on the formula market galenica diverse. The emulsions and/or applied after the bath, with the even humid skin, they are especially beneficial.
- d) Tars: Creams or ointments with coaltar of 2 to 5 % can be so or more effective than the local steroids. Especially applied in eczema areas chronic or dry. Otherwise, they complement each other very well alternating them with creams or ointments with steroids.
- e) Local Corticosteroides: At first there are the best local medicines to treat the eczema. His employment must always bear in mind the basic beginning not to produce undesirable effects. They will have to be chosen as regards the activity of the eczema. A very powerful local steroid must be used during a limited number of days. Later it can follow with other of medium or minor activity. In the face the dweebs must always be used and nearly time. In certain areas, like the creases, the areas of very thin skin or the corporal regions where clásicamente the network appears "striae distensae", must never use those of big potency.
PHOTOTHERAPY
The employment of Ultraviolet although it is not useful in all the patients, in some serious cases they have proved to be effective. Both the GRAPE and the UVB. The PUVA dose (oxoralen + GRAPE) is used because of two or more weekly meetings.
NEW INMUNOMODULADORES
In this group we have the Tacrolimus (Protopic ®) in ointment to 0.1 % (adult) and 0.03 % (children), which acts modulating the reaction come up by cells (Lymphocytes T), being classified therefore like an immunomodulator (immunosuppressant).
The tracolimus has been accepted for the short-term treatment and long term of intermittent form in the moderate and severe cases of dermatitis in adults and children older than 2 years who do not answer to conventional treatments.
As collateral effects there has been observed a developing incidence of superficial infections of herpes virus, foliculitis and acne.
It is not recommended to sunbathe or beams GRAPE in the active treatments with Tacrolimus. It usually produces in the skin intense heat itch and eritema in the place of application, which usually disappears with the maintenance of the treatment.
The efficacy of the Tacrolimus is similar to that of the corticoids but it has the advantage on these of not producing atrophy of the skin and therefore it is possible to administer on the injuries during more long periods.
Another local inmunomodulador is the pimecrolimus (Elidel ®) that has an efficacy similar to the previous one, presents the advantage of being able to administer from 3 months of age, not produce local intense heat and his formulation in cream (1 %) that makes her more tolerable and comfortable than the ointment.
TO SEE ALSO
WHAT DOCTOR CAN TREAT ME?
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DENOMINATION 
