Eczema medications
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Eczema Medications: A Comprehensive Overview
Tripterygium Agents for Atopic Eczema
Efficacy and Safety of Tripterygium Agents
Tripterygium agents (TA), derived from the traditional Chinese medicine Tripterygium wilfordii hook F, have shown promise in treating atopic eczema. A systematic review and Bayesian analysis of 13 trials involving 1385 patients revealed that TA, when combined with other drugs, significantly improved treatment outcomes. The most effective combinations were TA with Diyin tablet (DYP) and topical glucocorticoids (TG), and TA with compound glycyrrhizin (CG). However, the use of TA is associated with adverse effects, particularly reproductive system dysfunction, and further large-scale studies are needed to confirm their safety and efficacy.
Leukotriene Receptor Antagonists (LTRAs)
Montelukast for Eczema
Leukotriene receptor antagonists, particularly montelukast, have been explored for their potential in treating eczema. A review of five studies involving 202 participants found no significant difference in disease severity between montelukast and placebo groups. The studies also reported mild side effects such as headaches and gastrointestinal disturbances, but no severe adverse events. The evidence suggests that montelukast is not effective for eczema, and further research is needed to explore other LTRAs.
Experimental Drugs for Atopic Eczema
Novel Treatments and Biologics
Recent studies have highlighted several experimental drugs for atopic eczema, including topical phosphodiesterase E4 (PDE4) inhibitors like crisaborole and monoclonal antibodies such as dupilumab. These treatments have shown efficacy with minimal side effects in clinical trials. Additionally, various biologics, PDE4, and JAK inhibitors are in different phases of trials, showing potential for treating severe and recalcitrant eczema.
Antibiotics for Clinically Infected Eczema
Effectiveness of Oral and Topical Antibiotics
A randomized controlled trial (RCT) involving 113 children with clinically infected eczema found that neither oral flucloxacillin nor topical fusidic acid significantly improved eczema severity compared to placebo. The study concluded that antibiotics should be avoided in children with mild clinically infected eczema, as they do not provide additional benefits over standard treatments like emollients and topical corticosteroids .
Methotrexate vs. Ciclosporin
Comparative Effectiveness in Severe Eczema
An ongoing RCT aims to compare the effectiveness, safety, and cost-effectiveness of methotrexate versus ciclosporin in treating severe atopic eczema in children. This study is expected to provide valuable insights into the optimal systemic immunomodulatory treatment for severe cases.
Chinese Herbal Medicine
Pei Tu Qing Xin and Other Formulations
Chinese herbal medicine (CHM) has been explored as a complementary treatment for eczema. A pilot RCT found that the CHM preparation Pei Tu Qing Xin improved quality of life in children with moderate-to-severe atopic eczema. However, the study emphasized the need for more rigorous trials to confirm these findings. Additionally, traditional Chinese medicine (TCM) therapies, including herbal formulas and acupuncture, have shown potential in managing eczema symptoms and improving patient outcomes.
Evening Primrose Oil and Borage Oil
Lack of Efficacy in Eczema Treatment
A review of 27 studies involving 1596 participants concluded that oral evening primrose oil (EPO) and borage oil (BO) are not effective treatments for eczema. Both oils failed to show significant improvement in eczema symptoms compared to placebo, and their use is not recommended.
Oral H1 Antihistamines
Add-On Therapy for Eczema
The use of oral H1 antihistamines as an add-on therapy to topical treatments for eczema has been investigated. A review of 25 studies found no consistent evidence that H1 antihistamines are effective in improving eczema symptoms. While some antihistamines like fexofenadine showed minor improvements in pruritus, the overall benefit was not clinically significant.
Conclusion
The treatment landscape for eczema includes a variety of medications, from traditional Chinese medicine and experimental drugs to antibiotics and antihistamines. While some treatments show promise, others lack sufficient evidence of efficacy. Ongoing research and large-scale trials are essential to establish the most effective and safe treatments for eczema.
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