Pediatric+Eczema

=Pediatric Eczema= Eczema refers to superficial inflammation of the skin characterized by redness, swelling, blisters, crusting scaling and usually itching There is a damp brewing and steaming pattern and a spleen deficiency and blood depletion pattern. These two patterns can also be called wet or weeping eczema and dry, scaly eczema. The wet eczema tends to be acute, while the dry eczema seems to be more sub acute or chronic condition.

Damp Heat Brewing & steaming
Eczematous lesions begin as a red rash. Over time, this rash develops blisters which eventually burst and weep. If these are scratched, a secondary infection often occurs.
 * Herbal Tx:** Bei Xie Shen Shi Tang (Yi Yi Ren, Hua Shi, Beixie, Fu Ling, Mu Dan Pi, ZeXie, Tong Cao

Spleen Deficiency and blood depletion
A red swollen rash which is scaly and hard. Itching is relatively mild. There may be a yellow-colored, fatty exudates.
 * Herbal Tx:** Si Wu Tang + Ping Wei San (Cang Zhu, Hou Po, Chen Pi)
 * Acupuncture Treatment:** Sp10, Bl 40, Li11, Lu7 Bl13, 17, St36, Sp6 – GV14 Moxa, Ear – Liv, Lu, Shen men….

Researchers have found a link between increased risks of certain cancers and the use of two prescription creams commonly used to treat skin conditions in children has initiated a growing concern among scientists. This concern prompted scientists to propose adding stronger warnings to the product labels. The two brands of cream under investigation are Protopic and Elidel. Although the creams were approved only to be used for a short-term use for adults and children age 2 and older, the marketers of Elidel pushed aggressively for a longer indication. One researcher stated that the product is being heavily advertised without regard for the potential cancer risks, particularly among young children. The result of this marketing push is that both creams are being used for longer than they safely should be among adults and babies. On the contrary, the makers of the Elidel argued that the cream is an effective steroid-free treatment for mild to moderate eczema and has a well-established profile. Washingtonpost.com February 12, 2005

I use Vaseline and treat the gut and other pathogens, clear allergens (esp eggs, peanuts and milk – 80%), allergenic substances, Probiotis: L. Acidophilus, Bifidobacterium, Lactobacilli GG, use acupuncture and fatty acids especially Vit A and sometimes zinc. Arctium root, taraxacum, glycerrhiza and coleus reduce epithelial inflammation. Vit E, Quercitin –Reduces NFKb and bromelain. Lyme? Dyna Med Description: see notes

Helicobacter pylori colonization associated with decreased risk for atopic eczema

Treatment overview: from Dynamed non-pharmacologic treatment o minimize bathing, reduce bathing to every other day § wash with cool water § use small amount of soap, especially non-fragranced moisturizing soap (e.g. Keri, Neutrogena) § no trials comparing soap vs. no soap § 1 crossover trial with 25 patients 17-59 with atopic eczema found no difference comparing washing detergents with vs. without enzymes (Acta Derm Venereol 1998 Jan;78(1):60 § drying after bathing dries skin further, pat dry instead of rubbing dry o keep skin moisturized - emollients (moisturizers) after bathing § water-based, non-fragranced, non-preservative moisturizer (Moisturele, Eucerin, PN-Kera) § add humidity to environment o avoid irritants, avoid sweating, cover affected areas, avoid coarse fabrics § knitted fabrics (polyester or cotton) better tolerated than woven fabrics (all polyester) and finer fabrics better tolerated than coarser fabrics in randomized trial of 20 patients with atopic eczema (German reference in Clinical Evidence) § finer wool (20 micrometer fibers) better tolerated than coarser wool (36 micrometer fiber) in randomized trial of 24 women 15-20 with atopic eczema and history of wool irritation (Contact Dermatitis 1987 Jul;17(1):21) § dust mite control may be beneficial but not proven § no evidence regarding pets or animal contact avoidance use low-to-medium potency topical steroids on flaring areas o treatment with topical steroids for 1-2 weeks improves outcomes (NNT 2-3) o no data on long-term treatment o addition of topical antibiotics to topical steroids unlikely to be beneficial o addition of emollients to topical steroids likely to be beneficial, based on 2 trials o 3-day high-potency steroid bursts as effective as 7-day mild steroid cycles, based on 1 trial o twice-weekly fluticasone propionate (0.05% cream) to usually affected areas reduced relapse rates in randomized trial of 295 patients stabilized on 4 weeks of fluticasone propionate

Diet:
insufficient evidence to recommend dietary manipulation dietary exclusions appear ineffective in unselected patients with atopic eczema, egg-free diet may be beneficial in infants with suspected egg allergy (level 2 [mid-level] evidence) based on Cochrane review of trials with methodologic limitations systematic review of 9 randomized trials evaluating dietary exclusions in 421 patients with medically diagnosed atopic eczema methodologic limitations included poor concealment of allocation, lack of blinding, and high dropout rates without intention-to-treat analysis; no trial had clearly adequate allocation concealment no evidence of benefit with egg and milk free diet in unselected patients with atopic eczema (6 trials with 288 patients) elemental diet (2 trials with 48 patients) few-foods diet (1 trial with 85 patients) egg-free diet may be beneficial in infants with suspected egg allergy who have positive specific IgE to eggs (1 trial with 55 patients) Reference - systematic review last updated 2007 Nov 6 (Cochrane Library 2008 Issue 1:CD005203)

Insufficient evidence to support use of Chinese herbal medicine -based on Cochrane review systematic review of 4 randomized trials lasting 8 weeks with 159 patients aged 1-60 years dropout rates ranged from 7.5% to 22.5% and no trial used intent to treat analysis all 4 trials assessed Zemaphyte which is no longer manufactured 2 of 3 placebo-controlled trials of Zemaphyte reported greater reduction in erythema and surface damage and better sleep all 4 trials reported adverse effects but none considered serious systematic review last updated 2004 Aug 25 (Cochrane Library 2005 Issue 2:CD002291)

insufficient evidence to support use of Chinese herbal creams systematic review found 2 randomized controlled trials suggesting complex mixtures of Chinese herbal creams were more effective than placebo for eczema, but no independent replication and adverse effects have been reported (Br J Clin Pharmacol 1999 Aug;48(2):262 Chinese herbal creams are unregulated, 8 of 11 creams studied contained dexamethasone (BMJ 1999 Feb 27;318(7183):563)

Chinese herbal medicine concoction may improve quality of life but not severity of atopic dermatitis in children (level 2 [mid-level] evidence) based on randomized trial with potential confounding factor 85 children aged 5-21 years with long-standing moderate to severe atopic dermatitis (Scoring for Atopic Dermatitis [SCORAD] score > 15) were randomized to traditional Chinese herbal medicine (TCHM) vs. placebo 3 capsules twice daily for 12 weeks TCHM contained Flos lonicerae (Jinyinhua) 2 g, Herba menthae (Bohe) 1 g, Cortex moutan (Danpi) 2 g, Rhizoma atractylodis (Cangzhu) 2 g, and Cortex phellodendri (Huangbai) 2 g 4 patients non-compliant, but all 85 patients included in intention-to-treat analysis

comparing TCHM vs. placebo at end of treatment mean 8.6 vs. 10 point decrease (improvement) in SCORAD score (severity of atopic dermatitis) (not significant between groups, p < 0.01 compared to baseline in each group) approximate mean 3.5 vs. 1 point decrease (improvement) in Children's Dermatology Life Quality Index score (p = 0.008 between groups, p = 0.001 from baseline for TCHM, not significant for placebo) mean 4 vs. 1 day/month reduction in corticosteroid use (not significant between groups, p = 0.042 from baseline for TCHM, not significant for placebo) no significant difference between groups in antihistamine use 3 (7%) vs. 0 patients had diarrhea, approaching significance (p = 0.074, NNH 14) 21 (50%) vs. 11 (25%) patients had general practitioner visits (p = 0.02)

Herbal ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica may be effective for atopic dermatitis in dry cold weather (level 2 [mid-level] evidence) based on subgroup analysis of randomized trial 88 patients aged 18-65 years with mild to moderate atopic dermatitis were randomized to herbal ointment (containing Mahonia aquifolium, Viola tricolor and Centella asiatica in cream vehicle) on one side of body vs. base cream vehicle alone on other side for 4 weeks herbal ointment associated with slightly reduced symptoms compared to base cream, but no significant differences post hoc subgroup analysis of 64 patients with treatment when mean outside temperature = 10º C (50º F) showed significantly better outcomes for herbal ointment compared to base cream Reference - Int J Clin Pharmacol Ther 2007 Nov;45(11):583

Using peanut oil-containing skin creams on atopic dermatitis rash may trigger peanut allergy; Dust mite control may be beneficial but not proven Wet wraps have no apparent advantage over conventional treatment (level 2 [mid-level] evidence) -Narrow-band ultraviolet B (UVB) light more effective than UVA light or visible fluorescent light in randomized trial of phototherapy twice per week for 12 weeks in 73 patients with severe atopic -Switching to nonionic detergent with reduced additives associated with improvement in some patients in 2-week uncontrolled study (level 2 [mid-level] evidence); 148 Japanese patients aged 6-58 years with atopic dermatitis who wore cotton underwear washed in cold water with cold rinse and used detergent containing anionic surfactants and additives (such as whiteners and enzymes) switched to nonionic, additive-reduced detergent for 2 weeks; 78% subjects had dry skin, of whom 76% had improvement in dry skin and pruritus intensity at 2 weeks; no change in subjects without dry skin; results may not be replicable in subjects washing with hot water rinse which removes detergent residue (J Dermatol 2003 Oct;30(10):708 in QuickScan Reviews in Fam Pract 2004 Jul 19;29(12):10)

Undershirts coated with borage oil may reduce symptoms of atopic dermatitis in children (level 2 [mid-level] evidence) based on small randomized trial 32 children aged 1-10 years randomized to wear undershirt coated with borage oil vs. placebo uncoated undershirt every day for 2 weeks borage oil group but not placebo group showed statistically significant improvement in erythema and itch compared to baseline Reference - J Dermatol 2007 Dec;34(12):811

Eczema/Scabies Tx
Dr So: LI 11, 5, BL11, 17, SP 10, Bl40, red bean direct mocaLi11