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Oral Eczema Medications


Oral eczema medications are used either as standalone or in conjunction with topical medications. Some of them, like oral steroids (e.g. prednisone), work faster than topical steroids to clear up eczema. But the way prednisone is absorbed into our system tends to bring out more side effects.

This page documents the most commonly prescribed/used oral eczema medications, their pros and cons, and my personal experience using them.

Antihistamines

Antihistamines work by blocking the histamine release that causes itching and sneezing in people with allergies. In theory, they sound like they would stop or alleviate the itching from eczema.

But in my experience, they haven't worked too well - at least the ones I can get over-the-counter such as Claritin, Benadryl, and Zyrtec. There are many factors that cause itchiness and histamine is only one of many.

I did find that antihistamines work well with contact dermatitis. I once accidentally lied down on an unwashed sheet full of dust, which promptly made my skin break out in hives. Benadryl helped reduce the hives quickly.

The real value of antihistamines lies in their ability to cause drowsiness, with drugs like Atarax (hydroxizine). When taken right before bed, I've been able to sleep through the night.

But the grogginess next morning affects my day severely, since I can't stay alert throughout the day.

Pros

  • Inexpensive, with the exception of Zyrtec.
  • Can choose between drowsy and non-drowsy versions.
  • Antihistamines that cause drowsiness can promote the healing of the skin, since sleeping through the night inhibits scratching.
Cons
  • Not the most effective bunch of eczema medications with more chronic, severe eczema.
  • Drowsiness can last throughout the next day.


Oral Steroids (Prednisone)

Prednisone decreases our body's immune system in order to reduce inflammatory responses caused by certain conditions.

For eczema, it is mostly prescribed to quickly remedy the condition when it is severe. It is one of the most effective oral eczema medications.

Prednisone is to be used in "quick bursts" to clear up eczema; if used for a longer period, the dosage eventually needs to be tapered from strong to weak before coming off of it completely.

That is because after more than seven days of use, our body temporarily stops producing natural hormone such as cortisol, which causes dependency on the drug.

I have a love-hate relationship with prednisone. It is wonderful in a sense that if I'm feeling miserable, it works quickly to make my eczema go away. But the side effects would definitely make many people shy away from being prescribed this drug.

Pros

  • Works quickly - a short burst of 60 mg/day for 5 days usually does the trick for me.
Cons
  • Increased appetite - like, unbelievable, insatiable hunger. No one knows until he/she's actually gone through it!
  • Causes "moon face" (makes me look round and bloated).
  • When getting off of it, eczema returns and it's depressing.

The side effects are actually about a mile longer than what I've listed.

Despite these, I still occasionally turn to prednisone for a quick relief among other choice of eczema medications. Why? Because it is fast and easy and sometimes that's all I want.

Especially when I'm traveling or have important events (like meeting someone) at a short notice, prednisone provides the solution.

While preparing for my wedding, my stress level was at an all-time high, which caused my eczema to flare up like never before. One month before my wedding, I knew I wasn't going to have enough to time to clear up my skin "on my own." My dermatologist prescribed me prednisone for one month, with tapered, 2.5 to 5 mg doses towards the last 2 weeks, just so I could retain my sanity.

Of course, there were the usual side effects. I was hungry all the time. But one shining, definitive advantage of prednisone was that it took my itch away. No itch = sweat can't bother me!

So I exercised every day that month (did turbo kickboxing which supposedly burns up to 1000 calories an hour). That way, despite my massive eating, I was able to keep my weight in check.

Prednisone also keeps me in the "high-functioning" mode. It really suits me to say I'm "on steroids" (although I think that expression refers to someone on anabolic steroids).

When I'm not itchy all the time, I can actually get things done. It makes me think that if I weren't so itchy, I could've dominated the world by now!


Immunosuppressants

Immunosuppressants such as Imuran (azathioprine), Cellcept (mycophenolate mofetil), and cyclosporine are used most commonly to reduce organ transplant injection.

When a person receives an organ transplant, his/her body may recognize the new organ as "foreign" and start attacking it. These drugs inhibit the body's immune system to react less harshly.

Somewhere along the line, these drugs were found to be effective in severe cases of psoriasis and eczema.

And my dermatologist knew about it, so when I was at a point where my eczema wasn't responding to traditional methods (topical steroids), she recommended that I be put on azathioprine.

Wonder how it panned out?

Pros

  • May clear up skin - some people tolerate the drugs much better than others.
Cons
  • No immediate gratification - it takes a long time to see results, if any.
  • Nausea.
  • Suppressed immune system causing susceptibility to infection and other immune-related diseases.
  • Very expensive - it can run up to a few hundred dollars even with insurance.

My dermatologist did warn me that I may experience some side effects since I am essentially decreasing my immune system from functioning properly. However, I didn't count on getting eczema herpeticum within the first month of trying azathioprine.

That scared me, which I think was a reasonable response. But I was on my company insurance that significantly reduced the cost of the drug, so I didn't want to give up. My dermatologist switched me to Cellcept, which is said to have less side effects.

I wasn't on Cellcept long enough to determine whether it would work or not, due to financial and other reasons. It was mostly because I was feeling uneasy about going to such an extent for my skin. Maybe if I hadn't gotten eczema herpeticum, I would've been more open to continuing the treatment.

Immunosuppressants are not to be taken lightly; a full cooperation with a dermatologist is an absolute must. Also, my dermatologist had me getting blood test every month to make sure my liver and kidney weren't affected adversely.

Being on these drugs take time, money, and patience - the exact qualities I lack as a chronic eczema sufferer.


Some oral eczema medications work better than topical eczema medications, but not without more serious repercussions. There is a reason prednisone (oral) can't be taken indefinitely while triamcinolone (topical) is prescribed more casually, to keep it by your side "in case you need it."

Oral eczema medications are also a whole lot more convenient (take them by mouth as opposed to having to apply them over the skin). Because the life with eczema can be overwhelming sometimes, I have relied on them from time to time for a quick relief.

But since every one's tolerance level is different, it is best to read a lot of testimonials online to weigh the pros and cons before asking your dermatologist to prescribe any eczema medications.

I'm of the camp that I can deal with most side effects as long as my skin is clear for a while, because I want to do other important things in my life.

This view may be somewhat myopic since it might have long-term consequences on my health; but how can I worry about what happens in 5 to 10 years, when I'm dying NOW? 


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