What is the best treatment for eczema?
Only those of us who have eczema or know loved ones with severe eczema truly understand how costly it is to our minds and bodies. Doctors, books, websites, and whatever other supposed treatments are nothing but disappointing. We will take a serious look at trying to uncover the best treatment for eczema by discussing two innovative doctors and taking a look at the role of diet in eczema.
Why is eczema so difficult to treat?
Doctors can treat HIV. They can treat many other diseases. So why is eczema, also called atopic dermatitis, so difficult to treat?
The fact is that doctors do not understand why eczema occurs. The cause of eczema is also different for each person. It is not an ordinary disease resulting from a simple virus or bacteria. To be clear, we are talking about serious eczema, not uneven skin texture that can be treated by basic moisturizers and the latest asian beauty fad.
The bizarre thing is that doctors readily admit that they cannot cure other diseases like cancer. If you have cancer, a doctor will give you the sober truth about your odds of survival. However, if you have eczema, many doctors will not admit that they cannot treat it.
From our own experiences, we have observed how stubborn and arrogant doctors can be, even when they cannot treat eczema. Their treatment fails, but they insist that they are right and refuse to say “I don’t know”. We honesty don’t understand why experiences with eczema doctors are so poor.
The good news is that there are some skin specialists who sincerely try to understand eczema and develop treatments. These treatments do not always work, either. However, some patients swear by them. We will introduce you to these doctors below.
The bottom line is that eczema is a difficult and often impossible disease to treat. That means you need the best doctors to tackle it. The blunt truth is that all doctors are not equal, and your average doctor is not good enough for such a difficult disease.
Medical disclaimer and trusting your doctor
Before we proceed, we need to point out that you should always seek qualified medical advice for any medical condition you have. We are providing this information here for entertainment purposes only, and this article is not a substitute for medical advice.
On the topic of trusting doctors, in general, we still believe you should trust your doctor. We do not mean to erode this trust.
In particular, if it is a matter of life-and-death, always trust your doctor. If you have cancer, trust your doctor. Trust your doctor if your elderly parent has pneumonia. If your child needs a vaccine, by all means trust your doctor.
It is only for conditions that your doctor agrees is non-threatening where you should consider looking for further advice. If you have a headache your doctor can’t cure, why not look elsewhere for treatment. If you have pain in your back and no one can help you, keep looking for another treatment.
Most cases of eczema are not severe enough to require hospitalization. However, they are still chronic, incurable annoyances. As your doctor cannot help you, isn’t it fine to look to others for treatment options?
When you look for other treatment options, though, you shouldn’t listen to every stranger you meet. You should listen to other doctors. So if you do not trust your doctor, you should find a better doctor, not some random unqualified individual. That’s what we mean by looking for another treatment.
In this article, we will introduce two doctors and what each considers to be the best treatment for eczema.
Dr. Richard Aron and the Aron Regime
Note: As we continue, we want to stress that the Aron Regime is just one method that seems to relieve symptoms in some patients. We recommend that you read both of our doctors’ stories before pursuing any further action. We are not endorsing one or the other as the best treatment for eczema. Dr. Aron simply comes first alphabetically.
Many patients and parents of children with eczema hold UK-based dermatologist Dr. Richard Aron in high regard. At the same time, other doctors continue to ignore or even ridicule the so-called Aron Regime.
This story from the Telegraph is quite telling. A mother recounts her success with the Aron Regime and the resistance in finding a doctor to help implement it.
The mother says, “Every single [medical] professional I’ve told about it has reacted either with disinterest or scorn.” Her general practitioner refused to prescribe the medicines until she proved that she was legally entitled to them. What in the world is wrong with these doctors?
The evidence in support of the Aron Regime for treating eczema
Dr. Aron has a Facebook page (link) where countless patients and parents of afflicted children post pictures of their success stories. Many of these patients suffer from severe eczema of the hands, face, limbs, or all over the body. They have tried every single treatment you can imagine, hopping from doctor to doctor, brewing home remedies, and giving up all hope until finding Dr. Aron. The pictures on the Facebook page are near miraculous in the complete turnaround for these eczema patients.
We are genuinely surprised that many doctors refuse to even consider the possibility that the Aron Regime works. However, the tides may be shifting.
Read this independent account of the Aron Regime by a dermatologist at the Chicago Eczema Center. Dr. Peter Lio presents a humble and conservative approach to examining the Aron Regime. He sees evidence that it is the best treatment for eczema for some of his patients and cautiously agrees it is worth studying more.
The problem is that there has been no standard clinical study of the Aron Regime. Until dermatologists are at least willing to discuss it and study it, we can’t proceed.
In the meantime, Dr. Aron offers online consultations and prescription writing through his website draron.com.
How does the Aron Regime work?
The Aron Regime consists of a single homemade mixture applied multiple times a day. A mild topical steroid such as betamethasone valerate is mixed with an antibiotic in a moisterizer base such as Vanicream. In the UK, Dr. Aron usually prescribes fusidic acid first as the antibiotic, but as it is not available in the US, for Americans he prescribes mupirocin.
Dr. Aron believes that most cases of eczema involve infection by Staphylococcus aureus bacteria, also called a staph-infection for short. He believes that an antibiotic agents is required to reduce the infectious bacteria load. Only then is the root cause of eczema eliminated.
Steroids help reduce itching and irritation of the skin. However, that is simply treating the symptom, not the cause. The combined action of a topical steroid and an antibiotic is what provides restorative treatment.
A simple analogy is to think of a mosquito bite. You can soothe the itching of a mosquito bite with a cream such as Ben-Gay. This helps the bite heal faster since you aren’t scratching and damaging the skin further. However, if you live in a swamp with many mosquitoes, no matter how much Ben-Gay you use, you will still continue to receive mosquito bites. Combining Ben-Gay and a mosquito killing pesticide would rid of you of the mosquito bites permanently.
This dual action of steroid and antibiotics is the central key to Dr. Aron’s best treatment for eczema. Both of the medicines require a prescription, which is why you need the help of your doctor or a prescription from Dr. Aron himself.
What else does the Aron Regime involve?
Other parts of the Aron Regime for eczema are pretty standard. You should avoid exercise or activities that make you sweat. Avoid swimming and the use of bleach. Avoid foods that cause allergic reactions in the patient, such as dairy, wheat, or eggs.
The bleach recommendation is interesting, because our next doctor, Dr. Zirwas, actually recommends bleach baths. It’s important to use what works and not get stuck on dogma. That’s why we want to present two potential treatments for eczema.
The food recommendation is also interesting, because many doctors will vehemently swear that food allergies cannot affect eczema. We know from personal experience this is absolutely false, so it is vindicating to find a doctor that recognizes this.
Dr. Aron also recommends that you do not use any bath or soap products other than the Dove Cream Bar Sensitive. As you probably know already, bath products can also irritate and trigger skin problems. The Dove soap is the only bath product that Dr. Aron recommends, and you can buy it from Amazon for about $1 per bar (click here to check prices).
Criticism of Dr. Aron’s work
While doctors who dismiss Dr. Aron’s eczema work have nothing specific to say, there are reasons to proceed with caution.
The prolonged use of a topical steroid has unknown risks, since the Aron Regime has not been studied in a full clinical trial. Steroids are powerful drugs. What if it increases the long-term risk of skin cancer, for example? For many eczema patients, the immediate relief is worth the unknown risk. What do others say, though?
1. Topical steroid withdrawal as a cause of red skin syndrome
Dr. Marvin Rapaport has been a proponent of topical steroid addiction and its related topical steroid withdrawal. The AR vs TSW (Aron Regime vs Topical Steroid Withdrawal) debate is raging on certain internet forums with heated arguments from each side. Dr. Rapaport runs a site, http://www.red-skin-syndrome.com/, where he proposes that long-term steroid use is the problem causing irritated skin. It can take months or years of being steroid free to cure this condition. He argues that the Aron Regime exacerbates the skin’s addiction to steroids.
2. Long-term use of the Aron Regime
In principle, the steroids in the Aron Regime should be slowly tapered down as the skin heals. However, there are almost no testimonies or anecdotes of tapering. Some people report that going off the Aron Regime brings back the eczema. In this case, the Aron Regime is a treatment, not a cure, and a long-term treatment with unknown risks.
Is the Aron Regime the best treatment for eczema?
We don’t know the answer to this question. If all else has failed, we think it is at least worth considering. Before you proceed, though, do consider alternative viewpoints. The Aron Regime and the Topical Steroid Withdrawal camps are somewhat bitter enemies with completely opposite views. Rather than pick a side in this fight, we want to consider a completely different viewpoint next from another dermatologist.
Dr. Matthew Zirwas and Skin Barrier Dysfunction
While many of Dr. Aron’s patients are children, Dr. Matthew Zirwas is an American dermatologist who specializes in adult atopic dermatitis, or adult eczema. Rather than proposing a simple solution to all eczemas, he takes a careful and nuanced approach to dealing with adult dermatitis. He does not claim to be able to treat all eczemas, but tries to understand what actually causes eczema, and find the different types of eczemas that he can in fact treat.
Recommended podcast by Dr. Zirwas on eczema in adults
If you are interested in understanding the best treatment for eczema, we strongly recommend that you sit through this hour-long podcast by Dr. Zirwas.
If the link becomes broken, let us know, and we can look into posting a backup.
This podcast is extremely informative, not just about how to understand and treat eczema, but how doctors interact with patients. For example, even if a treatment can work, doctors will know that most patients will not follow directions. They have to look for ways to convince or trick patients into the right treatment.
As this podcast is rather complex and covers a large amount of information, we’ll try to cover some of the key points below.
Skin barrier dysfunction is a major cause of adult eczema
Dr. Zirwas believes that the vast majority of eczema in adults is the result of a defective skin barrier. Healthy outer skin should prevent irritants and allergens from reach the sensitive inner layers of skin. In barrier dysfunction. the outer skin is damaged. As a result, the underlying inner skin is constantly irritated with foreign proteins or other agents that should not be reaching them.
Dr. Zirwas uses the analogy of a brick wall built with bricks and a gooey peanut butter as the mortar. The problem in eczema patients is that the gooey mortar is no longer effective. The cause can be genetic or environmental. In either case, the wall or skin becomes dry, porous, and brittle without a proper mortar. It can no longer act as a real wall.
Ceramides as a solution to barrier dysfunction
Ceramides are a special types of natural body oils that compose the “peanut butter mortar” in the skin’s wall. Since this is lacking in eczema skin, one way to repair the skin’s function is to restore these oils. Dr. Zirwas calls these physiological moisturizers, in which he means moisturizers with ceramides.
Dr. Zirwas specifically recommends the CeraVe brand cream (Amazon link), which is an over-the-counter cream containing ceramides.
His discussion of ceramides reveals interesting perspectives on doctor-patient relationships. For example, he says to never give ceramides by itself to a patient. Ceramides like CeraVe cream penetrate into damage skin. Initially, this causes increased pain and a burning sensation. After several weeks of treatment, the skin will improve. However, Dr. Zirwas states that most patients will quit after a few days because of the pain. Then, the patients will never want to use CeraVe again.
Instead, Dr. Zirwas prescribes a steroid to mix in with the CeraVe. The steroid reduces inflammation and pain, while not actually treating the underlying damaged skin. It is the CeraVe providing the actual treatment. However, the steroid prevents pain and convinces the patient that it is okay to use CeraVe.
This really illustrates the complexities of treating patients who expect immediate outcomes or who do not understand the details of why they need to follow the doctor’s prescription.
Topical steroids are detrimental according to Dr. Zirwas
Dr. Zirwas believes that topical steroids are harmful to damaged skin as they can make the damage worse without treating the underlying damaged barrier. Instead, he believes that delivery of a steroid using a physiological moisturizer is much more effective.
In this sense, Dr. Zirwas might agree with Dr. Rapaport above and have more in common with the topical steroid withdrawal camp. It’s interesting to see this contrasting opinion with the Aron Regime.
Four major types of eczema
Dr. Zirwas asserts that he can treat about 90% of eczema patients and classifies them into 4 different groups.
Group 1 is for barrier dysfunction and includes everybody. In contrasting to most dermatologist advice, he believes people with eczema should shower at least twice a day to remove proteins and irritants from their skin, followed by application of a ceramide-based moisturizer. Laundry should be double-rinsed to remove potential irritants in the detergents.
Group 2 is for airborne-type eczema, where parts of the body exposed to airborne allergens, like the face and arms, have the worst eczema. These are the hardest to treat, according to Dr. Zirwas. In addition to the above treatments, they should use mattress and pillow covers to reduce exposure to dust mites and vacuum every week. People should also wash their face as often as they can to get rid of allergens.
Group 3 is for malassezia driven eczema. In addition to the general treatment, he prescribes anti-fungal drugs to treat the eczema. Dr. Zirwas views this yeast-based eczema as the easiest to treat.
Group 4 is for Staphylococcus driven eczema. He uses a combination of antibiotics with weekly bleach baths followed by clean bed sheets and clothes. Dr. Zirwas claims that most ointments for such eczema patients are infected with bacteria and should be avoided. He recommends using a moisturizing antibiotic wash to keep the bacteria load down, and vitamin D supplements to suppress the Staphylococcus infection even further.
Comparing the Aron Regime with Dr. Zirwas’ methods
What’s interesting is that only one of Dr. Zirwas’ categories of eczema involves the bacteria Staphylococcus. If you have the yeast-driven eczema, for example, antibiotics that only target bacteria would not help. This is in direct contrast to the Aron Regime, which focuses on Staphylococcus.
It’s also interesting to note that Dr. Zirwas specifically advocates against topical steroid use, again in direct opposition to the Aron Regime. Dr. Zirwas instead believes that steroids only mask the symptoms and fail to address the damaged skin barrier.
We tend to view Dr. Zirwas’ methods as more complete than the Aron Regime. Dr. Zirwas recognizes that bacteria infections have a role, and if they do, Dr. Zirwas also prescribes the frequent use of antibiotic agents. However, Dr. Zirwas goes beyond the simplistic view of steroids and antibiotics alone, and addresses the damaged skin itself with ceramides.
In this sense, we don’t think the Aron Regime is wrong. We do think that it may be incomplete or only part of the bigger eczema picture, and finding the best treatment for eczema requires carefully going through the facts.
The Royal Prince Alfred Hospital Elimination Diet
The Aron Regime covers steroids and antibiotics, while the Zirwas method goes beyond that to include ceramides and other good practices. In searching for the best treatment for eczema, we feel that one other factor is missing, which Dr. Aron does briefly cover. The remaining factor is food intolerance.
Food intolerance can also cause skin irritation and exacerbate eczema. Food intolerance is different from food allergies, which have a more stereotypical histamine response. The difference is that food intolerance can take hours or days to manifest, and they do not involve a classic type of immune response using IgE molecules. See this page from www.allergyuk.org for a more detailed explanation.
The Royal Prince Alfred Hospital Elimination Diet , developed in Australia, is a method for discovering if you have food intolerances. Some foods like eggplant or spinach are known to be frequent culprits of food intolerance. You remove the high-risk foods from your diet and only include low-risk foods. You then slowly test each new type of food to see if it causes a problem. This is very similar to how you introduce a baby to foods while testing for adverse reactions.
This handbook (allergy.net.au link) is a simplified explanation of the elimination diet and which foods are high-risk or low-risk. If this link goes down, let us know and we will look for a backup to upload. You can find other resources online going over various foods that are high or low in histamines, salicylates, or other potential sensitivities.
What is the best treatment for eczema?
Because each person’s eczema is different, there is no one best treatment for eczema. Also, eczema is very difficult to cure fully. However, we hope the information we provided here is a starting point for improving your eczema.
We recommend looking through the resources we describe above and perhaps talking to a dermatologist about them. As we pointed out, many doctors will refuse to listen. Then, go elsewhere and keep searching for answers.
Most of the medicines here require a doctor’s prescription. If you can’t find a cooperative doctor, you could try to use Dr. Aron’s online consultancy. Still, there are a few things you can do. You can use some of the over-the-counter recommendations, such as the Dove bar soap that Dr. Aron recommends. The CeraVe cream that Dr. Zirwas recommends is also available.
You can also certainly trying showering more often, or frequently washing with an antibiotic moisturizing wash. And looking for food intolerances is something you can do now in a casual fashion, without going on a severe diet. For example, you can try avoiding peanuts or dairy, and keep careful track of what happens when you do eat them.
Unfortunately, finding the best treatment for eczema is never easy. If you have been frustrated with the generic advice from doctors and online forums, we want the information here to provide you with new angles for further eczema treatment.