Results from this study indicate that coal tar can be maintained as a safe treatment in dermatological practice.Epub 2009 Dec 17. No increased risk of cancer after coal tar treatment in patients with psoriasis or eczema. Roelofzen JH, Aben KK, Oldenhof UT, Coenraads PJ, Alkemade HA, van de Kerkhof PC, van der Valk PG, Kiemeney LA. Click here to access the PubMed abstract of this article. Two double-blind, randomized, clinical evaluations were conducted to investigate the anecdotal belief that tachyphylaxis occurs in long-term treatment of scalp seborrheic dermatitis and dandruff when using a single pyrithione zinc-based product. Evaluation of data showed a consistent benefit for all products at all time points; therefore, no evidence of decreased benefit over time was found within 48 weeks of treatment. Does tachyphylaxis occur in long-term management of scalp seborrheic dermatitis with pyrithione zinc-based treatments? Schwartz JR, Rocchetta H, Asawanonda P, Luo F, Thomas JH.
Traditionally used in an ointment vehicle for psoriasis, clobetasol propionate 0.05% is also available in spray, foam, lotion, and shampoo formulations, which may provide for improved convenience and acceptance with similar efficacy, safety, and tolerability as the traditional ointment and cream formulations. For patients who prefer a less messy vehicle, adherence and outcomes are likely to be better with the formulations other than the traditionally recommended ointment. Am J Clin Dermatol. Topical clobetasol propionate in the treatment of psoriasis: a review of newer formulations. Feldman SR, Yentzer BA. Topical vitamin B12 offers a new therapeutic approach for eczema (atopic dermatitis) and psoriasis, and may be suitable for long-term therapy as no long term adverse effects have been reported. British Journal of Dermatology 2004; Topical vitamin B12–a new therapeutic approach in atopic dermatitis-evaluation of efficacy and tolerability in a randomized placebo-controlled multicenter clinical trial.
Vitamin B(12) cream containing avocado oil in the therapy of plaque psoriasis. Salicylic acid has been used alone as a treatment for psoriasis, but is most commonly used to increase the penetration of other topical preparations, primarily corticosteroids. In this small study, the use of 6% salicylic acid gel in conjunction with tacrolimus ointment showed statistically significant improvement for the treatment of plaque psoriasis compared with the use of salicylic acid alone. “For patients with localized psoriasis, and for many of those with moderate psoriasis as well, the mainstay of treatment is still topical therapy. The quality of life is greatly affected in such patients, and they often express high levels of dissatisfaction with current treatment options. Safe, convenient, and effective topical regimens, such as combination therapy with topical tacrolimus and salicylic acid, can be of great benefit in this large population.” Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment.
Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR. Click here to view the abstract or FREE FULL TEXT of this complete article. “Methotrexate has been used as an effective systemic chemotherapeutic drug for psoriasis by dermatologists for over 30 years. Nevertheless, pharmacokinetic data indicate that oral methotrexate can cause a decrease in red and white blood cell and platelet counts and can also cause severe liver damage, diarrhea, and stomach irritation, as dose-related drug-induced side effects. Such indications have limited its prescription by physicians. However, [Syed and Nordstrom of the Department of Dermatology, University of California-San Francisco, and researchers from three other locations note that] if its incorporation in a gel as a topical agent, in a proper dosage. imparts better results without the cited side effects, then such a formulation appears to justify a clinical evaluation. Furthermore, published data have indicated that 70% of patients prefer topical therapy for treating psoriasis.”
This article concludes: “methotrexate 0.25% in a hydrophilic gel is well tolerated and significantly more effective than placebo as a patient-applied topical medication to treat psoriasis vulgaris.” J Cutan Med Surg 2001; Management of psoriasis vulgaris with methotrexate 0.25% in a hydrophilic gel: a placebo-controlled, double-blind study. Click here to view the PubMed abstract for this article. This article concludes: “Methotrexate 0.25% in a hydrophilic gel is well tolerated but is not very effective in controlling the lesions of psoriasis on the palms and soles; however, a higher concentration in a different base with better penetration could possibly provide better results.” J Dermatol 2004 Oct;31(10):798-801 Topical 0.25% methotrexate gel in a hydrogel base for palmoplantar psoriasis. Tiwari, Kumar, et al. published a case report of topical methotrexate delivered by iontophoresis for the treatment of recalcitrant palmoplantar psoriasis.
Eczema is associated with thyroid problems, and this was one of the reasons I used to think I was hypothyroid a long time ago, before my “normal” basal body temperature measurements, and numerous bad reactions to various herbal “thyroid support” formulas, teas, and coconut oils, all put me off the trail of hypothyroidism. The first treatment my then-doctor prescribed me was a hydrocortisone antifungal cream that made my skin considerably worse. The correct treatment for perioral dermatitis, which is thought to be bacterial, is a three month course of erythromycin or another tetracycline. As erythromycin makes me throw up at night, my next doctor (who was not embarrassed to look up the correct treatment in his handbook), prescribed me a clindamycin lotion. Clindamycin, or the benzoate it is preserved with, gives me back ache and a foggy head, but it definitely improves the eczema, though it doesn’t get rid of it. I have to be careful not to drink when I use clindamycin lotion, as if I do I will throw up at night.
People with perioral dermatitis, which usually affects women in the 20-30 year old age group, have to be extremely careful not to use any cosmetics or moisturisers or lotions on their skin, and there are even recommendations not to use fluoride toothpaste, as virtually everything will make the eczema flare up worse. One should not even use plain fats on the skin, as some skin bacteria thrive by consuming fats. The only two things I am able to use on my face are pure vitamin E, and pure glycerine, which is sold as a sore throat medicine. I currently use glycerine as it feels much lighter on the skin than vitamin E. Glycerine is the second ingredient in any regular commercial moisturiser, the first ingredient being water. The most dramatic improvement I saw in my skin was after I went on the failsafe diet, when my eczema virtually cleared up from being all around my face and below my eyes, to having perhaps one small spot next to my mouth. My skin reacts negatively to supplementation with a wide variety of vitamins, particularly methyl donors (e.g. betaine, folate), zinc, and pantothenic acid.
Vitamins that my skin reacts positively to are: vitamin E (which reduces inflammatory leukotrines), vitamin A (which increases skin cell turnover), vitamin C (anti-inflammatory, but a mixed reaction, that can sometimes cause rebounds several hours after supplementation), vitamin B12, vitamin D (sunlight!), and calcium. Of these, B12, sunlight, and calcium have the most dramatic effects. Sunlight/vitamin D does not have an immediate effect, but usually kicks in around a week after getting a day of sunbathing in (regardless of its continuation in the mean time). I can usually see the effects of B12 and calcium the day after they are taken. Drinking a significant amount of goat’s milk (1.5 x my RDA of calcium) over the last few months has got rid of that last “one small spot” I could never get rid of on failsafe. However, the eczema is still there and I can still feel bumps and impurities in the skin that do flare up after two or three days of misbehaving, especially with stimulants like coffee, and amines in tomato and cheese dishes.
So the eczema came on when the thyroid problem came on. I believe there are several reasons for this. Firstly, calcium is hugely important for skin barrier protection, and when you don’t have enough thyroid hormone, you don’t have enough calcium, because thyroid hormone regulates the intake of calcium into your cells. Secondly, when the thyroid problem came on, my adrenals went wild in an effort to compensate. High levels of cortisol and adrenaline tend to depress the immune system and thereby allow the infection to take hold. I enabled my adrenals with many supplements, such as large doses of B vitamins, pantothenic acid, and vitamin C. I believe this probably made the eczema worse, though it made me feel better in myself because I needed the stress hormones. For quite some time I was highly dependent on pantothenic acid, one could say addicted. I have also noticed that during the first few days of starting a low carb diet my eczema is worse, due to the increase in cortisol and adrenaline that it produces.
I wonder how much the additional stress hormones have to do with a low carbohydrate diet making me feel better. So I’m in the situation where I need thyroid hormone and don’t have it, my skin calcium level is too low, my adrenals are outputting lots of stress hormones and depressing my immune system, and therefore I’m an easy target for an opportunistic skin infection. Unfortunately right now I have to manipulate this catch 22 situation, because it’s possible I need hydrocortisone in order to deal with the thyroid hormones I’m on, so that the thyroid hormones can get into the cells and start working. Therefore I may have to suck it up and allow my eczema to come back until I can get myself on a level. So I’ll be asking for some more clindamycin as well when I go to see the doctor again! Hopefully in a few months time when I’m feeling better, I’ll be able to take a course of erythromycin to kill it off once and for all, assuming that enough thyroid hormone fixes my erythromycin intolerance, unless just getting enough thyroid hormone in itself will fix it for me.