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Helping patients with eczema.  JP 2018

Atopic eczema is a frustrating disease; patients and their families suffer a great deal despite the best efforts of their GP or dermatologist, and flares are common.

I have been a GP, both in the NHS and in private practice for over 30 years, and treated many such patients. I have been impressed by the need to simplify treatment regimens using a compound cream, tailored to the individual, containing safely diluted steroid, antibiotic, and emollient. Although such compound creams have been used successfully by thousands of patients across the world, it is more usual practice in the UK to provide individual creams and complicated instructions. Patients or their parents are often wary of steroid creams owing to their assumed potency or side effects, and may be reluctant users. Antibiotic creams are seldom used for long because of concerns over development of resistance, despite the evidence that Staph Aureus is usually involved in flares of atopic eczema.

The principles of my approach are the use of readily available and conventional steroid, antibiotic and moisturising creams, pre-mixed for individual requirements, and advice concerning diet, exercise, bathing, clothing and sun-protection. It is an holistic approach.

It reduces the need for antibiotics by mouth, anti-histamines (which are usually ineffective), and unpleasant treatments such as wet-wrapping. It follows broadly the so called Aron regime, developed by Dr Richard Aron, a renowned South African dermatologist.

I also advocate the use of naturally produced vitamin E rich oils and artisan recipe soaps containing Argan oil, which are anti-oxidant and antibacterial.