Question 1: Why did I get a prescription for topical steroids for my eczema when my doctor knows I’m pregnant – is it safe for my baby?
Answer 1: Maybe your doctor thought they could nip it in the bud with a short, quick dosage to give you relief. The severity of the case must be weighed in relation to the risk. The risks have still been under scrutiny for over 30 years.
Question 2: What do the medical studies show about risks to the baby?
Answer 2: There are conflicting reports on this depending upon the studies. The results could have different conclusions based on different ascertainment of exposure. Variations of application, quantity and potency can make significant differences of fetal reception of the dermal absorption.
Another study in Norway reports, “In sum, the association of maternal corticosteroid exposure with oral clefts has been addressed in a range of large and relatively well-designed epidemiologic studies. The fact that a preponderance of reported associations have been positive may reflect publication bias. Still, it is not possible to exclude the possibility that corticosteroids present some underlying risk to the developing fetus. Our own attempt to clarify this question in two large studies has only added to the conflicting information. At this point, we can conclude only that a causal effect cannot be dismissed completely, and that if causal, corticosteroids could explain only a very small portion of oral clefts.”
In contrast, another case-control survey of 48 children with non-syndromic orofacial clefts, claiming a significant increase in the prevalence of maternal use of topical corticosteroids in the first trimester of pregnancy compared with 58 controls born in the same hospital.
“…maternal exposure to potent or very potent forms shortly before and during pregnancy was significantly associated with fetal growth restriction and was confirmed by a significant dose-response relationship.”
In summary, researchers are still conducting more studies. Until then, caution is the best option.
Question 3: I heard emollients help eczema around 67% more than topical steroids – is that true?
Answer 3: There’s been a lot of recent research that does suggest that emollients are better at retaining skin’s moisture barrier than normal moisturizers that are diluted with water and contain alcohol, preservatives, fragrance, and other toxins. So, yes – research has shown emollients do better, and the added benefit is they are typically safer without the side effects! The National Eczema Association also states, “Correct use of emollients can reduce the need for topical corticosteroids.”
Question 4: Why don’t more people know about emollient use and why didn’t my doctor tell me that first?
Answer 4: Recently studies have introduced the use of emollient therapy as a viable alternative to topical steroid therapy and now education of how to use emollients is getting pushed to the stage.
Their conclusions were:
A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control.
Education of parents and children with atopic eczema is now recognised as one of the most important interventions in the management of atopic eczema.
“Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community.”
Question 5: Is there actual evidence that educating patients on emollient use has direct benefit and actually helps reduce symptoms?
Answer 5: As part of a trial about atopic eczema education to parents of children and adolescents with atopic eczema, the results were significantly positive. Through a nurse-led educational intervention, the increase of emollient usage was 800% and resulted in 89% reduction the severity of the atopic eczema.
Question 6: What is an example of an emollient that has shown good results?
Answer 6: ELAJ Emollient has been in use for over 70 years around the world. It was introduced in the United States in 2008 and has become a popular resource to help alleviate the intense dry, itching flareups of eczema and psoriasis. More information can be found at www.ELAJnaturally.com. The founder of this company, Suhein Beck is the granddaughter of Dr. M. A. Bchihalouk, a Circassian doctor that formulated this and other medications originally for wound care. It was completely accidental that Suhein discovered ELAJ helped with eczema and other serious skin conditions.