Possible oral treatments for eczema are antibiotics, antihistamines, corticosteroids, and cyclosporine A (Neoral).
The use of oral antibiotics to reduce bacterial load is certainly helpful in difficult cases. Frequently this can be used with benefit even though there are no obvious signs of infection. There is normally a colonization of staph aureus even in normal looking skin in atopic individuals. The use of topical antibiotics such as Bactroban® (click here to view the A-Detail™ on Mupirocin (Bactroban®)) or Fucidin have shown some benefit but are not as easy to use compared to the systemic approach when the eczema is extensive.
Cloxacillin, erythromycin or cephalosporins may be needed for a few weeks.
Oral antihistamines have been helpful in reducing itch. The sedating antihistamines appear to give the best effect. These are usually used at bedtime. They will also help with any urticarial component of eczema. Hydroxyzine has been used with good effect. Doxepin also has a sedating value. (Klein PA, Arch Derm 1999;135:1522-5)
The importance of stopping itching is to reduce scratching, especially at night. This is an important component of therapy.
Non-sedating antihistamines do not appear to be as effective as the traditional sedating drugs.
Short courses of oral prednisone are occasionally used in severe intractable cases. Rebound of eczema is a concern as well as long-term side effects in those who demand or are unable to quickly wean off the medication.
Systemic steroids in the form of IM Triamcinalone can be very effective in stubborn cases. Potential serious side effects including possible avascular necrosis of the hip must be discussed before starting systemic corticosteroids.
Cyclosporine A (Neoral)
This is restricted for severe cases. It allows significant improvement. It is often started at a dose of 3mg. per kg. per day and is used to a maximum of 5mg. per kg. per day. Concerns about hypertension and renal problems are important concerns for this drug.