Eczema Q&A with Dr. Jose Peraza

In recognition of Eczema Awareness Month, which starts October 1, 2018, Dr. Jose Peraza answers questions about the skin condition and the latest advances in treatment.

Q: What are the latest trends in eczema treatments today?

A: There is a new drug, Dupixent, which represents the most significant advance we’ve had in eczema in a long time. Frankly, we’ve had some amazing results with it. It is used for moderate to severe atopic dermatitis, which is a condition that makes your skin red and itchy. Dupixent saves us from having to use systemic steroids, which have many side-effects. It’s been a godsend for patients suffering from severe atopic dermatitis. It’s an injectable treatment, with an initial load dose followed by injections every other week. Patients can either come to us for injections or do it themselves; it is fairly straightforward. Some patients experience remarkable clearance; clinical studies show half of all patients see a 75% improvement.

Q: How much eczema do you see in the practice?

A: I estimate that 5-10% of our patients have eczema-related problems. Not all suffer from atopic dermatitis. We also see a lot of contact eczema, meaning allergic reactions, like to poison ivy.

Q: Can eczema be a small, localized problem, or does it tend to affect skin generally?

A: Localized eczema occurs all the time. For example, if one is allergic to nickel, there can be skin irritation underneath a watch or earrings. The inner buttons of jeans can also cause problems. There is also more generalized eczema, in particular, reactions to certain drugs that present as a widespread rash.

Q: What’s the best way to manage eczema on your hands?

A: In simplest terms, try to avoid whatever is causing the problem. Citrus, tomatoes, excessive heat and cold, harsh household cleaners. Wear disposable, non-latex gloves, which we also use frequently in the office. There are barrier creams that can help, but they can make working with your hands more difficult because they are thick.

Q: Does diet play a role in eczema?

A: It can play a role. Nickel sensitivity – inexpensive earrings often contain nickel – can translate into systemic allergies from canned foods. We offer patients nickel-avoidance diets, but they are very restrictive.

Q: Do people self-diagnose eczema?

A: Sometimes there can be some confusion between psoriasis and eczema because they have a lot of the same symptoms. When things get very itchy and irritated, we are concerned about secondary infections caused by the bacteria that live in that climate, including staph infections.

Q: What are your expectations for eczema treatment in the next 5-10 years?

A: What we need is a topical solution without the side effects of steroids. Those side effects can include thinning of the skin and bone damage.

Q: What has changed the most in the past few decades?

A: The most important thing has been our ability to recognize and identify the immune pathways that lead to inflammation and tumor formation. As we find out more and more, we can develop drugs that block these pathways in a very specific and safe manner. As research unveils the complexities of the immune system, more and more effective therapies are developed to fight not only inflammatory conditions like eczema and psoriasis, but also many forms of cancer.

If you have questions about eczema, make an appointment to discuss in more depth.

Also be sure to check out the Peraza Dermatology Group Facebook page all month for tips on managing eczema from the Physicians Assistants and other insights and ideas on skin care from the professionals at Peraza Dermatology Group.