migraine

Migraine is a complex neurological disorder characterized by recurrent episodes of moderate to severe headache, typically affecting one side of the head. Unlike ordinary headaches, migraines involve a series of neurological changes that affect the brain and nervous system.

• The condition manifests as throbbing or pulsating pain that can last anywhere from four hours to three days if left untreated. Migraines are often accompanied by additional symptoms including nausea, vomiting, and heightened sensitivity to light, sound, and sometimes smells. Many individuals experience such severe symptoms that they must interrupt their daily activities and rest in a quiet, darkened room.
• Migraines occur in distinct phases. Some people experience a prodrome phase hours or days before the headache, featuring mood changes, food cravings, or neck stiffness. About one-third of migraine sufferers experience an aura, which consists of visual disturbances like flashing lights, zigzag patterns, or temporary vision loss occurring before or during the headache. The headache phase follows, succeeded by a postdrome phase where individuals may feel exhausted, confused, or washed out for up to a day.
• This neurological condition affects approximately 12 percent of the global population and is three times more common in women than men. Migraines typically begin during adolescence or early adulthood, though they can start at any age.

2. How Migraine is Caused

The exact mechanisms underlying migraine development remain an active area of medical research, but scientists have identified several contributing factors that work together to trigger these debilitating episodes.

• Neurological Mechanisms: Current understanding suggests migraines involve abnormal brain activity that temporarily affects nerve signals, chemicals, and blood vessels in the brain. The trigeminal nerve, a major pain pathway in the nervous system, becomes activated during a migraine attack. This activation leads to the release of substances that cause inflammation in blood vessels and nerves around the brain, resulting in the characteristic pain.
• Changes in brainstem function and its interactions with the trigeminal nerve appear to play a central role. Additionally, imbalances in brain chemicals, particularly serotonin, which helps regulate pain in the nervous system, are implicated in migraine development. Serotonin levels drop during migraine attacks, which may cause the trigeminal nerve to release neuropeptides that travel to the brain's outer covering, resulting in headache pain.
• Genetic Factors: Research demonstrates a strong hereditary component to migraines. If one parent experiences migraines, their child has approximately a 40 percent chance of developing them. If both parents have migraines, this risk increases to 90 percent. Scientists have identified multiple genetic variations that make individuals more susceptible to migraines, particularly those affecting ion channels and neurotransmitter systems in the brain.
• Common Triggers: While the underlying predisposition is biological, various environmental and lifestyle factors can trigger individual migraine episodes. Hormonal fluctuations in women, particularly drops in estrogen during menstruation, pregnancy, or menopause, frequently trigger migraines. Certain foods and beverages including aged cheeses, processed meats containing nitrates, alcohol especially red wine, and excessive caffeine consumption or caffeine withdrawal are well-documented triggers.
• Environmental factors such as bright or flickering lights, loud sounds, strong odors, and changes in weather or barometric pressure can initiate attacks. Sleep disturbances, whether too much or too little sleep, along with physical stress and intense exercise, may also precipitate migraines. Emotional stress, anxiety, and changes in daily routine are additional common triggers that many sufferers identify through careful tracking.

3. Medical and Diagnostic Tests Available for Identifying Migraine

Migraine diagnosis relies primarily on clinical evaluation rather than specific laboratory tests, as there is no definitive blood test or imaging study that can confirm migraine. However, medical professionals use various assessment tools and tests to support diagnosis and rule out other conditions.

• Clinical Diagnosis: Physicians diagnose migraines based on established criteria from the International Classification of Headache Disorders. The diagnosis requires a detailed medical history including headache characteristics, frequency, duration, associated symptoms, family history, and potential triggers. A thorough physical and neurological examination helps assess reflexes, sensation, coordination, and cranial nerve function to ensure no underlying neurological abnormalities are present.
• Diagnostic Criteria: Healthcare providers look for specific patterns. Migraines without aura require at least five attacks lasting four to 72 hours with at least two of the following characteristics: unilateral location, pulsating quality, moderate to severe intensity, or aggravation by routine physical activity. Additionally, attacks must include either nausea or vomiting, or sensitivity to both light and sound.
• Supplementary Testing: While not diagnostic for migraine itself, certain tests help exclude other serious conditions that might mimic migraine symptoms. Magnetic resonance imaging or computed tomography scans may be ordered if headache patterns change suddenly, if neurological symptoms are atypical or persistent, or if the physical examination reveals abnormalities. These imaging studies can rule out brain tumors, bleeding, infections, or structural abnormalities.

Blood tests may be conducted to check for systemic conditions that could cause headaches, such as thyroid dysfunction, infections, or inflammatory conditions. A lumbar puncture might be necessary in specific situations where meningitis or other infections affecting the brain and spinal cord need to be excluded, particularly if fever accompanies the headache.

Keeping a detailed headache diary for several weeks provides valuable diagnostic information. Patients record headache timing, duration, intensity, associated symptoms, potential triggers, and medications used. This documentation helps physicians recognize migraine patterns and distinguish them from other headache types.

4. How Testing and Evaluation Confirm Migraine

Since migraine is a clinical diagnosis, confirmation comes through pattern recognition and the exclusion of other conditions rather than through positive test results.

• Pattern Recognition: Healthcare providers confirm migraine by identifying the characteristic pattern of recurrent headache episodes that match established diagnostic criteria. The episodic nature of attacks, specific symptom combinations, and triggering factors create a recognizable clinical picture. When patients consistently describe unilateral throbbing headaches with nausea and light sensitivity that interfere with daily activities, and these episodes recur over time, the diagnosis becomes clear.
• Exclusion of Other Conditions: An essential part of confirming migraine involves ruling out secondary causes of headache. Normal imaging studies help exclude structural brain problems like tumors, aneurysms, or malformations that could produce similar symptoms. Normal blood work rules out systemic conditions affecting headache patterns. When these tests return normal results in a patient with characteristic migraine symptoms, it strengthens diagnostic confidence.
• Response to Treatment: Many physicians consider the response to migraine-specific treatments as a diagnostic confirmation tool. When patients experience significant relief from medications specifically designed for migraine, such as triptans, this therapeutic response supports the diagnosis. However, this should not be the sole diagnostic criterion, as some medications may provide relief for various headache types.
• Specialist Evaluation: In complex or atypical cases, neurologists or headache specialists bring additional expertise to the diagnostic process. They can identify subtle features distinguishing migraine from conditions like cluster headaches, trigeminal neuralgia, or secondary headaches. Specialists may also recognize less common migraine variants that general practitioners might not immediately identify.
• Long-term Monitoring: Migraine diagnosis sometimes requires extended observation over months or years as the condition's pattern becomes clearer. Some individuals initially diagnosed with tension headaches may later be reclassified as having migraines as their symptoms evolve or as additional features emerge. Continuous reassessment ensures accurate diagnosis and appropriate treatment.

5. How Migraine Can Be Treated

Migraine treatment involves multiple strategies aimed at both stopping active attacks and preventing future episodes. Effective management typically combines medication with lifestyle modifications tailored to individual needs.

• Acute Treatment Medications: For active migraine attacks, several medication classes provide relief when taken early in an episode. Over-the-counter pain relievers including aspirin, ibuprofen, naproxen, and acetaminophen can effectively treat mild to moderate migraines, especially when combined with caffeine. However, overuse of these medications can lead to medication-overuse headaches.

Triptans represent a major advancement in migraine treatment. These medications work by mimicking serotonin's effects, narrowing blood vessels and blocking pain pathways in the brain. Available in various formulations including tablets, nasal sprays, and injections, triptans are most effective when taken at the first sign of migraine. Common examples include sumatriptan, rizatriptan, and zolmitriptan.

For individuals who cannot use triptans, alternative acute medications include ergotamine derivatives and combination medications containing caffeine. Anti-nausea medications help manage the gastrointestinal symptoms accompanying many migraines and can improve absorption of pain medications.

• Preventive Medications: For people experiencing frequent migraines, typically four or more per month, preventive medications taken daily can reduce attack frequency, severity, and duration. Several medication classes serve this purpose. Beta-blockers like propranolol and metoprolol, originally developed for high blood pressure, have proven effective for migraine prevention.

Certain antidepressants, particularly tricyclic antidepressants like amitriptyline, can prevent migraines even in people without depression. Anti-seizure medications including topiramate and valproate help stabilize nerve cell activity and prevent migraine initiation. These medications require several weeks to months to demonstrate full effectiveness.

• Novel Treatments: Recent years have brought innovative migraine treatments. CGRP inhibitors represent a new class of preventive medications specifically designed for migraine. These monoclonal antibodies target calcitonin gene-related peptide, a molecule involved in migraine development. Administered monthly or quarterly via injection, these medications include erenumab, fremanezumab, and galcanezumab.

Neuromodulation devices offer non-medication options. Single-pulse transcranial magnetic stimulation devices deliver magnetic pulses to interrupt migraine-related brain activity. Vagus nerve stimulators send mild electrical pulses to the vagus nerve in the neck. External trigeminal nerve stimulation devices apply electrical stimulation to branches of the trigeminal nerve on the forehead.

• Interventional Procedures: For chronic migraine sufferers who have not responded adequately to other treatments, botulinum toxin injections may provide relief. Administered every three months in specific head and neck locations, these injections can reduce migraine frequency in those with chronic migraine. Nerve blocks involving injection of local anesthetic around specific nerves may provide temporary relief for some individuals.
• Lifestyle Management: Successful migraine treatment extends beyond medication. Identifying and avoiding personal triggers through careful tracking significantly reduces attack frequency. Maintaining regular sleep schedules, eating consistent meals, staying well-hydrated, and managing stress through relaxation techniques all contribute to migraine control. Regular moderate exercise, when not triggering migraines, can reduce attack frequency over time.

6. Home Remedies and Natural Approaches for Migraine Management

While medical treatment remains essential for many migraine sufferers, various home remedies and natural approaches can complement conventional therapy and help reduce migraine frequency and severity.

• Immediate Relief Strategies: During a migraine attack, several simple measures may provide comfort. Resting in a quiet, darkened room minimizes sensory stimulation that can worsen pain. Applying cold compresses or ice packs wrapped in cloth to the forehead or back of the neck can reduce inflammation and numb pain. Some individuals find warm compresses or heating pads applied to the neck and shoulders helpful for relieving muscle tension associated with migraines.
• Gentle pressure applied to specific points on the head may offer relief. Massaging the temples using small circular motions or applying pressure to the space between the thumb and index finger can help some individuals. Staying hydrated is crucial, as dehydration commonly triggers or worsens migraines. Sipping water or electrolyte-containing beverages throughout an attack may provide benefit.
• Dietary Approaches: Maintaining stable blood sugar levels through regular, balanced meals helps prevent migraines triggered by hunger or blood sugar fluctuations. Including magnesium-rich foods such as leafy greens, nuts, seeds, and whole grains in the diet may be beneficial, as magnesium deficiency has been linked to increased migraine susceptibility.
• Some individuals find relief by incorporating certain foods while avoiding others. Ginger, consumed as tea or in supplement form, has anti-inflammatory properties and may reduce nausea accompanying migraines. Foods rich in riboflavin including eggs, lean meats, nuts, and green vegetables may help prevent migraines when consumed regularly. Omega-3 fatty acids found in fatty fish, flaxseeds, and walnuts possess anti-inflammatory properties that might reduce migraine frequency.
• Identifying food triggers through an elimination diet can be valuable. Common dietary triggers include aged cheeses, processed meats, artificial sweeteners, monosodium glutamate, and alcoholic beverages. Systematically removing suspected triggers and reintroducing them one at a time helps identify personal sensitivities.
• Herbal Supplements: Several herbal remedies have shown promise for migraine prevention, though individuals should consult healthcare providers before starting supplements, especially when taking other medications. Feverfew, an herb traditionally used for headaches, may reduce migraine frequency when taken regularly. Research suggests doses of 50 to 100 milligrams daily may be effective.
• Butterbur extract has demonstrated effectiveness in clinical studies for reducing migraine frequency. However, only products certified free of pyrrolizidine alkaloids, which can cause liver damage, should be used. Coenzyme Q10, though not technically an herb, is a naturally occurring antioxidant that may reduce migraine frequency at doses of 100 to 300 milligrams daily.
• Mind-Body Techniques: Stress management through various relaxation techniques can significantly impact migraine frequency. Progressive muscle relaxation, where individuals systematically tense and relax different muscle groups, helps reduce physical tension that may trigger migraines. Deep breathing exercises activate the body's relaxation response and can be practiced during migraine attacks or preventively throughout the day.
• Biofeedback training teaches individuals to control certain physiological functions like muscle tension and blood flow through awareness and practice. This technique has substantial research support for migraine management. Meditation and mindfulness practices help manage stress and may reduce migraine frequency and intensity over time.
• Physical Approaches: Regular gentle exercise, when not triggering migraines, can reduce attack frequency. Yoga combines physical movement, breathing exercises, and meditation, addressing multiple aspects of migraine management. Certain yoga poses may help relieve tension and improve circulation. Maintaining good posture throughout the day reduces muscle strain in the neck and shoulders that might contribute to migraine development.
• Acupuncture, a traditional Chinese medicine practice involving insertion of thin needles at specific body points, has shown benefit for some migraine sufferers in clinical studies. Regular sessions may reduce migraine frequency and intensity. Similarly, acupressure, which involves applying pressure to these same points without needles, can be self-administered and may provide relief.
• Sleep Hygiene: Since sleep disturbances commonly trigger migraines, establishing healthy sleep habits is essential. Maintaining consistent sleep and wake times, even on weekends, regulates the body's internal clock. Creating a comfortable, cool, dark, and quiet sleeping environment promotes restorative sleep. Avoiding screens for at least an hour before bedtime reduces blue light exposure that can interfere with sleep quality.
• Essential Oils: Some individuals find aromatherapy helpful for migraine management. Peppermint oil applied topically to the temples may provide a cooling sensation and pain relief. Lavender oil, known for its relaxing properties, may be inhaled during migraine attacks or used preventively to reduce stress. However, strong scents trigger migraines in some people, so essential oils should be used cautiously and discontinued if they worsen symptoms.
• Successful migraine management typically requires a comprehensive approach combining medical treatment with lifestyle modifications and natural remedies tailored to individual triggers and preferences. Working closely with healthcare providers ensures safe, effective integration of these various strategies while monitoring for potential interactions or complications. With proper management, most individuals with migraines can significantly reduce their impact on daily life and overall wellbeing.

Eczema

• Eczema, medically known as atopic dermatitis, is a chronic inflammatory skin condition that causes the skin to become dry, itchy, red, and inflamed. It represents a group of conditions that make skin irritated and inflamed, with atopic dermatitis being the most common form.
• The condition occurs when the skin's protective barrier function is compromised, allowing moisture to escape and permitting irritants, allergens, and bacteria to enter. This leads to inflammation and the characteristic symptoms associated with eczema.
• Eczema affects people of all ages but most commonly begins in childhood. Approximately 10-20% of children and 1-3% of adults worldwide experience this condition. While many children outgrow eczema by adolescence, some continue to experience symptoms throughout adulthood.
• The condition tends to run in families and is often associated with other atopic conditions such as asthma, hay fever, and food allergies. This connection suggests a genetic component involving the immune system's response to environmental triggers.

2. Symptoms of Eczema

Eczema symptoms can vary significantly between individuals and may change over time. The presentation also differs based on age and the severity of the condition.

Common symptoms include:

• Intense itching that often worsens at night, making sleep difficult. This itching can be so severe that it significantly impacts quality of life and daily activities.
• Dry, sensitive skin that feels rough to the touch. The skin may appear scaly or leathery in texture, particularly in areas that have been affected for extended periods.
• Red or brownish-gray patches that typically appear on hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of elbows and knees, and in infants, the face and scalp.
• Small, raised bumps that may leak fluid and crust over when scratched. This weeping or oozing is particularly common during flare-ups and can lead to secondary infections.
• Thickened, cracked, or scaly skin that develops from chronic scratching and rubbing. This condition, known as lichenification, creates a leather-like appearance.
• Raw, sensitive, swollen skin from scratching. Repeated scratching can damage the skin barrier further and lead to a cycle of itching and scratching that worsens the condition.

Age-specific presentations:

• In infants, eczema typically appears on the face, scalp, and outer surfaces of the arms and legs. The rash may be particularly weepy and crusty.
• In children, eczema often affects the creases of elbows and knees, as well as the neck, wrists, and ankles. The skin may become lighter or darker in affected areas.
• In adults, eczema commonly appears on the hands, neck, face, and around the eyes. The skin tends to be very dry and scaly, with more pronounced lichenification.
• 3. Medical and Blood Tests for Identifying Eczema
• Eczema diagnosis is primarily clinical, meaning doctors typically diagnose it based on physical examination and medical history rather than specific laboratory tests. However, certain tests can help confirm the diagnosis, rule out other conditions, or identify triggers.

3. Diagnostic approach:

• Physical examination remains the cornerstone of eczema diagnosis. Dermatologists assess the appearance, distribution, and pattern of skin lesions, along with evaluating the patient's personal and family history of atopic conditions.
• There is no single definitive blood test for eczema. However, several tests can provide supporting evidence and help guide treatment decisions.

Blood tests that may be ordered:

• Total serum IgE (Immunoglobulin E) levels are often elevated in people with atopic dermatitis. Normal IgE levels vary by age: in adults, normal values are typically below 100-150 IU/mL. However, elevated IgE is not specific to eczema and can occur in other allergic conditions, asthma, and parasitic infections. Conversely, some people with eczema have normal IgE levels.
• Complete blood count with differential may show elevated eosinophils (a type of white blood cell associated with allergic reactions). Normal eosinophil count is 0-500 cells per microliter of blood. Elevated levels suggest an allergic or inflammatory process.
• Specific IgE testing (RAST test or ImmunoCAP) can identify allergies to specific foods, environmental allergens, or other triggers. These tests measure antibodies to particular substances and help identify potential triggers that may worsen eczema.

Other diagnostic procedures:

• Patch testing helps identify contact allergens that may trigger or worsen eczema. Small amounts of potential allergens are applied to the skin under patches, which are removed after 48 hours. The skin is then examined for reactions.
• Skin biopsy is rarely needed but may be performed in atypical cases to rule out other skin conditions such as psoriasis, cutaneous T-cell lymphoma, or fungal infections. The biopsy shows characteristic changes including spongiosis (fluid between skin cells) and inflammatory cell infiltration.
• Skin swab cultures may be taken if secondary bacterial infection is suspected. Staphylococcus aureus commonly colonizes eczematous skin and can cause infections requiring antibiotic treatment.

Important considerations:

The absence of abnormal test results does not rule out eczema, as diagnosis relies primarily on clinical presentation and history. Tests serve to support the clinical diagnosis and identify contributing factors rather than definitively confirm or exclude eczema.

4. How Eczema Can Be Treated

Eczema treatment focuses on repairing the skin barrier, reducing inflammation, controlling itching, and preventing flare-ups. A comprehensive approach combining multiple strategies typically yields the best results.

Moisturization and skin care:

• Regular application of emollients and moisturizers forms the foundation of eczema management. These products should be applied at least twice daily, and ideally immediately after bathing to lock in moisture. Thicker ointments and creams are generally more effective than lotions for severe dryness.
• Bathing practices significantly impact eczema management. Lukewarm baths lasting 5-10 minutes help hydrate the skin. Adding colloidal oatmeal or bath oils can provide additional relief. Pat skin dry gently rather than rubbing, and apply moisturizer within three minutes of bathing.

Topical medications:

• Topical corticosteroids reduce inflammation and remain the first-line treatment for active eczema. These come in various strengths, from mild (hydrocortisone) to very potent formulations. The appropriate strength depends on the severity of eczema and the body area being treated. Face and skin folds require milder preparations.
• Topical calcineurin inhibitors such as tacrolimus and pimecrolimus offer an alternative to steroids, particularly for sensitive areas like the face and eyelids. These medications reduce inflammation without the side effects associated with prolonged steroid use.
• PDE4 inhibitors like crisaborole provide another non-steroidal option for mild to moderate eczema, working by reducing inflammation through a different mechanism.

Systemic treatments:

• For moderate to severe eczema not adequately controlled with topical therapy, systemic treatments may be necessary. These affect the entire body rather than just the skin surface.
• Biologic medications such as dupilumab target specific parts of the immune system involved in eczema. These injectable medications have shown remarkable effectiveness for severe cases with a relatively favorable safety profile.
• Oral immunosuppressants including cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil may be prescribed for severe, refractory eczema. These require careful monitoring due to potential side effects.
• JAK inhibitors, both topical and oral formulations, represent a newer class of medications that block specific pathways involved in inflammation.

Phototherapy:

• Ultraviolet light therapy, particularly narrowband UVB, can effectively treat moderate to severe eczema. This treatment involves exposing the skin to controlled amounts of ultraviolet light under medical supervision, typically two to three times weekly.

Management of complications:

• Secondary bacterial infections require prompt treatment with topical or oral antibiotics. Staphylococcus aureus commonly infects eczematous skin, causing increased redness, warmth, oozing, and crusting.
• Antihistamines may help reduce itching, particularly at night. Sedating antihistamines can improve sleep quality when itching is severe.

5. Home Remedies and Natural Remedies for Eczema

Natural and home remedies can complement medical treatments and help manage eczema symptoms. While these approaches may provide relief, they should not replace prescribed medical treatments for moderate to severe eczema.

Natural moisturizers and oils:

• Coconut oil possesses natural antibacterial and anti-inflammatory properties. Virgin, cold-pressed coconut oil can be applied directly to damp skin to seal in moisture and reduce bacterial colonization.
• Sunflower seed oil helps maintain the skin barrier and reduces inflammation. Applied topically, it can improve skin hydration and reduce the severity of eczema symptoms.

Soothing compresses and baths:

• Colloidal oatmeal baths provide immediate relief from itching and inflammation. Finely ground oatmeal disperses in bathwater, creating a milky solution that soothes irritated skin. Soak for 10-15 minutes in lukewarm water, then apply moisturizer.
• Wet wrap therapy involves applying moisturizer and wrapping damp gauze or clothing over affected areas. This technique enhances moisture penetration and provides a barrier against scratching. It is particularly effective for severe flare-ups and can be done under medical guidance.

Dietary supplements:

• Probiotics may help modulate the immune system and reduce eczema severity, particularly when started during pregnancy or early infancy. Strains like Lactobacillus rhamnosus have shown promise in studies.
• Omega-3 fatty acids found in fish oil supplements possess anti-inflammatory properties that may benefit people with eczema. However, evidence for effectiveness remains mixed, and consultation with a healthcare provider is recommended.
• Vitamin D supplementation may help, as deficiency has been associated with increased eczema severity. Maintaining adequate vitamin D levels through supplementation or safe sun exposure may support skin health.

Herbal remedies:

• Chamomile applied topically in cream form or used in compresses may reduce inflammation. However, people allergic to ragweed should avoid chamomile as it can cause allergic reactions.
• Calendula cream has been traditionally used for skin inflammation and wound healing. Some studies suggest it may help reduce eczema symptoms.
• Aloe vera gel provides cooling relief and may help reduce inflammation. Use pure aloe vera gel from the plant or products with high aloe content.

Stress management:

• Stress commonly triggers or worsens eczema flare-ups. Incorporating stress-reduction techniques such as meditation, yoga, deep breathing exercises, and adequate sleep can help manage symptoms.

Important considerations:

• Always perform a patch test before applying any new substance to large areas of skin. Apply a small amount to a discrete area and wait 24 hours to check for adverse reactions.
• Natural remedies can still cause allergic reactions or irritation. Discontinue use if symptoms worsen.
• Consult healthcare providers before starting supplements, especially if taking other medications or if treating children.

6. Diet Recommendations for Eczema

Diet plays a complex role in eczema management. While food is not the primary cause of eczema, certain foods can trigger or worsen symptoms in susceptible individuals, particularly children.

General dietary principles:

• An anti-inflammatory diet rich in whole foods, vegetables, fruits, and omega-3 fatty acids may help reduce eczema severity. This approach emphasizes nutrient-dense foods that support immune function and skin health.
• Identifying and eliminating personal food triggers is crucial, as these vary considerably between individuals. Working with an allergist or dietitian can help identify specific problematic foods through elimination diets or allergy testing.

Foods that may help manage eczema:

• Fatty fish including salmon, mackerel, herring, and sardines provide omega-3 fatty acids that possess anti-inflammatory properties. Consuming these two to three times weekly may benefit skin health.
• Foods rich in quercetin, a natural antihistamine and anti-inflammatory compound, may help reduce eczema symptoms. These include apples, berries, cherries, broccoli, spinach, and kale.
• Probiotic-rich foods such as yogurt with live cultures, kefir, sauerkraut, kimchi, and other fermented foods support gut health, which may influence skin conditions through the gut-skin axis.
• Foods high in vitamin E, including nuts, seeds, avocados, and leafy greens, provide antioxidant protection that may benefit skin health.
• Adequate hydration through water and herbal teas helps maintain skin moisture from within. Aim for eight glasses of water daily.

Foods to avoid or limit:

• Common food allergens may trigger eczema flares in sensitive individuals. The most frequent culprits include cow's milk, eggs, soy, wheat, peanuts, tree nuts, fish, and shellfish. However, these should only be eliminated if testing or supervised elimination diets confirm sensitivity.
• Processed and refined foods high in sugar and unhealthy fats may promote inflammation. Limiting consumption of packaged snacks, fast food, and sugary beverages may help some individuals.
• Foods high in histamine or that trigger histamine release can worsen itching in some people. These include aged cheeses, fermented foods, processed meats, alcohol, and certain fruits like strawberries and citrus.
• Artificial food additives, preservatives, and food colorings may trigger reactions in sensitive individuals. Reading labels and choosing whole foods over processed options reduces exposure.
• Nightshade vegetables including tomatoes, eggplant, peppers, and white potatoes contain compounds that may worsen inflammation in some people, though this is not universal.
• Trans fats and excessive omega-6 fatty acids found in many processed foods and vegetable oils may promote inflammation. Reducing intake of fried foods and processed snacks helps balance fatty acid ratios.

Important dietary considerations:

• Restrictive diets should only be implemented under medical supervision, particularly in children, to ensure adequate nutrition for growth and development. Unnecessary food restrictions can lead to nutritional deficiencies and eating disorders.
• Elimination diets should be conducted systematically, removing suspected foods for 4-6 weeks before reintroducing them one at a time to identify true triggers.
• Food allergies differ from food sensitivities. True food allergies involve immune responses and can be life-threatening, while sensitivities may cause less severe but bothersome symptoms.
• Keeping a food and symptom diary helps identify patterns between diet and eczema flares. Record meals, snacks, and any changes in skin condition over several weeks.

7. Medications Available to Treat Eczema

A wide range of medications is available for eczema treatment, from over-the-counter options to prescription therapies. Treatment selection depends on severity, age, location of affected skin, and response to previous treatments.

Topical corticosteroids:

• These remain the cornerstone of eczema treatment, available in seven potency classes from mild to very potent. Hydrocortisone in 0.5% to 1% strength is available over the counter for mild eczema. Prescription-strength options include triamcinolone, betamethasone, clobetasol, and others, prescribed based on severity and location.
• Application typically occurs once or twice daily during flare-ups, with gradual tapering as symptoms improve. Prolonged use requires medical supervision due to potential side effects including skin thinning, stretch marks, and systemic absorption.

Topical calcineurin inhibitors:

• Tacrolimus ointment and pimecrolimus cream offer steroid-free alternatives for treating eczema, particularly on sensitive areas like the face, eyelids, and skin folds. These medications work by suppressing immune system activity in the skin.
• These are typically used twice daily and may cause temporary burning or stinging upon application. They are approved for patients aged two years and older.

Topical PDE4 inhibitors:

• Crisaborole ointment provides a non-steroidal option for mild to moderate atopic dermatitis in patients as young as three months. Applied twice daily, it works by inhibiting an enzyme involved in inflammation.

Topical JAK inhibitors:

• Ruxolitinib cream represents a newer class of medications that block Janus kinase enzymes involved in inflammation. Approved for mild to moderate atopic dermatitis, it offers another non-steroidal treatment option.

Systemic immunosuppressants:

• Cyclosporine effectively treats severe eczema by suppressing immune system activity. It requires careful monitoring for side effects including high blood pressure, kidney function changes, and increased infection risk.
• Methotrexate, traditionally used for psoriasis and rheumatoid arthritis, can help severe eczema cases. Weekly dosing requires regular blood test monitoring.
• Azathioprine and mycophenolate mofetil offer alternative systemic immunosuppression options for severe, refractory cases.

Biologic medications:

• Dupilumab, administered by injection every two weeks, specifically targets interleukin-4 and interleukin-13, key proteins involved in eczema inflammation. This medication has demonstrated excellent efficacy for moderate to severe atopic dermatitis with a favorable safety profile. It is approved for patients aged six months and older.
• Tralokinumab, another biologic targeting interleukin-13, offers an alternative for adults with moderate to severe eczema.

Oral JAK inhibitors:

• Upadacitinib and abrocitinib represent oral medications that block JAK enzymes involved in inflammation. These medications have shown significant efficacy for moderate to severe atopic dermatitis but require monitoring for potential side effects.

Antihistamines:

• Both sedating antihistamines like hydroxyzine and diphenhydramine and non-sedating options like cetirizine and loratadine may help reduce itching. Sedating antihistamines taken at bedtime can improve sleep quality when nighttime itching is problematic.

Antibiotics:

• Topical antibiotics such as mupirocin treat localized bacterial infections. Oral antibiotics including cephalexin, dicloxacillin, or doxycycline are prescribed for more widespread infections or when topical treatment is insufficient.

Barrier repair moisturizers:

• Prescription moisturizers containing ceramides and other skin-identical ingredients help restore the skin barrier. Examples include products with specific ceramide formulations designed to mimic natural skin lipids.

Important medication considerations:

• All medications carry potential benefits and risks. Discuss thoroughly with healthcare providers to understand expected outcomes, proper application techniques, duration of treatment, and possible side effects.
• Combination therapy often proves more effective than single treatments. A comprehensive approach addressing multiple aspects of eczema typically yields the best results.
• Regular follow-up with dermatologists ensures optimal treatment adjustment as the condition evolves over time.
• This comprehensive information about eczema provides educational content for better understanding and managing this common skin condition. Always consult qualified healthcare professionals for personalized medical advice, diagnosis, and treatment plans tailored to individual circumstances. While home remedies and dietary modifications can support conventional treatment, they should complement rather than replace medical care for moderate to severe eczema.