Immunosuppressants for Atopic Dermatitis

I talked about treatments and what constitutes treatment. Now, as the wise Rafiki said, "it is time". Time to talk about immunosuppressants for Atopic, what they are and what they do, the dangers and complications, and (soon) the different types available to you.

Immunosuppressants are drugs that an expert dermatologist can prescribe for you. Their basic effect is, well, what their name says: they suppress your immune system. [As an aside, their main usage is "in organ transplant surgery to prevent organ rejection" (taken from Answers.com) and sometimes they are originally chemotherapeutic agents].

Don't try this "at home", i.e. without the benefit of an expert. Do not, I repeat, do not count on your physician to cut it. He or she may know you best but they do not know the effects of these drugs best. Let the experts do their job; dermatologists spent four or five extra years studying this, and they treat cases like you all the time. And definitely do not take them without medical advice at all! Don't even think about it.

Why could this be good for you? Basically, your immune system working over-hard, "panicking" and fighting things that aren't really dangerous to you (namely, allergens). This useless fight is causing you to itch, scratch, etc. Therefore, telling your system to "cool it" means it should stop fighting so hard. So it should cause an improvement in your situation. Several immunosuppressants have been consistently shown to cause improvement in many cases of atopic.

Why could this be bad for you? Well, immunosuppressants are heavy artillery. There are several effects, first and foremost - a higher sensitivity to contagious diseases. You should be careful not to come in too close contact with too many people, especially if you know they're sick. What's more, there can be interference with all sorts of normal bodily functions. During the time you're taking them, you should be under nearly constant "surveillance": complete blood count (CBC - the most basic blood test) and blood tests for liver and kidney functions, as well as blood pressure. The exact battery of tests you should undergo varies with the precise medication.

What else should you know?

Using immunosuppressants should clear up your atopic symptoms, including infections (via a complex mechanism that I don't entirely understand), but there is a possibility that you will be more vulnerable to skin infections, such as folliculitis, in which case you may need to add antibiotics as a backup player (or switch to a different immunosuppressant). Consult your doctor!

Note for the sexually active -

• females: for most of these drugs (if not all), you need to avoid pregnancy during the whole period of taking the medicine, and potentially for awhile after you stop. Plus, some of these drugs may reduce the efficiency of The Pill, so make sure you talk to your doctor about this, and add alternative contraception (condoms or otherwise).
• males: mostly there should be no problem, but double-check. At least one of these drugs (methotrexate) may cause birth defects in an unborn child if your partner gets pregnant. Best to be on the safe side and ask your doctor.
  

So, when should you take them?

First of all, it's important to note that it's not totally your decision to make. An expert doctor (usually a dermatologist) will decide whether or not your situation and specific condition merits this kind of treatment. Of course, you do have some choice here - you can (a) suggest it in case your doctor doesn't, or (b) refuse to take it if your doctor does suggest it.

But let's take a look at the criteria. An expert dermatologist may look at:

• How widespread your atopic is (are you erythrodermic?)
• How resistant your case is (did you respond to other treatment? topical cortisons? maybe UV?)
• How badly is atopic affecting your life (how much is it interfering with your day-to-day life?)
• How do your blood tests look before you start the drug (as mentioned earlier - are liver and kidney functions OK?)
  
• And potentially other things... see warning signs, and remember, I'm no doctor.

A separate post is coming up with the different types of drugs available to you.

News Flash: Warning Signs

Edit (6.4.08): just for clarification, these are warning signs of when your atopic is getting bad or worse. They are meant for people already diagnosed with atopic, not for the diagnosis. Only a doctor can diagnose you correctly (and even they can be wrong).

I had missed the signs. Some of them I chose to ignore, or repressed the fact they existed. Some of them I saw, but did not recognize them for the huge, flashing red bulbs that they should have been. Finally, some warning signs were written in a language I had never heard of and therefore I walked right by them.

So, know your warning signs.

1. You are scratching nonstop.
• Recognition: I know, nonstop is very subjective. Still, try to be honest with yourself. When was the last time you sat still for an hour without scratching? Can you even do that? Or are you truly the itchy and scratchy show?
• e.g. in my friend's wedding, same day as my birthday, there is a photo of me in which I am "hugging myself" - in other words I couldn't stop scratching my upper arms. And I was posing for this photo.
• You may not be that far gone, but if you are scratching a lot more than your usual self, make note of this.
  
• Result #1: The restless feeling of scratching alone can drive you nuts. Seriously. Self-image problems may also arise (can anyone say teenagers?).
  
• Result #2: If you have atopic, you'll probably hate hearing this (I certainly do), but scratching really does aggravates the situation. as I understand it, scratching causes more Mast cells to release the histamines that are causing the allergy in the first place.
• that doesn't mean I can tell you how to stop, or that people should in fact tell you to stop - sorry, that's a separate post. But it's definitely a warning sign.
  
2. You can't sleep because you're so itchy.
• Recognition: One or even a few sleepless nights are not a major indication, although you should take notice. If there's a pattern of recurring sleepless nights, beware. Sleepless nights can be either that you can't fall asleep, or you wake up in the middle of the night and can't fall back asleep.
• Result: short and long-term lack of sleep can (obviously) have a harmful effect on your entire well-being and health. It has a systemic effect, especially when it recurs frequently. You literally "need your beauty sleep".
  
3. Your skin is infected.
• See post about infections.
  
• Recognition: infections may have a few forms:
• folliculitis: acne-like pimples wherever your hair grows. This alone may have nothing to do with atopic, but if it's in combination with rashes and itching of the same areas, that is a surefire sign.
  
• secondary inflammation: bacteria may develop in the place your itching has left open wounds. Fluids exuding from the wound, or a honey-colored crust, are some indications of this. (termed secondary inflammation IIRC)
  
• Result: This is more important than you may realize. I certainly didn't. When your skin is infected, it is not able to function as your body's barrier from the world. You become much more sensitive to outside effects such as other diseases. Skin infections can and should be treated.
  
• Also, there is a claim that when your skin is infected, it itches more; I can certainly attest to that personally.
4. Erythroderma: cuts, scratches and rashes are spread over more than 80% of your body.
• Recognition: if the atopic is contained in certain areas, that's bad enough, but if it's all over your body, that is a sure sign that something is very wrong.
• Result: see number 1: you can't stop scratching. This is a vicious cycle that must be broken.
5. Flaky, scaly, peeling skin.
• Recognition: do you leave a trail of white powder behind you? Is your skin falling apart in certain places? If the skin is peeling off or flaking off, this is not good. The more intense the flaking, the worse.
• Result: your skin cannot heal, because it is involved in a continuous effort to grow back. The epidermis turns so thin that it breaks more easily, so scratching has an even more adverse effect.
  

If one or more of these signs are happening to you, run - don't walk - to your doctor. And remember, your physician is absolutely not enough for this. Go straight to the experts. It's worth your time and money to find a good doctor. Again, it's possible a combination of dermatologists and allergists will be needed.