Chronic Hand and Foot Eczema

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Achilles
Posts: 6
Joined: Tue May 07, 2013 7:03 pm
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by Achilles on Mon Sep 23, 2013 3:12 pm

Chronic Hand and Foot Eczema

Hello,

Background

I have chronic hand and foot eczema characterized by a cycle of extreme dryness, itching, and inflammation, and then scaling, and then painful cracks and fissures. It came out of the blue at the age of 47 and I have had it now for 3 years. Four different steroid creams didn't work; nor did Protopic. I find Cetaphil to be the most effective moisturizer and use it 2-3 times daily, and I wear white gloves when cooking, doing work, or driving. I am too fair for UV Treatment. I think my eczema is of the hyperkeratotic fissured variety.

Toctino

I am now halfway through my second six-month period of Toctino, an oral retinoid. The first six month period cleared up the symptons very well. Within days my feet stopped hurting when I walk, and my hands cleared up nicely over a few weeks. It took a while for the dead thick skin to peel from my feet. After I stopped using the Toctino, the eczema came back slowly on my feet, and getting to about 60 % as bad on my hands after three months. I could have lived with this level on my hands without going back on Toctino. But the eczema came back on my feet too...it took longer to come back, but by 4 months it was very painful to walk and I had to go back on Toctino. So I went on Toctino a second time after this four month period. It is working again beautifully on the symptoms. It took a little longer to get rid of the eczema, especially the feet, but the hands after two months were beautiful (better than the first usage of eczema), and the feet are now good too but still have a few dead skin spots to go.

My question is how has the success rates for Toctino been? Are patients ever cured one-hundred percent? If it does come back, does it usually come back to the same degree or a lesser degree? Will Toctino work on the second or third times it is used? And are there any dangerous long-term side effects (my short-term side effects have been minimal)?

Balsam of Peru

I have been diagnosed with a Balsam of Peru allergy. In case this was contributing to my eczema, I went off the recommended foods (and cosmetic products) for close to a year: tomato products, citrus products; vanilla, cinnamon, chocolate, etc. I also went off more routine eczema culprits like dairy, nuts, and eggs. Despite all this, the eczema did come back. It's hard to tell but I don't think the diet has had any effect. Should I go back to eating these foods given not eating them hasn't seemed to help? If I am allergic to Balsam of Peru, should I stay off these foods anyway? Is there a clear relationship anywhere between Balsam of Peru and hand eczema?

Other Suggestions or Comments

Is there anything else I could be doing for my hand eczema? We have waterproofed our basement and changed our furnace in case of mold or allergies. And are there any other ideas on what could be causing the eczema?

Thank you for your time and assistance!

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Wendy Green
Posts: 159
Joined: Thu May 24, 2012 11:27 am
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by Wendy Green on Tue Sep 24, 2013 5:11 pm

Re: Chronic Hand and Foot Eczema

Hi Achilles,

Re. Toctino

In a major double blind, placebo-controlled clinical trial involving 1032 participants with severe chronic hand eczema that hadn’t responded to topical corticosteroids, of those treated with 30 mg of Toctino daily almost 1 in 2 reported clear or almost clear hands, while those taking 10 mg daily had an almost 1 in 3 success rate.

Of those successfully treated, 1 in 3 relapsed during the following 6 months and of these, 8 out of 10 found relief from their symptoms after a 2nd course of the drug, so it clearly works the 2nd time it's used. These results suggest that of sufferers taking 30 mg of Toctino daily, around 1 in 3 will find long-term relief from symptoms.

I haven't seen any information regarding whether it'll work a 3rd time, nor whether the symptoms are any better or worse when they return. Also, there doesn't appear to be any information as to whether the drug offers a permanent cure to the condition. My guess is that it won't, as eczema tends to be a chronic condition. You can read the report for yourself here:
http://www.medicalnewstoday.com/releases/120692.php

The most serious side effect from taking Toctino is severe birth defects - therefore women who could become pregnant can only take the drug if they use two forms of contraception one month before, during and one month after treatment.

Other common and potentially dangerous side effects include raised cholesterol or triglyceride levels in the blood, decreased thyroid hormones, increased liver enzymes, anaemia, or decreased white blood cells.

Other less common, but potentially serious, side effects include joint, muscle and bone pain, ankylosing spondylitis, depression, mood changes and suicidal thoughts. None of these sound pleasant, but it sounds as though you've been relatively lucky so far in that your side effects have been minimal.

Re. Balsam of Peru

With regard to your diet - as you have cut out the foods often linked with eczema i.e. dairy, nuts, eggs and that you thought might be causing your hand and foot eczema, without noticing any improvement, I'd suggest that you reintroduce them; cutting out whole food groups can lead to severe nutritional deficiencies, so it's never a good idea, unless it's done under the supervision of a dietician. However, it might be a good idea to continue to avoid foods that contain balsam of Peru, as studies show that balsam-restricted diets improve contact dermatitis in patients with a contact allergy to balsam of Peru. Here's a link to one such study that you may find helpful: http://ainotes.wikispaces.com/file/view ... D+2001.pdf

For more information on diet and supplements and eczema please see another of my replies: viewtopic.php?f=497&t=4953#p14551 This post also touches on managing stress, as stress often triggers eczema flare ups.

Re: Other Suggestions or Comments

With regard to what else you can do - taking good care of your general health by eating well, taking regular exercise, getting sufficient sleep and taking time out to reduce your stress levels could help to reduce the incidence of your eczema flare-ups.

I've answered your question as fully as I can and hope I've been of some help :)

Wendy
Wendy Green
Health Expert and Author

http://www.talkhealthpartnership.com/on ... _green.php

Achilles
Posts: 6
Joined: Tue May 07, 2013 7:03 pm
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by Achilles on Tue Sep 24, 2013 7:23 pm

Re: Chronic Hand and Foot Eczema

Thanks Wendy for a very thorough and informative reply to my questions! And thanks for the excellent article links too.

I am three months into my second round of Toctino, with 3 more months to go. My hands are looking great (I'd say 100%) and my feet are at about 95% and still improving (mainly just some hard/dead skin to peel).

I'm hoping this round clears everything up for at least six months or more afterwards!

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