Why Are People Talking About Aron's Regimen for Eczema?

Is Aron's regimen of steroids, antibiotics, and a moisturizer more effective in treating eczema?

What is Aron’s Regimen?

Aron’s Regimen is named after Dr. Richard Aron, a dermatologist from Cape Town now practicing in London, who has been treating his eczema patients with this regimen.[1] The principal of Aron’s regimen is actually very similar to what practitioners have been routinely advising people with eczema to do, but it combines them into one single source. It utilizes a cream that combines a mixture of a topical steroid, an antibiotic, and a moisturizer.

 

Why Does Aron’s Regimen Work for Eczema?

In theory, Aron’s Regimen covers several major components of eczema treatment.

  • Topical steroids: Topical steroids are the mainstay treatment in people with eczema. They work by reducing skin inflammation which is one of the major causes of itching and the eczema rash.[2]
  • Topical antibiotic ointment: Topical antibiotic ointments help to lower the number of bacteria that live on the skin. Studies have shown that during an eczema flare, between 78 to 100% of the people are tested positive for the Staphylococcus aureus bacterium on their skin.[3] Recently, researchers have found that our skin microbiome plays an important role in eczema. The diversity of bacteria that live on our skin shifts and decreases during eczema flares, where certain species of bacteria (such as Staphylococcus aureus) predominate.[4] These “bad” bacteria release toxins that can actually cause eczema on healthy skin.[5,6] They also make enzymes called proteases that digest and destroy our skin’s protective barrier,[7] another major problem associated with eczema.
  • Moisturizer: A successful treatment plan must include skin emollients and moisturizers, which aid in repairing the defective skin barrier found in people with eczema. Moisturizers function in several ways by preventing water evaporation through the skin surface, helping to introduce water to the skin to keep it hydrated, and decreasing the entry of microbes, irritant, and allergens.[8] In Aron’s regimen, the concentration of the moisturizer is usually about 10-15 times the amount of the topical steroid.

 

How Is Aron’s Regimen Done?

There is no “one-size-fits-all” approach to Aron’ Regimen because everyone’s eczema severity and response vary. Typically, the cream mixture is applied 4-6 times daily (compared to the twice daily application of topical steroids) during the first week, and the frequency of daily application gets tapered over several weeks as one’s eczema improves. In some people, the antibiotic component of the mixture may be removed once the eczema flare is under control. The length of therapy also varies depending on the person. Some eczema people may be able to stop Aron’s regimen all together and have clear skin, while others may need to stay on a maintenance treatment (such as 2-3 times daily application) for several years.

 

Is Aron’s Regimen Better Than Using the Components Separately?

One may ask, how is Aron’s Regimen more effective if it contains the same ingredients that most eczema patients have already been using? Actually, there have not been any recent research studies specifically comparing the effect of Aron’s combination regimen vs. applying the components separately. However, the thought is that combination therapy is a more convenient treatment regimen. In other words, people with eczema may be more likely to use one topical cream than three.

Another reason why Aron’s Regimen may be more effective is that the topical steroid component is essentially diluted by adding a topical antibiotic and moisturizer, which is safer to use for a longer period of time. The more frequent application may prevent a potential rebound eczema flare when topical steroids are otherwise abruptly stopped. The objective of Aron’s Regimen, according to Dr. Aron himself, is to “reduce the degree of itch within 5-7 days and to maintain this improved state via continuing therapy.”[1]

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References

  1. Link to research. February 18, 2017.
  2. Lee JH, Son SW, Cho SH. A Comprehensive Review of the Treatment of Atopic Eczema. Allergy Asthma Immunol Res.2016;8(3):181-190; PMID: 26922927 Link to research.
  3. Higaki S, Morohashi M, Yamagishi T, et al. Comparative study of staphylococci from the skin of atopic dermatitis patients and from healthy subjects. Int J Dermatol.1999;38(4):265-269; PMID: 10321941 Link to research.
  4. Dybboe R, Bandier J, Skov L, et al. The Role of the Skin Microbiome in Atopic Dermatitis: A Systematic Review. Br J Dermatol.2017PMID: 28207943 Link to research.
  5. Nakamura Y, Oscherwitz J, Cease KB, et al. Staphylococcus delta-toxin induces allergic skin disease by activating mast cells. Nature.2013;503(7476):397-401; PMID: 24172897 Link to research.
  6. Bunikowski R, Mielke ME, Skarabis H, et al. Evidence for a disease-promoting effect of Staphylococcus aureus-derived exotoxins in atopic dermatitis. J Allergy Clin Immunol.2000;105(4):814-819; PMID: 10756234 Link to research.
  7. Miedzobrodzki J, Kaszycki P, Bialecka A, et al. Proteolytic activity of Staphylococcus aureus strains isolated from the colonized skin of patients with acute-phase atopic dermatitis. Eur J Clin Microbiol Infect Dis.2002;21(4):269-276; PMID: 12072937 Link to research.
  8. Giam YC, Hebert AA, Dizon MV, et al. A review on the role of moisturizers for atopic dermatitis. Asia Pac Allergy.2016;6(2):120-128; PMID: 27141486 Link to research.