NSAIDs have anti-inflammatory (reduce inflammation), analgesic (relieve pain) and antipyretic (lower temperature) effects. Although different NSAIDs have different structures, they all work by blocking cyclooxygenase (COX) enzymes. There are two main types of COX enzymes: COX-1 and COX-2. Both types produce prostaglandins; however, the main function of COX-1 enzymes is to produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract, whereas COX-2 enzymes are responsible for releasing prostaglandins after infection or injury. Prostaglandins have a number of different effects, one of which is to regulate inflammation. Most NSAIDs inhibit both enzymes, although a few are available that mainly inhibit COX-2. The pain-relieving and anti-inflammatory effects of NSAIDs are mainly due to inhibition of COX-2, and their unwanted side effects are largely due to inhibition of COX-1.
Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .
Lots of unsubstantiated alternative eczema therapies are promoted in the press. Be wary of these claims. Miraculous natural cures for eczema often contain crushed cortisone tablets. Evening Primrose oil (or gamolenic acid), flaxseed & omega 3 oils offer no real additional benefit to eczema. Chinese herbal tea extracts have been evaluated but taste unpleasant and may even cause liver toxicity. Recalcitrant eczema on the face may respond to non-steroidal immune-modulator preparations such as Tacrolimus (Protopic) and Pimecrolimus (Elidel) however skin redness may be a temporary side effect. Ultra-violet light therapy treatment has been helpful so get out into the sunshine! There is growing proof that lactobacillus GG probiotics (Reuterina) supplemented in pregnancy, breastfeeding and early in life may reduce eczema in babies by altering their gut immune reactivity.