Eczema: Are You Scratching Your Head Trying to Help Patients?
MiriamWeinstein, MD, FRCPC, Editorial Board Member, Pediatrics in Review
Eczema (atopic dermatitis) is a common, chronic and recurrent disease that causes
much morbidity for patients and their families, and it need not!
One of the biggest hurdles to achieving such success with eczema management is the
vast amount of information available—some great; some poor; much of it conflicting;
some information backed up by evidence, although a lot of suggestions are not. The
number and variety of sources of information is almost as overwhelming as the actual
volume of information available. Pediatricians are well-positioned to implement simple,
safe, and effective management plans and to educate and support families suffering
with atopic dermatitis.
Much of the severe or recalcitrant eczema that is seen in subspecialty clinics is
actually mild and/or moderate eczema presenting as severe because it is so profoundly
under-treated or un-treated. Key in driving this suboptimal therapeutic control is
frequent corticosteroid phobia (on the part of patients, families, and health care
practitioners at times); lack of adherence to daily skin care routines, including
consistent moisturization; and information overload.
Identifying that hydration of the skin on a regular basis is a “cornerstone” of successful
therapy. While moisturizing the skin is a technically simple and rapid task, the unrelenting
need to do this daily and consistently can be a major hurdle. The article provides
guidance on moisturizer choice, usage, and its vital role in eczema management.
Helping the practitioner understand that the risk of adverse effects associated with
steroids is much lower than is commonly perceived. Understanding this, communicating
this information to patients, and enabling them to use their medications effectively
and safely should not be under-estimated as it is a profound intervention. The patient
with eczema and their family are often receiving messages that trivialize the disease
and make them feel a sense of guilt for using safe and effective treatments that is
not typically experienced by those with other chronic diseases of childhood.
Highlighting the critical role of educating patients and families about the details
of the disease and how to manage it. There are many ways to educate families—formal
or informal, individual vs. group, oral vs. written, etc— and these choices should
be tailored to the resources of the health care practitioner and the learning needs/style
of the patient and family. What is undeniable is that education is vital to success.
The article provides useful information with background rationale to enable the pediatric
health care practitioner to successfully manage eczema. Response to appropriately
implemented therapy is usually rapid and as a practitioner, it can be immensely satisfying
to see patients’ and families’ quality of life improve—at times dramatically!