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Eczema: Are You Scratching Your Head Trying to Help Patients? :

July 6, 2018

Eczema (atopic dermatitis) is a common, chronic and recurrent disease that causes much morbidity for patients and their families, and it need not!

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.

The article in the April issue of Pediatrics in Review by Waldman. Ahluwalia, Udkoff, Borok, and Eichenfield provides background on the disease, the pathophysiology, and the therapeutic strategies and choices to ensure health care practitioners managing children with eczema have the “tools” needed in the tool box to educate, plan, implement and monitor therapy.  Some important highlights include:

  1. 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.
  2. 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.
  3. 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!

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