This is a fight we need to win, dermatologists say

Eczema is not an allergy — it is a genetically determined condition that tends to be most severe in early life. The basic problem is skin dryness which affects the skin barrier, which in turn leads to inflammation and infection. It can be intensely itchy.  Eczema has a number of triggers, some of which are easy to avoid and some of which are difficult to avoid.

Eczema can be mild or severe and can present in different ways. It can impact significantly on quality of life but, despite this, parents and doctors are commonly too apprehensive to use appropriate treatment.

“Parents and doctors somehow believe that treatment is more dangerous than the condition itself,” said Associate Professor Gayle Fischer from the University of Sydney. “This leads them to search relentlessly for an external cause, most often an allergy, that is tangible and that they hope they can eliminate. This belief that treatment is dangerous is the most common cause for poorly controlled disease. I spend a great deal of time convincing patients to use the right treatment and reassuring them that it really is safe. Fortunately, now that I have grey hair, they tend to listen to me. Much better engagement with the public on social media is needed to counteract the agendas on the internet that deliver incorrect messages to patients. This is a fight we need to win.”

Treatments for eczema include environmental modification and infection control. Emollients are used to control skin dryness and restore the skin barrier, and in all but the mildest cases, topical corticosteroids must be used. Topical calcineurin inhibitors such as pimecrolimus can also be used as treatment for facial and eyelid eczema.

The mum of 10-year old Evie, who has severe eczema, said: “The general practitioner initially prescribed sigmacort, which did not work at all. The dietary changes advised by the dieticians may have helped. I also saw herbal specialists and chiropractors, which didn’t help. We didn’t receive any direction in our treatment and continued down the wrong path and were not educated regarding the chronic nature of eczema needing consistent treatment.

“Increasing the education of doctors regarding eczema and knowledge of when to refer patients for severe eczema would help. Doctors need to listen to their patients. When they’re coming back to you again and again, with no improvement in their child, don’t just send them away. People think that it will just get better easily, but if it’s not then refer to a specialist,” she said.

She continued, “Our dermatologist is practical. She’s very concise. Her advice is clear, which is what a parent needs. We receive thorough, accessible and consistent care with a consistent message, which is reassuring.”

The Australasian College of Dermatologists (ACD) recently released a position statement, a patient fact sheet and Q&A on the use of steroids used to treat eczema in children.

ACD President Associate Professor Chris Baker said: “The ACD position statement provides needed recommendations to GPs, nurses and pharmacists on the safe and effective use of steroids. The fact sheet and Q&A provide practical advice for parents on the safe use of steroids to help treat eczema in their children. Our focus is to improve outcomes for the skin health of individuals and the community as a whole.”

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