Management of mild-moderate eczema ‘overlooked’ 

Eczema patient advocates are calling on dermatologists not to overlook management of the condition for the majority of people who experience mild to moderate disease.

With novel and highly effective biologics becoming available for treating severe eczema it’s important for clinicians to continue helping the many patients who have less severe disease by providing adequate advice on practical measures such as use of emollients, according to Eczema Association of Australasia President Dr Cheryl Talent.

“We want to help everybody with eczema, not just concentrate on the ones who are really severe,” she told an Eczema Awareness Week 2022 online forum.

“I feel that sometimes [severe eczema patients] get more assistance than the ones who just have quite bad flares from time to time but aren’t eligible for some of the newer treatments. They seem to get overlooked a lot.”

Sydney-based consultant dermatologist Dr Philip Tong, who also took part in the forum, agreed that it was important for all patients with eczema to have access to education and advice on skin care for managing the condition.

He said his own practice was to have a long consultation focusing on managing flares, followed by further education on prevention of flares with topical treatments such as emollients, topical corticosteroids as well as avoidance of irritants.

“This is the cornerstone of treatment of mild-moderate eczema and [we] have spoken at length to trainee dermatologists GPs and pharmacists on this education about managing mild-moderate eczema,” he said.

“Yes there is a category of severe patients who do require our assistance as well but for the most part of lot of atopic eczema can be managed with topical measures, and therefore emphasising that education is really important not just for patients but for all healthcare providers involved in eczema such as nurses” he said.

Individualising emollients

Dr Tong’s comments are supported by new findings from the UK showing that even parents and carers with extensive experience of looking after childhood eczema are often unaware of why, when, and how to use emollients and topical corticosteroids.

The qualitative research in the form of interviews for the development of a new online intervention to assist families to manage eczema found many parents had knowledge gaps, and a reluctance to co-manage the condition with their child.

“Parents’/carers’ skills can be enhanced by demonstrating how to use treatments, and involving children in this could help with transitioning to co-management, the authors suggested in the British Journal of General Practice.

A second study in the same journal found there was a wide and sometimes confusing number of different lotions, creams, gels and ointments available for eczema, as well as varying recommendations for use. Responses from families showed that their eczema treatment decisions were made on disease burden, discomfort, and expense, and there was no one product that was suitable for all parents or children.

“Thicker emollients were liked [by some]  because of their ‘protective’ and long-lasting qualities, but tended to affect clothing and were difficult to apply. The lighter emollients absorbed into the skin, which for some highlighted moisturising capability but for others indicated a lack of ‘protection’,” the authors noted

There was also nuance in how emollients were used in individual cases, with some patients using different types of emollient on different parts of the body such as face and hands based the emollient characteristics to suit their needs.

The study authors said it would help to have a patient decision-making aid based on their preferences around thickness, texture and even packaging to find an emollient that “worked” for each individual.

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