Eczema (atopic dermatitis) is a recurring, non-infectious, inflammatory skin condition that affects one in three (almost six million) Australians at some stage of their lives.
The prevalence of eczema has increased two- to three-fold in recent years, with research showing the rise is linked to a range of environmental factors.1
Cheryl Talent, President of the Eczema Association of Australasia (EAA), says eczema is a common disease of increasing prevalence with the potential to cause significant problems for the affected individual, and its impact is extremely onerous for the family and economically burdensome for society.
“The potential for psychosocial difficulties makes it clear that people with eczema and their families need more than just the physical treatment of symptoms,” she told Retail Pharmacy Assistants.
“Because constant scratching can maintain or aggravate skin inflammation, educational and psychosocial support for patients and their families, in addition to medical treatment, may improve the long-term physical outcomes.”
What is it?
Atopic eczema is the most common form of the disease, with areas of the skin becoming red, dry, itchy and scaly, and in severe cases, weeping, bleeding and crusting over.
Although eczema affects all ages, it usually appears in early childhood and disappears at around age six, but some people may experience severe eczema into adulthood.2
Although eczema is thought to be hereditary, around 30 per cent of people affected by it have no family history of allergic diseases.
A child with both parents who have an atopic condition such as eczema, asthma or hay fever, has up to an 80 per cent chance of inheriting eczema.1
Beyond being an irritation, eczema can put people at risk of other issues.
“Eczema sufferers are more likely to catch other people’s infections,” Ms Talent said, adding that it’s essential to prevent contact between an eczema sufferer and a person with either of the following infections:
- Cold sores (herpes simplex). These can lead to a very serious viral illness (Eczema herpeticum).
- Impetigo (a contagious pustular skin disease). This can lead to the development of infected eczema, which may need antibiotics to be cleared.
Aggravating factors
The condition fluctuates and some sufferers experience worse symptoms than others, despite excellent care.
“Eczema is individual, and all sufferers have different triggers,” Ms Talent said.
“Most people find summer, due to the heat, rather than winter, worse, but there are others who are completely the opposite. Research has shown that more than half of people with eczema believe that their flares are worse in spring.3
Because eczema sufferers’ skin produces fewer fats and oils, it can’t protect effectively against bacteria and irritants. This means everyday substances can make skin irritated, cracked and inflamed, says Ms Talent.
“Eczema may be made worse by woollen clothing, ordinary soap, laundry powders, chemicals, metals, fur and hair, pollen, dust, dairy produce, eggs, colourings and preservatives,” she said.
Worrying about family problems, school, work or the physical discomfort of eczema and its effects on lifestyle and appearance can also aggravate the condition.
Role of pharmacy
Pharmacies are usually the first port of call for eczema sufferers, so the information provided by pharmacists and pharmacy assistants is vital for beginning a skin management program – to assist in keeping their eczema under control with the help of their health professional.
“There’s a need for specific eczema training for pharmacists and pharmacy assistants, as there are many ways to minimise the discomfort and distress that eczema can bring, the foundation of which is an effective skincare routine,” Ms Talent said.
“Eczema is a highly individual condition, and what works for one sufferer may not be suitable for another.”
Ms Talent says a good pharmacy assistant should always advise the patient to seek the correct diagnosis of their skin condition by visiting a GP or dermatologist.
“If the pharmacy assistant doesn’t know the correct product advice to give, they should refer the patient to someone in the pharmacy who does,” she said.
The goal of treating eczema is to heal the skin and to both prevent and minimise flare-ups. This can be achieved by using a moisturiser to prevent the skin from cracking or itching and offer relief.
“Well moisturised skin also helps block out germs that cause infections, and recommending to sufferers that they use only sensitive/hypoallergenic products for cleansing and moisturising is important,” Ms Talent said.
Also important, when it comes to flare-ups, is using the steroid cream recommended by the patient’s GP or dermatologist, or an over-the-counter one.
“There aren’t many treatments for eczema. so reassuring patients about using those treatments available, such as topical steroids to manage flares, is very helpful and reinforces the advice from their doctor,” Ms Talent said.
“It’s also a good idea for the patient to be referred to the EAA for support in managing their skin condition.”
Pharmacists are encouraged to keep in contact with the EAA to be aware of any new developments in eczema treatment and management and to gain up-to-date educational information for distribution, which can give patients an updated overview of how to manage their condition.
The EAA also provides an Eczema Care Plan that can be downloaded from its website via eczema.org.au/Eczema-Care-Plan-A4.pdf.
“This can be a really helpful addition to the management of their eczema, and printed copies can be requested,” Ms Talent said.
References
- Lieberman P, Anderson JA. Allergic Diseases, Diagnosis and Treatment (2nd ed). Humana Press, New Jersey, US.
- Eczema Association of Australasia. Membership Survey 2003.
- Department of Dermatology, St Vincent’s Hospital Melbourne. Atopic Eczema Health Survey, January 1999 – February 2000 (sample size: 85).
This feature was originally published in the September issue of Retail Pharmacy Assistants e-magazine.
