Eczema Management: Latest UPDATES

ECZEMA MANAGEMENT, Eczema is a chronic inflammatory skin disease that affects 20-30% of children and 2-10% of adults. Eczema is a multifactorial disease with genetic and environmental aetiology.

Atopic eczema is a common skin condition that causes patches of skin that are itchy, cracked and sore.

---

The main symptom of atopic eczema is patches of skin that are itchy, dry, cracked and sore.Treatments for atopic eczema include emollients (moisturising treatments) and steroid creams.You’re more likely to get atopic eczema if you have allergies or other family members with conditions like atopic eczema, asthma or hay fever.

In secondary care, eczema severity is increasingly measured using the Eczema Area and Severity Index (EASI). EASI is a clinical tool scored by assessing the erythema, excoriations, induration and lichenification of the skin.

The NICE guideline for dupilumab requires that patient outcomes are measured according to EASI, which has influenced its uptake as a clinical disease severity tool for eczema in the UK.

Eczema Management,

IMPACT ON QUALITY OF LIFE

Optimal treatment of eczema is important because poorly managed disease has a significant impact on mood, sleep, relationships, school and work life. In a large US study, one third of patients with eczema reported mood and sleep disorders at more than twice the rate of matched controls without eczema.

NICE guidance suggests that flares of eczema could be reduced with optimised topical therapy and there is often undue concern about overuse of topical steroids.

A 2020 synthesis of qualitative studies performed to explore the views and experiences of people with eczema demonstrated that:

• eczema is often not viewed as a chronic condition
• the significant psychosocial impact of eczema is not acknowledged by others
• hesitancy is communicated to patients with regards to eczema treatments, and
• there is insufficient information and advice about treatments available for eczema.

MORE INFO CLICK HERE

Eczema Management,

TOPICAL THERAPY

When dermatologists review people with eczema in secondary care, assessment of topical therapy is always taken into account, this may include:

• whether the person is using a soap substitute or low-soap wash
• whether they are using adequate emollient, which will often mean the addition of an ointment into a regime with creams only, and encouraging increased amount and frequency of emollient application
• use of adequate topical corticosteroids.

If there is a need for daily topical corticosteroids to keep eczema controlled, and especially if there is facial eczema with eyelid involvement, the next step is often to introduce a topical calcineurin inhibitor (TCI).

The steroid-sparing TCIs pimecrolimus (Elidel®) and tacrolimus (Protopic®), have been available since 2000. Protopic 0.03% ointment and Elidel cream are licensed for ages 2 years and above. Protopic 0.1% ointment is licensed for ages 16 years and above.

It is worth reminding patients that side effects with immunomodulators, including burning and stinging, tend to improve over time.

MORE INFO CLICK HERE

Eczema Management,

PHOTOTHERAPY

Most patients with eczema have mild-to-moderate disease and can be managed with optimisation of the topicals already discussed.

If topical therapy fails to control disease, and patients can attend hospital for the required appointments, phototherapy remains a useful second-line treatment for children and adults.

Eczema Management,

ORAL SYSTEMIC THERAPY

An expert panel for the International Eczema Council has devised a pathway to demonstrate when it is appropriate to consider starting a systemic therapy for eczema.⁶

The advice includes starting a systemic if:

• patients have moderate-to-severe disease (measured using a score such as EASI) that has not responded to topicals and phototherapy
• adequate education has been provided, including discussion of possible steroid phobia,
• infection has been excluded and allergy has been considered including, if indicated, patch testing or referral to allergy services.

Eczema Management,

SYSTEMICS USED FOR ECZEMA

Drug	Approved for atopic dermatitis?	Reported efficacy in moderate-to-severe disease	Side effects
Azathioprine	No	30-40%	Hematologic abnormalities, skin and other malignancies, hepatosplenic lymphoma, and central nervous system infections
Ciclosporin	Yes, in Europe	50-90%	Renal insufficiency, hypertension, and drug interactions
Methotrexate	No	40%	Hepatotoxicity, hematologic abnormalities, teratogenicity, gastrointestinal intolerance, nausea, and fatigue
Dupilumab	Yes	70%	Injection site reactions and conjunctivitis

MORE POSTS CLICK HERE