Pots, tubes and pumps – so many treatments

People with eczema often have a lot of different treatments. They come in a variety of shapes and sizes, in pots, tubes and pumps. At my clinic, I ask my patients to bring all their treatments with them; most people have at least a carrier bag with them………..one patient even brought their treatments on a small trolley. So imagine how hard it is to not only learn how to use and apply all these treatments effectively; but to keep supplies and prescriptions up-to-date. On top of this you have the need for a substantial bathroom cabinet or extra shelving to store all your ointments.

I have to say though; it is very helpful for the patient and incredibly useful for me, as a clinician, to physically see all their treatments. You would be amazed how many treatments are white with red writing! What is often astonishing is how many treatments have not really been used. Many of the steroid tubes, for example, have barely been squeezed. Pots and pumps of emollients have often been used for 3-4 months, when a 500g container should only last one week. A little detective work by looking at the label and dispensing date is often all that is needed for me to assess under-treatment. However, my patients are very honest and will admit under-use, which consequently means that their eczema is not optimally treated or even under control.

 

So why is under-treatment of eczema such an issue for so many people, especially if they have so many pots and tubes? Firstly, different treatments are often prescribed on return visits to their health care professional. The patient will generally report that the treatment is not working and they would like to try something else.  So the health care professional prescribes something else and for a short time the patient is happy. Actually, what needs to happen is for the health care professional to take some time exploring with the patient why they do not think the treatment is working, asking them about their daily skin care routine, where, when and how much they apply. Then asking pertinent questions, such as: Are there any treatment that give them particular concerns?

 

This dialogue between health care professional and patient can be incredibly revealing. Generally, a small change in attitude towards a treatment, such as dismissing fears about topical steroids or explaining how much should actually be applied (approximately 500g of emollient a week for an adult and 250g  a week for a child); can actually be life changing as far as self management of eczema is concerned.

 

Sometimes, the patient is right-they do have too many treatments. Finding the right emollients, wash products and moisturizer, and having a range of treatments for flare-management can quickly make extra space in that bathroom cabinet disappear. Therapeutic clothing, such as the DreamSkin polymer coated silk compliment all eczema treatments and has therapeutic effects which may help reduce the need for other treatments.

Here is one final tip for you. If you pay for your prescriptions, don’t skip or ration your treatments due to prescriptions charges. Each year, take out an investment in your skin care by applying for a NHS Prescription payment Certificate (£29.10 for three months or £104.00 for a year). With this certificate there is no limit to the number of prescription items and if you need more than 13 items a year you will save money on the current item charge of £7.65. So, if you have eczema, there are massive saving to be made.

 

Eczema Expert

 

Innovation in Eczema

The pharmaceutical industry is constantly evolving and although billions of pounds are spent yearly developing new drugs and medical devices, innovation in the field of dermatology is one area that has lacked investment for a number of years.

From my humble beginnings as a sales rep, selling the first form of liquid Gaviscon, to board level positions in multi million pound pharmaceutical companies, I have seen almost everything the industry has to offer.

In many people’s eyes the first major development in the treatment of skin conditions was the introduction of Topical steroids in the 1950’s.  These revolutionised the treatment of eczema and inflammatory skin conditions generally. For decades the indication “steroid responsive dermatosis” gives a clue as to how specific a diagnosis had to be when choosing appropriate drug treatment for widely varying skin diseases!

There then followed a gap of almost 40 years before the next class of topical eczema treatments were introduced into clinical practice. Tacrolimus and pimecrolimus (topical immunomodulators, TIM’s) were launched in the 1990’s at a time when fears over the potential side effects of topical steroids were reaching fever pitch. Subsequent safety warnings from regulators seriously limited the usage of TIM’s through the 2000’s.

Apart from techniques such as wet-wrapping (now declining in popularity) nothing significant has happened in the last 20 years and it looks as though nothing significant is going to happen for the next 20 – unless research into filaggrin bears fruit.

A review by Massimo Riccaboni of the University of Trento and published by the Office of Health Economics (OHE Seminar Briefing No 11 June 2012) makes depressing reading for sufferers of skin diseases.

Dermatology accounts for 3% of worldwide pharmaceutical industry R&D spend and is declining, whereas research into new anti-cancer agents makes up 30% of investment and is growing at 8%. Yet the probability of success (measured by regulatory approval) is 7% in dermatology and 2% with anti-cancer programmes.

We believe that it is companies such as ours that can truly innovate and develop a unique product such as DreamSkin that eczema patients will rely on for years to come.

Eczema affects up to 10% of the UK population, 20%-25% of children and is increasing.  15% of all visits to a GP include skin complaint as the reason for the consultation, with eczema being by far the most common reason.

About Dreamskin

DreamSkin polymer coated silk clothing is changing the way eczema is treated. The polymer moisturises the skin, protects against common irritants such as washing powder residues, pollen and dust and helps to regulate body temperature.

DreamSkin is available on prescription

By Tony Wilson

Central Heating... Eczema's Autumn Enemy

I find my patients often dread the autumn, as this is the time when their skin really dries out and consequently their eczema flares. “Why is this?” They say… “I am still using lots of moisturizer and my skin is literally cracking up!  After a good summer with my skin, autumn feels like my eczema is coming back with a vengeance. Is there any way to prevent this autumnal eczema onslaught, as I know this is going to happen every year?”

 

Of course, every person with eczema has individual factors which they know trigger their eczema. Sometimes, these triggers are seasonal and sometimes a person’s triggers can change. However, one of the few universal eczema triggers is heat; everyone with eczema is affected by changing temperatures. Autumn is often a bad time for people with eczema, as the central heating goes on, humidity is reduced and we are all constantly moving from cooler, outdoor conditions to warmer, indoor environments.  This leads to skin becoming much drier; and as we all know dry skin is itchy skin.

 

So, remember that as we move into autumn and the central heating goes on; keep on moisturizing, and think about using an ointment or oily cream, to stop your skin becoming drier. If you find the regular application of creams and ointments inconvenient or unpleasant you should try a medical grade garment such as DreamsSkin. DreamSkin garments improve moisture retention of the skin; help reduce skin itching and irritation, are resistance to common irritants and help maintain comfortable body temperature. Here are a few more tips to help you as we move into winter:

 

·         Prevent skin from becoming dry, by washing with soap substitutes and avoiding bathing products, such as bubble baths, which will dry the skin further.

 

·         Moisturize skin regularly all over and don’t forget the lips.

 

·         If lips become chapped lip licking worsens the situation; apply a thick layer of greasy emollient at night and use chapsticks (without colouring or perfume) in the day.

 

·         Keep heating at a constant, comfortable temperature and don’t overheat homes; keep the bedroom temperature at no more than 18^oC.

 

·         Consider using a household humidifier.

 

·         Wrap up well when outside, use hats and scarves to protect the face and wear gloves to protect the hands.

 

 

by Eczema Expert