When Eczema Sticks

I meet so many patients with eczema, who often cry with relief, when they are allowed time to talk about their unpleasant eczema symptoms and how their eczema affects their life. The symptom of itch is key for everyone with eczema and health care professionals are aware of the itch-scratch-damage cycle (something I discussed in a previous blog http://bit.ly/11YvN2f). However, many health care professionals perhaps do not realise how painful and distressing severe eczema flares can be.

Everyone with eczema has the potential for a severe flare – this is generally associated with infected eczema. My patients often become very distressed when they have a severe eczema flare and describe intense itch, eczema spreading all over their body, red, burning skin; wet and weepy skin which sticks to clothes and bed sheets. Literally, when eczema is this bad, clothing and bedclothes sometimes have to be peeled off the skin; causing intense agony and skin damage; as the outer layers of skin are removed. The skin becomes so painful; nerve pathways alter and the person with eczema cannot even touch their skin. In this situation, the person with eczema quickly becomes exhausted, as they are unable to sleep. Skin healing is inevitably delayed and the sufferer's quality of life diminishes.

Severe flares can sometimes be isolated to areas of the body for certain groups of people with eczema. For example, I often see babies with severe facial eczema and adults with severe hand eczema. Face masks and gloves often stick to these wet and weepy areas. This causes a great deal of distress for not only the sufferer but also the caregiver, who has to peel clothing off of their young child's skin.

I am describing a severe flare of eczema; and I hope that most people with eczema would seek medical help and treatment before this situation escalates but sometimes eczema can become very severe, very quickly. Firstly, the correct treatment with a course of strong steroids and antibiotics is essential. Secondly skin comfort and assisting skin healing is crucial. Emollients are very important and need to be used liberally.

Therapeutic clothing provides comfort by keeping skin cool and reducing itching in all stages of eczema. When eczema becomes severe and leads to sore, wet and weeping skin, it is vitally important that therapeutic clothing does not stick. DreamSkin Health is the only therapeutic clothing with a unique polymer coating. The polymer is non-adherent, so does not stick to skin; so in severe eczema flares this means that skin damage is prevented and healing accelerated. In addition, the polymer, reduces moisture loss, provides a protective barrier against irritants and helps keep skin cool.

In severe eczema flares, clinicians will always treat the skin but remember to also prescribe for assisting skin healing and preventing skin damage.

Eczema Expert

An issue that gets right under your skin

In response to the Daily Mail’s article in which they explore “The nasty bugs lurking in out-of-date make-up” linked here: http://bit.ly/14vHh4h we here at DreamSkin have some thoughts of our own.

While topical steroids are an essential treatment for severe eczema flare ups, they should rarely be used as part of a daily skin routine.  Despite the fact that according to research from the ISOLATE study (International Study of  Life with Atopic Eczema) 42% of eczema sufferers “live in a state of constant concern over when they might experience their next flare up”, there is no guarantee or pattern in many cases for when a flare might happen.  Therefore, creams and ointments do have limitations, although we fully appreciate they are a mainstay treatment for many skin conditions. This is highlighted within the Daily Mail article and brings to light an issue which is a major concern for doctors, nurses and the pharmaceutical industry– compliance. 

Under use of emollients is a primary cause of the mis-management and poor treatment of dermatitis.  The recommended weekly use of emollients is 500g a week for an adult and 250g a week for a child.   However, many patients are either unaware of these amounts or they fail to comply with the recommended dosage, as their lifestyle does not allow it.  As a result patients begin to collect a large stash of pots, tubes and pumps half full with eczema creams that are way beyond their use by date.   Patients then begin to use out of date creams on an ad-hoc basis which can cause more harm than good.   

We believe that DreamSkin therapeutic clothing offers a perfect solution. Compliance is easily achieved and thus much higher in users of DreamSkin. For those unable to apply moisturizers regularly while at work, school or at sleep, garments such as DreamSkin offer the patient the option to be on top of their treatment needs.

Chickenpox Case Study

Here at DreamSkin Health we are always looking for new ways our technology can help families. Chickenpox is a common childhood illness that affects most children at some point. As most parents probably know, it causes a rash of red, itchy spots that cause an extreme amount of discomfort and irritation. A big concern of parents is that the child’s desire to scratch could lead to permanent scarring of the skin. In the war against chickenpox parents have taped gloves to hands, applied copious amounts of calamine lotion and placed children in oatmeal baths.

DreamSkin Health garments are designed to treat skin conditions such as eczema. They help the skin to remain moist, stop irritants attacking the skin and help the skin to maintain its normal temperature. We believed that similar results could be had by those currently suffering from chickenpox.

We received a case study of two girls aged 4 and 7, who trialled our garments to see if they could help relieve the symptoms of chickenpox, and sedate that irresistible urge to scratch away at the skin. The mother of both these girls told us how happy she was with the performance of DreamSkin.  

Her youngest child had typical chickenpox symptoms.

'She started with a few large blisters on her torso and after about 3 days she had many more blisters on her arms, legs and on her face’ mother told us ‘From the very first spot I put her into the DreamSkin pyjamas’.

She reported to us that her daughter had almost no urge to scratch.

'I am absolutely convinced that these pyjamas helped to reduce the itch associated with chickenpox and so helped to reduce the likely hood that her chickenpox will have left permanent scars’.

The mother’s seven year old had similar results.

'Despite a high temperature and getting hot in the night she never once said that she was itchy, or tried to scratch at the spots’.

Chickenpox can be a very stressful and traumatic time for both child and parents. DreamSkin garments may be able to provide relief from the extreme symptoms of chickenpox, and put an end to some of the more antiquated remedies.

Serving up an ace product

When we think of drugs and other medicinal treatments, we normally think of tablets, capsules, creams, ointments and injections. However advances in fabric and yarn technologies have spurned a whole new world of treatment dispensing opportunities – technologies that improve our quality of life.

Back in the early 90’s IFT plc was asked by Le Coq Sportif to develop a new fabric to celebrate the signing of their new tennis star, Justine Henin and hopefully one that would help to improve her performance. We realised that Le Coq Sportif wanted something special and as a small company trying to make its mark in the sportswear industry, we put our thinking caps on to see what we could come up with.

Having scratched our heads and brainstormed the idea, taking ideas from the shop floor right through to the HR department, we eventually agreed on an innovation that we thought might interest Le Coq Sportif.

Our research revealed that Henin had very sensitive skin, so we began exploring the concept of a fabric that would moisturise her skin whilst she was playing tennis. We started to investigate if and how we could coat some of our sportswear fabrics with known moisturisers such as Aloe Vera or Squalene. After a few stops and starts, we discovered that the best way forward was to capture microscopic amounts of the moisturiser in an egg like capsule which could then be applied to the fabric.  When worn, the fragile microscopic structures on the surface of the fabric would be broken, releasing the moisturiser on to the skin.

The good news is that Le Coq Sportif loved both the idea and the fabric and the company received a personal note from the tennis star herself - which took pride of place in the company’s trophy cabinet!

It was hard to prove whether the technology was helping her to play better tennis, but our breakthrough spurred us on to investigate other technologies that could treat skin and improve the quality of life of the wearer.

The company’s second breakthrough was a skin friendly and natural insect repellent which could be applied to textiles. When worn, the garment delivers long lasting insect repellent properties for the wearer and negates the need for smelly lotions and sprays.

In the last 10 years, we have managed to refine our expertise and have been able to turn our attention to the major issue of damaged skin conditions such as eczema.

Today, the unique polymer that is used in the eczema soothing range of Dreamskin garments is probably the most advanced example of incorporating a technology into a fabric to deliver a medicinal treatment.          

To find out more about IFT plc products, please visit http://www.ift-plc.co.uk.

George Costa
 

Itch-Scratch-Damage

I always ask my patients ‘What is the worst thing about your eczema?’ The top answer is always – the itch. Eczema causes a lot of unpleasant symptoms; my patients often express how difficult it is to live with the constant itch. If itchiness wasn’t a symptom, eczema would be a much easier condition to cope with and much simpler for the health care professional to treat.

The itch is responsible for the vicious itch-scratch-damage cycle, which drives all the other eczema symptoms. The urge to scratch caused by the constant itchiness, damages the skin and causes ‘flare-ups’. As a result the skin becomes red, weepy and sore. This vicious itch-scratch cycle then needs to be broken with eczema treatments. However, this is often easier said than done.

For lots of people, itch is the most difficult eczema symptom to deal with. The itch affects the skin and everyday life. Itch means that you feel uncomfortable from the moment you wake. You are often constantly tired, as itch stops you from sleeping properly. Itch can make you feel irritable and affect your concentration at school and work.

How do eczema sufferers cope with itch? For most people with eczema, itch is part of life, which they deal with on a daily basis. People who have had eczema since childhood do not know a life without itch. Adults and children with eczema learn to cope with itch in lots of different ways. Parents try to keep their children distracted with toys and games, in the hope this will stop them from scratching. To press, squeeze or rub the troublesome area is another common way sufferers try to get a moments relief from the incessant itch. Health care professionals need to be giving good advice on treating eczema.

Practical advice includes keeping the skin cool, comfortable and maintaining a barrier between the skin and fingernails (which should always be kept short and clean).  Therapeutic clothing, such as Dreamskin Health garments, are an essential adjuvant treatment, which can reduce itching and scratching in eczema, prevent damage and help reduce the number and severity of eczema flares.

Diamond anniversary for topical steroids

Topical steroids shared their diamond anniversary with the Queen in 2012. Sixty years ago they were developed as a new dermatological treatment and remain the mainstay of eczema treatment today. Topical steroids are used to control eczema flares, so are not a cure. They are prescribed widely but often parents and people with eczema are very cautious about topical steroids as a treatment for eczema.

 

Why are topical steroids viewed as such a controversial treatment? In my clinic, I spend time with my patients discussing how they use their treatments. I ask if they have any concerns about using their treatments. Topical steroids tend to be a treatment that in most cases is under-used and the one treatment that everyone is concerned about. Surely, this is a strange for a treatment that has been available for 60 years.

 

Topical steroids are drugs applied to the skin, so like any other drug they have side effects. However, side effects are unlikely if they are used correctly for short-term treatment of eczema flares. My patients are very worried about topical steroids damaging and thinning their skin. Unfortunately, these concerns are often accentuated by health care professionals, as they are often reluctant to apply potent steroids and tell patients to apply very sparingly. In reality, skin is more likely to be damaged from constant scratching and rubbing, if an eczema flare is not adequately treated.

 In the 1950’s, topical steroids were regarded as a break-through in eczema treatment. In the 1960-70’s, they were prescribed in large quantities, often mixed with emollients and used continually. This is when over-use did result in side effects and in the 1980’s and beyond, health care professionals became very cautious in prescribing and patients became fearful of topical steroids.

 

There have been few significant innovations in eczema treatment over the last 60 years. Topical calcineurin inhibitors were developed in the 1990’s and are a topical treatment, used for flares and maintenance treatment, alongside topical steroids. DreamSkin Health garments represent a break-through in eczema treatment for the 21st century.

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