Why we need better care for people with eczema

Atopic eczema, the most common form of the skin condition eczema, affects one in five children and one in ten adults in the UK. Not only does it cause the skin to become itchy, sore, dry and cracked, the discomfort and appearance can lead to considerable psychological distress - affecting people's sleep, work and more. Despite this, many people with eczema wait many months for treatment and suffer in silence.

Around 1.5 million people live with moderate or severe eczema in the UK. However, a recent report by Allergy UK and Sanofi highlights a number of problems they face when trying to access care.

National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for health and care in England. Yet for adolescents and adults with eczema, there are no standardised guidelines to reduce the variation of timely care and treatment seen across the country. As a result, nearly half of the healthcare professionals surveyed in the report, including GPs and dermatologists, said they did not have clear guidance and support around when to diagnose and refer people with severe eczema.

The impact of this for people with eczema is far-reaching. More than 50% wait more than a year for a treatment regime that makes their condition manageable, with over 75% saying eczema had impacted their mental health. The condition also disrupts daily life for many people, with almost 25% of adults with eczema taking more than 15 days off work a year due to their eczema.

Although the report highlights that these issues existed before the pandemic, COVID-19 has had an impact on care and treatment too. Almost half of patients surveyed said COVID-19 has made it more difficult to access services and treatments, while 87% of healthcare professionals say the pandemic has made it harder to identify patients.

Eczema isn't always taken seriously

Dr Adil Sheraz, a consultant dermatologist and British Skin Foundation spokesperson, says it's important that patients are assessed carefully in primary care, both for their skin issues but also for the impact the condition has on their mental well-being.

"Unfortunately on many occasions patients are asked to just 'stop scratching' or are not taken seriously as it's perceived as 'just' a skin condition," he says.

"For most patients, eczema tends to be something that they have lived with for most of their lives," Sheraz adds. "In the case of adults with eczema, I often get the impression that when patients are seen in a specialist dermatology clinic, they are surprised to learn that there are other options than topical steroids to treat eczema."

Eczema is a relapsing and remitting condition, which means that there will be periods when a short course of topical steroid use will clear the skin. The patient may remain in remission for many months before their eczema symptoms return. "Occasionally it may also take some time to build up to a treatment regime that works for the patient," says Sheraz.

Timely eczema treatment is key

Eczema can have a serious impact on people's physical and mental health. Adequate psychological support for people with eczema is essential. As well as treating the physical symptoms of eczema, interventions such as counselling allow people to cope better with the mental impact of their condition.

"Living with eczema can have a profound impact on one's mental health. It is absolutely vital that patients who have eczema and are struggling either physically or mentally as a result are referred onwards to a dermatologist to start treatment early," says Sheraz.

"We must not forget the impact that eczema will have on family members, particularly in the case of children, who may be up all night scratching, resulting in tired and weary parents. There are also some schools of thought that early, effective intervention and treatment of eczema may help prevent the development of other conditions such as food allergies or allergic rhinitis," he adds.

"Early and effective treatments will also lead to reductions in skin flare-ups, fewer GP and hospital visits, and a reduced need for admitting patients."

Why eczema patients need better mental health support

A study in the British Journal of Dermatology revealed that atopic eczema has a significant detrimental impact on patients' quality of life. When looking at the Children's Life Quality Index - a measure used to assess the impact of any condition on quality of life - eczema had the second highest score, surpassed only by cerebral palsy.

"From a physical perspective the skin of course is extremely itchy, can burn or become infected. Sleep is often disturbed, leading to further tiredness and physical stress," says Sheraz. "A factor that is often overlooked with severe eczema is the pain that can be associated with inflamed skin. Over time the skin can thicken, become discoloured or scarred. Scratching behaviour is worsened when patients are frustrated or stressed."

A survey by the National Eczema Association revealed that more than 30% of people with eczema were diagnosed with depression or anxiety. Additionally, research published in JAMA dermatology in 2018 showed a significant increase in risk of suicidal thoughts in adults with eczema when compared to the general population.

"The impact that moderate-to-severe eczema continues to have on people's lives is laid out here in stark terms," says Carla Jones, CEO of Allergy UK. "Yet still, a very small percentage of Integrated Care Systems (ICSs) and their predecessors, Clinical Commissioning Groups (CCGs), have an eczema commissioning policy in place. And there is still no NICE adolescent or adult guidelines for eczema to help reduce unwarranted variation in care."

By providing these guidelines, healthcare professionals will be better able to support patients with eczema.

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