The recent Georg Rajka International Symposium on Atopic Dermatitis was a truly fascinating conference. Not only was it in Saõ Paolo, Brazil, a metropolitan sprawl of 20 million inhabitants which afforded us a brief and sometimes gritty glimpse of true Brazilian culture but, for those interested in atopic dermatitis, it really shed light on the problems in managing this chronic inflammatory condition.
What sort of problems?
The first thing that can be said is the atopic dermatitis is everywhere, in every town, city and country in the world. Lack of data capture from third world countries doesn’t mean it’s not there, just that we haven’t recorded it in any epidemiological study.
Various representatives from countries/continents across the world spoke up about their experience of atopic dermatitis.
In the UK 70% of eczema patients have a fear of topical corticosteroids.
This fear can be so great that 24% of patients are non-compliant with their eczema regime despite what their doctor or dermatologist will tell them.
[CR Charman, Morris AD, William HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000; 142(5):931-6.]
In France, more than 1 patient in every 3 present to multiple doctors per year for their atopic dermatitis. Patients present to an average of 5-7 doctors per year with their eczema. This therefore explains why patients get multiple different ways of managing their eczema.
In countries such as Africa, prescription topical steroids are extremely hard to find. To get around this, African doctors have said it is often easier to go to the local market and purchase a skin lightening product (which we know generally contain potent topical steroids) as a substitute for the prescribed alternative.
In Brazil, topical and oral steroids can be obtained without prescription. For Brazilian doctors, steroid overuse can often be a problem!
If we think we have it bad in this country with too short consultation times, in China, they see on average 100 patients per clinic. Here, traditional Chinese medicine is prolific.
The National Eczema Association of USA reported that 86% of patients are not satisfied with how their eczema is treated. Only 9% of patients think their doctor knows how to treat their eczema!
Again, like in France, many patients see anything from 2 to 10 doctors on average per year for their eczema.
What do patients really want?
Well, this was quite surprising. The majority of patients did not want another prescription medication. The majority wanted more compassion in order to combat the feeling of hopelessness that can happen when you suffer with a chronic skin condition.
Patients described their ‘ideal’ doctor as being someone who loves to treat eczema, treats the patient as a whole person and is also a doctor who is up to date on the latest treatments. On further reflection, this ‘ideal’ doctor most likely describes the type of doctor we all would like to treat us whatever our health problem.
So where do we go from here?
NICE deemed patient education in managing their eczema as the most cost effective measure in the management of atopic dermatitis. However, patient education is dependent on there being enough trained health professionals with enough time and resources to deliver such a service. For example, in Denmark, two specialists and two specialist nurses spend 45 minutes to 1 hour per patient going over treatment options and practical exercises and this is backed up by an ‘Eczema School’. This is an extra evening event to further educate patients .
That sounds amazing!
It does and in an ideal world, it would be something that every eczema patient would be able to access. However, we can all recognize that this is something which is not present in all, if any, areas of this country.
That is quite depressing news…
However, on a positive note, it is something which we could all aspire to.
Dr Sandy Flann, Consultant Dermatologist