The agony of eczema

San Diego - Eczema's effects on patients and those who love them was the topic of a lunchtime symposium at the Dermatology Nurses Association (DNA) meeting here. "Atopic Dermatitis: Impact on Family and Quality of Life" introduced a novel assessment tool designed to enhance physician-patient communication, provide more precise staging based on quality of life and physical symptoms and enable physicians to more accurately evaluate treatment efficacy.

The "Eczema Assessment" screening tool was developed by the Life Improvement for Eczema (LIFE) Committee, a project of the National Eczema Association, which is dedicated to education and advocacy for patients with eczema. The LIFE Committee's research revealed that patients often minimize symptoms' severity or impact on psychological or emotional health.

'Entryway to psyche'

It also asks patients or their parents to note any negative effect eczema has had on work, self-esteem and social relationships, as well as its overall impact on personal and family life.

"The assessment tool is an entryway into the psyche of the patient with eczema," says William Abramovits, M.D, professor of dermatology at Baylor University Medical School during an interview with Dermatology Times after the symposium. "We designed it to help us go beyond the findings of a physical exam."

Often dermatologists limit their interaction with eczema patients to clinical exams and history of physical symptoms when more is needed. Physicians may only discuss physical signs and symptoms and not delve into the disease's psychosocial implications because of time pressures.

"Or the physician may feel it is intrusive to ask personal questions," Dr. Abramovits says.

Larger implications

However, eczema can have serious implications for patients and their families - including exhaustion of the patient from nighttime symptoms, poor work or school performance and financial issues for families of patients with atopic dermatitis.

"Parents with children with eczema, for instance, may lose time from work because they must take off to care for their children. Their sleep may also be disrupted if they have to get up several times during the night to apply soothing creams for their child," Dr. Abramovits says.

Atopic dermatitis (AD), the most common form of eczema and the most common inflammatory skin disease in children, affects 17 percent of children in the United States. Ninety percent of all cases appear in the first five years of life, which is a critical period of a child's psychosocial development.

"Eczema creates a lot of anxiety, some frustration and a constant search for relief," notes Susan Tofte, M.S., R.N., F.N.P-C, who spoke during the lunchtime symposium. "Children wonder why their bodies feel so itchy and sore, and some don't want to go out in public. This disease affects the quality of life of the entire family."

Recalling a child with eczema whose socks stuck to his feet, Ms. Tofte described Alex, an 8-month-old boy with generalized dermatitis. Alex slept in his parent's bed at night because of his symptoms and awoke often during the night. His weight gain was poor, because his anxious, guilt-ridden parents had restricted his diet in an effort to pinpoint the source of his symptoms.

The lifelong toll of eczema can also be seen in the story of Claire, a 5-year-old twin who developed AD when she was 10 months old. She had always been smaller than her twin and was never able to "catch up" in either height or weight. Her twin sister and older brother had "perfect skin" and Claire suffered emotionally from the comparisons made between her and her siblings.

Another patient, Eric, was diagnosed with AD in infancy. With asthma, and small for his age, he rarely dated as a teenager. He told Ms. Tofte that he had been unable to find a girlfriend until age 24, when he finally dated a woman who understood his condition because her mother also had AD.