Jessica Hui, MD: Non-Visible Considerations for Eczema Management

The National Eczema Association (NEA) is highlighting the lived experience of eczema with weekly themes throughout October as part of Eczema Awareness Month. Each week sheds light on different aspects of the disease.

Dermatology Times recently spoke with Jessica Hui, MD, an allergy and immunology physician in Denver, Colorado, at National Jewish Health, to discuss the NEA's theme: Eczema is more than the visuals. Hui explored the burden of disease, delving deeper into the broader impact of eczema, emphasizing how it affects patients far beyond the visible symptoms.

Transcript

Dermatology Times: What are the most overlooked aspects of eczema that clinicians should be aware of?

Hui: Clinicians don't always ask about quality of life, mental health, and people with eczema really may feel more isolated, or maybe they have self-esteem issues. We know there's greater anxiety, depression, and other mental health consequences, and individuals with eczema and even family members and caregivers have greater stress and even decreased quality of life.

Dermatology Times: What are some of the non-visible challenges patients with eczema face?

Hui: We often think of eczema as just an itchy, red rash, but what it really is is a chronic inflammatory skin condition, and there are inflammatory and itch mediators that can cause significant itch and pain, and so even after the skin has cleared up, the itch mediators don't go away immediately. We also know that itching can cause sleep disruption, and the mental toll and the time it takes to do your skin care regimen every morning, every evening, throughout the day, or taking your medications, that all really contributes to the disease burden.

Dermatology Times: Can you elaborate on the role of pruritus and sleep disruption in the overall disease burden of eczema?

Hui: Individuals with eczema certainly have pruritus. As I alluded to, there are certain mediators in the skin that cause itching. Then you can also have reflexive scratching that takes place. Some of my babies, even when they're anxious, or they start crying, or they feel like they need to soothe, they just scratch. They might, even, if they're being held, scratch the back of their caregiver in the moment. At night, there can be scratching that occurs to the point of bleeding, and then pain associated with it, and then overall poor sleep quality. All of this can really perpetuate this itch-scratch cycle. Then that leads to both worsened sleep and worsened eczema.

Dermatology Times: How do you counsel patients on managing the psychological effects of living with eczema, especially when their condition is not outwardly obvious?

Hui: Know your skin care regimen, and beyond that, there's breath work, behavioral therapy, and a lot of different modalities of care that can address this aspect.

Dermatology Times: What are the most effective strategies for long-term management of eczema’s burden of disease, particularly in severe cases?

Hui: I think close follow-up with your provider is important. If you've been dealing with this for quite some time, it's not like overnight, everything is going to change. It is really important to make that follow-up; you leave the doctor's office, have that follow-up appointment, because this really allows us to review your plan and then answer or clarify something you're confused about, and then see if what we've prescribed is actually working. There's a lot of different treatment options these days, and I really need to know how my patients are doing to see if we need to change anything.

Then also, they may have misheard or misunderstood some of the the skin care recommendations that I made, so small tweaks in how things are being applied or when they're being done, can really change the skin and turn it into being healthy again. Long term, there are a lot of comorbidities, and really understanding the full scope of the individual is important. Of course, we talked about mental health, self care, and then also: What is in your lifestyle? If someone loves to swim, but pool water is irritating for your skin, we really need to talk about that. What do we do after getting out of the pool to minimize your flares? Really understanding hobbies, your big scope of what you do at work and who you are, is very important.

Dermatology Times: What emerging treatments or therapies show promise in managing the full spectrum of eczema symptoms, both visible and non-visible?

Hui: We know that biologics have been very helpful for many people in really targeting inflammatory markers. Then we have now oral JAJ inhibitors and in severe cases, that's nice as an oral medication option. Then we have lots of topical therapies that have many different mechanisms of action. I think this has really broadened the landscape and is really exciting for us in terms of what's being studied. There is an anti IL-31 which targets itch, targets inflammation, that's being studied. It's a very exciting time in the field for sure. Not one patient is identical, and so having a lot of different medication options is really great for us.

I think ultimately, shared decision making is really important with patients and caregivers. Even if we think this medication is truly what's going to be best, they have to be on board, and really understanding their goals and where they might be hesitant in or where they might feel confident in, is really important. Just taking that time to listen and really make decisions together [is important].

[Transcript has been edited for clarity.]