As part of Eczema Awareness Month, the National Eczema Association (NEA) is highlighting various facets of the condition, emphasizing that eczema is much more than just a visible skin problem. Throughout October, the NEA is focusing on different themes to raise awareness about the lived experience of eczema patients.
In an interview with Dermatology Times, Jessica Hui, MD, an allergy and immunology physician at National Jewish Health in Denver, Colorado, discussed the NEA’s theme that eczema is more than just what meets the eye. She emphasized how the disease extends beyond visible symptoms, affecting patients’ quality of life, mental health, and overall well-being.
The Overlooked Aspects of Eczema
Dr. Hui pointed out that many clinicians overlook key elements of eczema, particularly the mental and emotional toll it takes on patients. “Clinicians don’t always ask about quality of life or mental health,” she noted. “People with eczema often feel isolated or struggle with self-esteem. There’s a strong link between eczema and increased anxiety, depression, and stress—not just for patients, but for their family members and caregivers as well.”
Non-Visible Challenges of Eczema
Eczema is often characterized as an itchy, red rash, but Dr. Hui explained that it is a chronic inflammatory condition with significant non-visible challenges. “Even when the skin clears up, the itch mediators don’t disappear immediately. This can cause ongoing discomfort, disrupt sleep, and add a mental burden,” Hui said. She further noted that the daily skin care regimen required to manage eczema can also contribute to the disease burden.
Pruritus and Sleep Disruption
Itching, or pruritus, is a hallmark symptom of eczema and plays a significant role in the overall disease burden. “Eczema patients experience itch due to inflammatory mediators in the skin, which often leads to reflexive scratching,” Dr. Hui explained. “In some cases, the scratching becomes so severe that it causes bleeding, which then leads to pain and disrupted sleep. This cycle of itch and scratch worsens both sleep quality and the eczema itself.”
Managing the Psychological Effects
Dr. Hui emphasized that eczema management goes beyond physical treatment, and addressing the psychological aspects is critical. She advises patients to adhere to their skin care regimen while also exploring additional therapies such as breath work and behavioral therapy. “There are many different modalities of care available to help manage the psychological burden that comes with eczema, especially when the condition is not outwardly visible,” she said.
Long-Term Eczema Management
Effective long-term management of eczema, especially in severe cases, requires consistent follow-up with healthcare providers. “This is not a condition that will improve overnight. Regular follow-ups are essential to review the treatment plan, address any misunderstandings, and make adjustments if necessary,” Dr. Hui stressed. She added that minor tweaks in the timing or method of applying treatments can significantly improve the skin’s condition.
Understanding a patient’s lifestyle is also crucial. For example, Dr. Hui mentioned that if a patient enjoys swimming, but pool water exacerbates their eczema, it’s important to discuss strategies to minimize flares after swimming. “Recognizing hobbies, work environments, and individual preferences is key to tailoring eczema management effectively,” she said.
Emerging Treatments for Eczema
There are several emerging therapies showing promise in treating both the visible and non-visible symptoms of eczema. Biologic treatments, oral JAK inhibitors, and a wide array of topical therapies have expanded the treatment landscape, providing more options for patients. Dr. Hui highlighted ongoing research into anti-IL-31 therapies that specifically target itch and inflammation.
“It’s an exciting time in the field,” she said. “The variety of treatment options allows us to tailor therapy to each patient’s unique needs. Not one patient is the same, so having multiple options is beneficial.”
Shared Decision-Making in Treatment
Dr. Hui also emphasized the importance of shared decision-making between clinicians, patients, and caregivers. “Even if we believe a specific treatment is ideal, it’s important that the patient is on board. Understanding their goals, hesitations, and comfort level with different treatments is critical to successful management,” she said.
In conclusion, managing eczema involves more than treating its visible symptoms. By considering the non-visible aspects—such as emotional well-being, lifestyle, and mental health—clinicians can provide more comprehensive care for their patients. With advancements in treatment options, the future of eczema care looks promising.
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