Presenters: Dr George Varigos and Emma King
PDF Slides – Emma King & George Varigos
Dr George Varigos and Ms Emma King have worked together in the Dermatology Department at the Royal Children’s Hospital for the past 15 years. They have seen the numbers of cases presenting to the dermatology outpatient clinic and emergency department increase and have developed strategies in clinical management as well as the service model change to provide excellent care and cope with the demand.
Dr George Varigos will explore the up to date pathophysiology of atopic eczema and the latest treatments and management in regards to this.
Ms Emma King, Nurse Practitioner will discuss the increasing demand for the dermatology service and how the dermatology department have developed strategies to cope with this demand and include the community health care providers.
Presented on Wednesday 20th April 2011
12 comments for “Eczema in the community: new approaches to treatment”
Gerri D'Orival
What are the major errors made by health professionals and or parents in the the application of creams – cortisone and moisturisers
Emma King
Dear Gerri,
The main problems I find are;
1) Doctors tend to prescribe a mild steroid for the body and consequently the eczema does not improve.
2) Doctors do not give authority prescriptions for the body steroids and then parents believe that a 15 gram tube should last longer than it should and therefore do not apply enough to get the eczema under control
3) Parents apply the steroids sparingly and consequently the eczema does not get controlled
4) parents do not apply the moisturisers thick enough, only to the affected areas where as they should be applied to all areas of the face and body even if eczema is not present.
5) reducing heat factors in the environment is just as important as prescribing topical treatments and parents usually overheat their children
I hope this helps and thank you for your question
regards
emma
george
agree with Emma
some points to add
1)We see mostly not enough or not understanding the appropriate use of steroids as a result of steroid PHOBIA over the last 20 years and driven by health professional naturalists .
2)Not early enough in disease process to be active and consider it serious ( Like Asthma)
3)Not understanding use of pimecrolimus on face or folds when Hydrocortisone has failed
4)Often not enough moisturisers and use of Baths with salts and oils and more recently the use of Hypochloride ( Bleach)
5)Too much emolient resulting in blocked pores and flares
6)Not understanding the role of infection to and treat early with simple techniques like wet compresses and salts and bleach bathing
Michael Ee
Q to Emma King,
Is clinical photography used or considered an adjunct in the management of eczema specifically for follow-up in a department with various clinicians and staffs involved?
Emma King
Dear Michael,
We are looking into telehealth with dermatology more and more. This could easily be done with email however the hospital are working out privacy and protection. George and I have talked about this for sometime.
Some GPs and parents send us photos of patients now. This helps with diagnosis as well as the appropriate triaging.
Dermatology is perfect for telehealth and we just need to refine the process and protection/consent issues.
Thanks for your question
regards
emma
Michael Ee
All the best with telehealth setup hopefully in the near future. As you have indicated, dermatology is perfect for it.
Michael Ee
Q to Dr George Varigos
What percentage of children with eczema will require immunosuppressant or even immunomodulators? How long can they be used for safely for eczema?
george
We would see about 5 % in our selected group which is different form the general population seen in GP
As an rough figure please.
How long can be variable and we try and limit it to one year or less to give a patient and parents a break an skin to heal and be sure to look at objective measures of improvement SCORAD and sleep.
We have cases who have severe eczema and our immunologist with us have left on Immune suppression for 3 to 4 years and to help with school and quality of life if this is needed. I would count about 5 or 6 cases like this over the years. Careful monitoring is needed and we have discussed the drugs with our renal transplant doctors who use them for long periods.
This is the same as in Adults even longer times , as we wait for new treatments like Biologics more specific therapies.
Most can come off or try another therapy and i like to be objective and make sure nutrition , hormone D and bowel issues coeliac iron and immune function is checked in all these serious cases prior to immune therapy .
I do go back to the long term antibiotics and now Salts with Beach baths daily in some has changed their lives
Michael Ee
With further understanding of skin barrier and its properties in the pathogenesis of eczema, let’s hope there will be less need for immunosuppressants or immunomodulators in the future.
Emma King
Dear Cathy,
The most effective moisturise is one that the patient likes and uses. Ones obtained in pharmacies are of a better quality than the ones obtained in supermarkets. Also the more user friendly the better i.e. creams are better than creams as they do not stain and do not leave a greasy look.
My favourite moisturisers are; Avene Trixera, QV cream and Cetaphil cream. I do not use ointments alot now, and keep this for children with really dry skin; children that seem to find creams sting (although once under control the creams no longer sting usually!) or for babies faces as a barrier as well. Ointments also tend to cause heating especially on hot days. The ointments I prefer are; QV Kids Balm or Dermese.
Al;so moisturisers should be applied top to toe minimum bd
Hope this helps
regards
emma
a da silva
Enjoyed the presentation but would have liked an update on the treatment .
Thank you.
Dr Barb Uhlenbruch
Hi Emma,
can you advise about bleach baths instructions? I could not find it in the eczema fact sheet
thanks
Barb