Explaining eczema

Question 1

What are the steps in explaining eczema to a patient?

Answer 1

1. Info sharing:
   - Brief history
   - Understanding
   - ICE
2. Explaining:
   - Normal anatomy
   - What the disease is
   - Cause
   - Problems/complications
   - Management

Question 2

How would you start off a consultation with a patient for an ‘Explaining eczema’ station?

Answer 2

• Wash hands, intro etc
• Ask patient what has brought them in today
• What symptoms do they have?
• Are there any risk factors to be identified? (lifestyle, family history, drugs etc)

Question 3

What questions might you ask patients to check their understanding of eczema?

Answer 3

• “What do you think is causing your symptoms?”
• “What do you know about eczema?”
• “What has been explained to you about eczema so far?”

Question 4

What would you say in regards to normal anatomy in relation to eczema?

Answer 4

• The normal function of the skin is to act as a barrier
• Imagine the skin to be a layer of bricks stacked on top of each other
• In normal skin, the mortar between the bricks prevents irritants from getting in and prevents water from getting out, to stop the skin from drying out
• In eczema, bricks become dry and cracked, and mortar between the bricks can be lost
• This means that moisture from the skin can escape, causing it to be dry and itchy and increases the exposure to irritants
• Patches of skin most commonly affected include skin creases - inside of the elbows, wrists, backs of knees and the neck

Question 5

How would you explain the incidence of eczema?

Answer 5

• Eczema is a condition that mostly affects children, who may grow out of it, but it can still affect adults

Question 6

How would you explain the cause of eczema?

Answer 6

• Eczema tends to come and go in what we call flares
• The exact cause of eczema isn’t known
• It can run in families, particularly families with a history of conditions such as hayfever and asthma
• Condition is thought to be a complex immune reaction in the skin

Question 7

What complications should patients be made aware of in regards to eczema?

Answer 7

• Sudden worsening of the eczema symptoms (flares)
• Thickening of the skin affected by eczema due to repeated scratching
• Infection of the skin due to loss of protective barrier - can be bacterial or viral

Question 8

How would you explain eczema herpeticum/infected eczema to a patient?

Answer 8

• One of the serious complications of eczema is an infection of the skin
• The signs to look out for are if your skin starts to ooze, crust, you see clusters of blisters or if you have any of these symptoms with a fever
• If at any point you feel like your eczema is infected or is getting worse quickly you should see your doctor the same day and attend A&E if that is not possible

Question 9

How would you explain management of eczema to a patient?

Answer 9

“Eczema can really affect people’s confidence, particularly when it is visible, and it can also affect sleep if it becomes severe, so we know that it’s important to get the symptoms under control.”

“The mainstay of management for eczema is what we call emollient therapy. Emollients work by filling the cracks between the dry bricks, which stops irritants getting in and prevents water from escaping, which helps to moisturise the skin. This can also reduce the number of flare-ups of eczema. There are lots of different types of emollients such as creams, ointments, and gels, so we can pick ones that are most effective and work best for you. This can sometimes be a case of trial and error at the beginning. I can give you some samples of the different types of emollients, and ask a specialist nurse to speak to you about them today if you would like?”

“During a flare, we suggest that you use a topical steroid cream. Steroids work by reducing inflammation, and we know that the best way to do this in eczema is to rub it directly onto the inflamed skin. We recommend that you continue to use this for 48 hours after your skin improves, to help prevent it flaring up again, but we don’t suggest continuing to use it after that. Only mild steroids can be used on the face as stronger ones can cause thinning of the skin and other serious side effects. You should always wash your hands after applying steroid creams.”

“In most people, the treatments we have discussed will control your eczema extremely well. However, we do have other options for treatment if these are not successful and we can discuss those if it becomes appropriate.”

Question 10

How would you close an ‘Explaining eczema’ consultation?

Answer 10

• Summarise the key points:
  “In summary, eczema is a very common skin condition which often gets better with age. We have lots of treatment options available to manage your eczema, and we usually start with emollient therapy and add in other things if they are needed. If your eczema gets worse quickly or you have any concerns about it being infected, you should see a doctor the same day. You are going to meet the specialist nurse today to talk about the emollients which will suit you best, and then we can meet again in a few weeks to see how things are going.”
• Questions/Concerns
• Arrange follow-up
• Offer patient info leaflets
• Thank patient, wash hands etc