Peter Lio, MD, talks about the difficulties and strategies used when treating patients with this common skin disorder.
October is National Eczema Awareness Month. Approximately 16.5 million adults in the US have eczema; 6.6 million say their symptoms cause skin to be itchy, inflamed, and can produce changes to skin color and blisters.1 This year, the National Eczema Association’s awareness campaign is focusing on the diversity of the condition and the experiences of those living with eczema. There are seven different types of eczema, in varying degrees of severity, and it is possible to have several types at the same time.
Dermatology Times© spoke to Peter Lio, MD, clinical professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois to discuss treatment options for eczema and what patients can do to reduce symptoms.
Lio: This is such an exciting time for all our patients who are affected by eczema because it really brings awareness to a disease state that, honestly, I think still suffers from being dismissed. Patients are being told that it’s just a rash, or children are being told they will grow out of it, but the condition brings with it a tremendous amount of suffering.
With National Eczema Awareness Month, we really try to bring some more light onto this topic that affects not only patients who really must deal with it directly, but their families and society at large. As a dermatologist who treats eczema patients, I can say it is a hard condition to treat. You must go beyond what you normally do for a patient who is in a much better place. We are incredibly lucky that we now have a lot of new treatment options. And I will tell you, I have been focused on atopic dermatitis for more than a decade.
In the very beginning of my career, we really did not have much at all to offer; we used a lot of things that had been used for 50 years, like topical steroids, moisturizers, and in very severe cases, we can use more powerful systemic, immunosuppressant, or anti-inflammatory medicines; things like cyclosporine or methotrexate. We also use phototherapy healing with the power of light; we have a specialized light booth that allows us to use narrowband ultraviolet B for many of our patients. All those things have been helpful, but they have limitations. And many of my patients have hit a wall where they are concerned about using too many topical steroids. In the past five or six years, we have had a huge explosion of new treatments; like biologic agents, which block inflammation and itch without damaging the rest of the immune system. We have a whole bunch of new topical therapies. These new topicals that are non-steroidal have really opened the door to new pathways and healing.
We also finally have an incredible array of moisturizer technology. This may be one of the smaller unsung heroes, and they do not have the FDA (Food and Drug Administration) approval or the big budgets necessarily, but they are wonderful products that are available. I think we have seen a refinement in this, and we also have new understanding about the connection of diet in skin, overall health, and skin and the connection between allergies that often come along with eczema. There is a lot of new understanding, but we have a way to go. The microbiome is now finally getting in the spotlight. We also now understand there is a huge amount we can do here with the microbiome, both on the skin and in the gut. The nerve endings play a role; the peripheral nerve endings in the skin and we know there is a huge and key component of stress that can drive this disease. And there can be environmental, psychological, and physical factors.
We say the foundation of eczema therapy is good education about what to expect and what is going on to the best of our knowledge. Patients need to moisturize their skin and use gentle skincare. There are also triggers that patients need to avoid. Those triggers can be certain fabrics, like wool, or sweaty skin after a workout. If that is not enough, we can do something called proactive or maintenance therapy. That happens when a patient isn’t having a flare-up, but doctors medicate them anyway with something safe and gentle, like a non-steroidal agent. They can put it on a few times a week. For patients who want to take back their life, it can be a game changer.
Transcript edited for clarity
1. What is Eczema? National Eczema Association. Accessed October 5, 2022.https://nationaleczema.org