evolution of eczema treatment gives children the chance to be kids
5 minute read
an estimated 17 per cent of canadians are living with atopic dermatitis and the majority are kids.
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atopic dermatitis (ad)—commonly referred to as eczema—is difficult physically and emotionally. your skin is constantly inflamed and irritated, so you scratch until you bleed. your skin blisters, scabs and scars. the relentless itch impacts every aspect of your life, even causing you to toss and turn in your sleep.
now, imagine a child living with this skin disease.
the canadian dermatology association estimates 17 per cent of canadians are impacted by ad, the most common chronic skin disease, and the majority are children. people stigmatize individuals with ad, assuming their skin disease is contagious or that they are unclean. that stigma is tough for anyone, but it’s especially hard on vulnerable kids.
“parents often talk to us about how they feel guilt, frustration and helplessness when flare-ups occur. they also mention how much time is involved with daily management of ad from applying creams to wet wraps, bathing to monitoring lifestyle restrictions and having items available at school when they experience flare-ups away from home,” says dana gies, executive director of the canadian skin patient alliance. she also says there’s usually a long wait, often more than a year, to see a dermatologist. finding the right treatment takes time as well.
“not all treatment options are one-size-fits-all. patients often cycle through various treatment options until they find one that works for them and their lifestyle. some patients are more comfortable with applying topical creams and having the option of non-steroid creams is increasingly popular.”
new non-steroid topical creams on the market, like janus kinase (jak) inhibitors recently approved by health canada for pediatric patients, are a win for the patient community, offering more choice. this topical blocks immune system signals that cause inflammation, falling in line with the new canadian consensus guidelines for ad management with topical therapies. the guidelines note that treatment starts with disease education and lifestyle-based strategies, such as trigger avoidance, which can be stress and allergies. this, along with supportive measures like moisturizers, can help reduce signs and symptoms of ad.
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although topical corticosteroids are often used as first-line treatment, they should be limited to intermittent short-term use, according to the guidelines: “noncorticosteroid topical therapies (e.g., topical calcineurin inhibitors; topical phosphodiesterase-4 inhibitors; and topical janus kinase inhibitors) can be used for widespread involvement of ad according to approved use. once treatment goals are achieved, noncorticosteroid topical maintenance therapy should continue to prevent flares.”
as dr. alim devani, dermatologist at the skin health & wellness centre in calgary, explains, “there are not as many offerings because of their developing bodies.” steroid use has been linked to a range of serious health risks, including cardiovascular issues, liver damage, hormonal imbalances and increased susceptibility to infections.
devani has been active in research and clinical trials at the dermatology research institute since 2012, giving him early access to novel therapies for ad and other conditions, like psoriasis and hair loss.
he also understands the challenges youth go through from a personal perspective. he’s had psoriasis since he was 14, drawing him to pursue a career in skin health. “my early experience in medicine was seeing a dermatologist every three months, every six months, every year for almost a decade until my psoriasis was treated effectively.”
devani says corticosteroids work well as the primary treatment for those with mild ad disease and only a bit of their body surface covered because it’s effective in the short-term. but it’s not suitable for long-term use.
“with eczema being more of a long-term chronic condition, you can run into side effects of those topical corticosteroid treatments, including thinning of the skin, and you develop tolerance to it as well.”
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and with larger body surface areas in kids, providers and families worry about systemic absorption of corticosteroids and issues of dependency on the medication.
roughly 50 per cent of his patients have severe disease where they’ve already tried the traditional topicals. the worst symptom is constant itch, which leads to an inability to sleep at night.
“they don’t get that proper sleep, they’re constantly interrupted and they wake up and they’ve got blood on their sheets,” he says, adding the psychological impact is significant as well, “even down to your six-year-olds with early signs of anxiety, early signs of depression. and then as they get older, their impairment in daily activity starts to increase, their work productivity decreases. so you see that whole spectrum of this in patients, especially those with more severe disease.”
for kids, they start early on trying to hide their skin, not wearing short-sleeve shirts or shorts in the spring and summer, because those areas of the body are affected. they may not be as active or play sports because sweating can make their itch a lot worse.
devani emphasizes the need for a holistic approach to treatment, starting with basics like regular moisturization and avoiding potential triggers.
“if they have animals in the house and they seem to cause flares in the eczema, or if they have certain foods that trigger the eczema, then we try to avoid those. we use things like wet wraps, which are basic ways to hydrate the skin.”
families also need to understand the pathology of the disease, where environmental factors play a role along with genetic factors that may cause an impaired skin barrier that activates the immune system, causing this inflammatory response.
when simpler measures like moisturizing are not as effective, prescription treatments follow, aided by phototherapy. in some cases, more systemic options are needed, like injectables or oral medications.
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“we need to have good options available and we’re very fortunate that dermatology in the last decade has seen so many new options,” he says. his involvement in research has put him at the forefront.
“we’ve done all age groups from as young as the age of two all the way up to 55 years of age. and part of the studies are topicals, some of them are injectables, some of them are oral, and so we get that early-on experience and then when it does come on the market, fortunately, we have a lot of experience with it,” devani explains, adding he’s in a great position to help patients immediately because of deep expertise with the treatments that others may not have.
most important, he says, is that there are very effective medications to treat all types of eczema, whether it’s mild, moderate, or severe. and these treatments typically work very fast.
don’t suffer and hide your skin.
november is eczema awareness month and the eczema society of canada is helping light up monuments in blue across the country.
as gies says, “many people underestimate eczema’s seriousness, leading to stigma and lack of empathy. we need to continue to shed a light on this skin condition because it impacts people on many levels.”
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