Communication Skills: Explaining Eczema

Eczema is a common skin condition that patients regularly present to their general practitioner about, and it is therefore a common topic for OSCE 'explaining stations'. It is important to be able to provide information about the disease and explain the main management options to patients.

• Eczema is a skin condition characterised by inflammation, itching and redness of the skin, occasionally accompanied by localised infection if the skin is damaged
• Symptoms can often get worse during 'flares', and then symptoms can subsequently resolve
• There are many triggers to the condition. Generally, there is a hypersensitivity of the skin to contact with precipitants. Triggers can include:
  • Dust mite
  • Chemical products, including deodorant, shower gel/soap, clothes washing powder
  • Stress
  • Diet - e.g. cows milk allergy
• It is thought to have a genetic element, and is seen to run in families
• Usually this condition starts in childhood, and in 90% children, is gone by adulthood

• There are many different methods of managing eczema
• Non-pharmacological:
  • Avoidance of allergens known to aggravate eczema
  • Change of diet if this aggravates eczema e.g.: nuts, soya, wheat
  • Discussing with the family about how best to minimise the contact with any family pets
  • Avoid soaps and bubble baths, which dry out the skin
  • Use of cotton rather than wool or synthetic fabrics to decrease aggravation of the skin
  • Keep nails short to avoid damage to the skin from excessive itching
• Pharmacological:
  • Application of emollients
    • These are simple creams which aim to keep the skin supple and moisturised and protect it from infection and water loss
    • These come in ointment, lotions, creams, moisturiser, shampoo and bath oil forms - these provide different durations of protection and multiple varieties can be used with the same patient to ensure good protection all day
    • They should be applied regularly and liberally throughout the day and before bed
    • Emollients are used during acute exacerbations and as preventative measures in between exacerbations
    • You cannot overdose on these
    • Wet wraps (moist bandages used to keep in cream and moisture) can be used with children overnight to protect the skin
  • Topical steroids with moisturisers
    • Should be used only for flares of eczema
    • 1-2 week course
    • E.g.: 1% hydrocortisone is usually sufficient
    • Side effects: rare if used for 2 weeks. Long term use or use on delicate areas of skin (e.g. face) can predispose to skin infections and can cause thinning of the skin
  • Oral antihistamines at night to reduce itching at night
  • Other treatments are available if the eczema cannot be controlled with the above measures, which you can offer to discuss at a later date
  • Emphasise that is important to arrange regular follow-up to ensure that the treatments are being used and titrate these as necessary

• Offer to provide links to local and national support groups to help with the condition. This can be essential if the patient is a child and the parents are struggling to manage the conditions (advice from other parents can be vital!)
• Ask if they have any further questions or if they would like to clarify anything
• Thank the patient or parents.

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