VANCOUVER, B.C. — The battle against atopic dermatitis and eczema is often won or lost in the home, and educating parents by giving them simple and practical instructions can enhance the daily management of the diseases in children, Alfons Krol, M.D., said at the annual meeting of the Pacific Dermatologic Association.
The message that meaningful parental education is pivotal to success, and that without it, no other therapy is bound to be successful, is highlighted in a provocative study from the United Kingdom, said Dr. Krol, professor and director of pediatric dermatology at Oregon Health and Science University, Portland.
In the study from Sheffield (England) Children's Hospital, a specialist dermatology nurse spent at least 40 minutes demonstrating how to apply topical therapy and offering general eczema education to the families of 51 children with poorly controlled atopic dermatitis.
Lessons were reinforced by the nurse at subsequent visits (Br. J. Dermatol. 2003;149:582–9).
Within 1 year, eczema severity had declined 89%, attributable to a remarkable 800% increase in the use of emollients. There was no overall increase in the use or potency of topical steroids.
Dr. Krol suggests giving parents tangible, concrete advice.
For example, Dr. Krol draws on a study from Wales in prescribing topical medications according to fingertip units. The medications can be easily squeezed out onto a parent's pointer finger, to ensure they are applying a proper amount (Br. J. Dermatol. 1998;138:293–6).
At another recent meeting, Alfred Lane, M.D., cited the same Sheffield Children's Hospital study and explained how its principles can be applied to emollients.
He instructs families to use petroleum jelly according to the size of the jars. Parents of a 4- or 5-year-old should be using a 14-ounce tub every other week, he said.
“I try to talk [teenaged patients] into using a pound a week,” said Dr. Lane, professor of dermatology and pediatrics and chairman of dermatology at Stanford (Calif.) University.
At each visit, he simply asks patients or parents how many jars they've used, Dr. Lane said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.
Other educational messages are vital to convey as well. These include:
▸ Atopic dermatitis is not a food allergy. Many children with eczema have IgE antibodies to molds, pollens, and grasses, and they may have food allergies as well; parents should be clear about the fact that their children's eczema is not caused by what they eat.
Dr. Lane described an infant who developed zinc deficiency and severe protein malnutrition when a foster mother accepted a naturopath's advice to limit the child's diet to goat's milk and rice milk in the belief that everything else was worsening the child's atopic dermatitis.
He emphasized that extreme diets do not improve eczema and may pose serious risks to children.
▸ Topical steroids are not what's worrying Congress and major league baseball. The word steroid brings to mind oversized muscles, “'roid rage,” and testicular shrinkage. Physicians should not assume that parents understand that there is a difference between the substances that are banned in competitive sports and the medicines prescribed for atopic dermatitis.
▸ Emollients don't have to be fancy to work. “There's certainly nothing cheaper and nothing as nonsensitizing as petrolatum,” Dr. Krol said.
He advises parents to apply it within 1 minute of bathing, all over a child's body before swimming, and over the perioral area before and after feeding a baby who has atopic dermatitis.
▸ Bathing is good. Sponging is bad. A 15- to 20-minute, not-too-hot daily bath followed by a coating of petroleum jelly is beneficial for atopic dermatitis.
“Sponging is the worst thing for a child's skin,” Dr. Krol explained.
“It chaps it, encourages microfissures, and worsens eczema,” he said.