Since its debut in April of 2007, the Eczema Center at Rady Children's Hospital in San Diego has received hundreds of e-mails, phone calls, and visits from families in western states and some from the East Coast, many desperate to find relief for their children's eczema.
The bustle of activity illustrates the rising prevalence of eczema, which has more than doubled among American children since 1960, from a prevalence of 7% to a range of 15%–20%. “There is clearly a rising prevalence of atopic dermatitis in the United States and throughout the world, and it seems to parallel other allergic conditions which include asthma, allergic rhinitis, and food allergy,” the center's director, Dr. Lawrence F. Eichenfield, said in an interview. “This creates a whole set of questions regarding why and how can it be mediated. It also raises the question: Are these conditions related? We know that life-threatening food allergies are much more common than they used to be, and we know that food allergies are much more common in atopic dermatitis patients. But how important are food allergies in atopic dermatitis? That's a different question.”
The three key components to the Eczema Center include clinical, translational, and basic science research; comprehensive, individualized patient care; and an intensive educational intervention for patients and their families, including “atopic dermatitis school” led by a nurse with expertise in the disease, and detailed eczema management handouts which can be downloaded from the center's Web site (www.eczemacenter.org
The education component is crucial, Dr. Eichenfield said, because studies in the medical literature have demonstrated that intensive education is more effective in impacting eczema than is traditional education. A study in Germany found that children whose parents received 6 weeks of intensive education in the management of atopic dermatitis fared better at 1 year follow-up compared with those who did not (BMJ 2006;332:933–8).
To illustrate the success of the Eczema Center model, Dr. Eichenfield described the recent case of a 2-year-old child who had severe inflammatory eczema with a secondary bacterial infection that involved 60%–70% of body surface area, recalled Dr. Eichenfield, chief of pediatric and adolescent dermatology at Rady Children's Hospital.
Dr. Eichenfield prescribed aggressive topical corticosteroid therapy with wet wraps and a standard course of antibiotics. The family members attended atopic dermatitis school in which they learned to not fear using an appropriate quantity of mid-strength topical corticosteroid. In 2–3 weeks, the child was 90%–95% better and “was easily transitioned to a maintenance regimen of only intermittent prescriptive medicines with excellent disease control over the next 4 months,” he said. “The intervention wasn't different than what we did before the Eczema Center was established, but having the dedicated nurse to explain how to do the wet wrap therapy, and providing the opportunity for the parents to explore their questions and concerns about safety with other families in the atopic dermatitis school, made them feel comfortable taking on a regimen that was very effective in treating the disease with a minimum of stronger medicine.”
The mission of the medical center also includes efforts to improve the education of health professionals about eczema. Dr. Eichenfield and his associates recently received a Program for Innovative Continuing Medical Education in Dermatology grant from the American Academy of Dermatology to develop new ways to educate providers about the disease using podcasts and other Web-based material. And the center will cosponsor the annual meeting of the National Eczema Association in San Diego July 24–27.
The center, which moved into dedicated office space in April of 2008, operates in conjunction with the pediatric and adolescent dermatology department at Rady and the University of California, San Diego; the dermatology research unit at Rady; the department of pediatrics and the division of dermatology in the department of medicine at the university; and Children's Specialists of San Diego, a group of more than 150 specialists in child care.
The rising prevalence of atopic dermatitis worldwide seems to parallel other allergic conditions. DR. EICHENFIELD