Atopic Dermatitis (Eczema) Eczema (atopic dermatitis) is a common, recurring, non-infectious, inflammatory skin disease in which the skin becomes red, dry, itchy or scaly and may weep, bleed or crust overAustralia has one of the highest incidences of eczema world-wide 1It is estimated that more than a million Australians suffer from eczema 1,2,35% of adults aged 18 and over have eczema3 About 30% of adults with eczema suffer from facial eczema4Around 90 per cent of people with eczema develop symptoms by the age of 5 years5Approximately 50 per cent of adults complain of sensitive skin6The incidence of atopic dermatitis (eczema) and contact dermatitis has tripled in the last 50 years and has been linked to a range of environmental factors7
The skin barrierThe skin barrier is the outermost layer of skin which protects the body from the environment7In eczema-prone skin, there are less layers of skin cells resulting in a thinner skin barrier6The addition of irritants such as soap and detergents on eczema-prone skin breaks down the skin barrier, allowing the entry of irritants and allergens which triggers an eczema flare6Prolonged use of steroid creams damages the skin barrier and causes skin thinning and irreversible damage to the skin8
Genes and the environmentA person with both parents who have eczema has a 50% chance of developing the disease6A person with both parents who have an atopic condition such as eczema, asthma or hayfever, has an 80% chance of developing eczema9 Although eczema is mostly hereditary, around 30% of people affected by eczema do not have a family history of allergic diseases9 Soaps and detergents are a common irritant and can trigger flares of eczema7Soaps and detergents have been shown to reduce the skin barrier by 40%6Triggers of eczema can include stress, foods, preservatives, chemicals, pollens, dust mites, toiletries and weather conditions1A change of season can trigger an eczema 'flare up'. Research has shown more than half of people with eczema believe that their flares are worse in spring1
Elidel - a non-steroidal creamElidel belongs to a group of non-steroidal creams known as topical calcineurin inhibitors (TCIs) 10Elidel cream is the only TCI available in Australia for eczema10Elidel cream does not cause break down in the skin barrier5 or thinning of the skin11Elidel cream works on the skin and is specific to the T-cells which cause redness and itching in eczema very early on in the cycle12,13,14Intermittent use of non-steroidal creams at the first sign of flare keeps patients flare-free for significantly longer15
The cost and impact of eczema· People with eczema can spend up to $1,200 annually on treatments, depending on the severity of their eczema16· Eczema has a significant impact on quality of life and may affect daily routines1· On average, people with eczema spend 1 out of every 3 days in a flare17· During flares people avoid everyday activities, suffer from sleep disturbances and have to take time off school / work.17
1. Marks R et al. The prevalence of common skin conditions in Australian school student: 2. Atopic Dermatits. British Journal of Dermatology 1999; 140: 468-473
2. Foley P et al. The frequency of common skin Conditions in preschool-age children in Australia Arch Dermatol 2001; 137: 293-300
3. Plunkett A et al. The frequency of common non malignant skin condition in adults in central Victoria, Australia International Journal of Dermatology 1999,38,901-908
4. Bannister M, Freeman S. Adult-onset atopic dermatitis. Australasian Journal of Dermatology (2000) 41, 225-228.
5. Su J et al. Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997; 76: 159-162.
6. Cork et al. Predisposition to sensitive skin and atopic eczema. Community Practitioner 2005; 78, 12: 440-442.
7. Cork et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006; 118: 3-21.
8. Hoetzenecker W et al. Pimecrolimus leads to an apoptosis-induced depletion of T Cells but not Langerhans cells in patients with atopic dermatitis. J Allergy Clin Immunol 2005; 115 (6) 1276-83.9. Lieberman, P et al. Allergic Diseases, Diagnosis and Treatment 2nd Ed. Humana Press, New Jersey.
10. Elidel Product Information, Novartis Pharmaceuticals, 2006.
11. Therapeutic Guidelines Dermatology, Version 2, 2004.
12. Hultsch T et al. Dermatology 211, 2005: 174-187.
13. Grassberger M et al. A novel anti-inflammatory drug, SDZASM981, for the treatment of skin diseases in vitro pharmacology. Br J Dermatol 1999; 141(1): 264-73. III F 47 156.
14. Meingassner J et al. A novel anti-inflammatory drug, SDZ ASM 981, for the topical and oral treatment of skin diseases in vivo pharmacology. Br J Dermatol 1997; 137(1):568-76.
15. Meurer et al. Pimecroliums cream in the long-term management of atopic dermatitis in adults: a six-month study. Dermatology 2002; 205: 271-277
16. Kemp A. Cost of illness of atopic dermatitis in children. A societal perspective. Pharmacoeconomics 2003; 21 (2): 105-113.
17. Zuberbier T et al. Patient perspectives on the management of atopic dermatitis (ISOLATE). J Allergy and Clin Immunol 2006; 118: 226-32.