Are You Getting the Most Out of Your Atopic Dermatitis Treatment?
There have been many studies conducted on the effectiveness of treatments for Atopic Dermatitis. Eczema is one of the most common dermatologic conditions affecting up to 25% of children and 3% of adults in the United States. But are we using our eczema treatments correctly; and are variances in our applications/techniques affecting outcomes?
The Center for Dermatology Research in Winston-Salem, North Carolina recently published an article reviewing the latest research on this delicate subject. Generally speaking, when used correctly, the various topical treatments (corticosteroid creams, ointments, lotions, etc.) are quite effective at controlling atopic dermatitis. However, the studies are demonstrating that we often overestimate how often (and how thoroughly) we apply these treatments, and that may be adversely affecting the treatment’s success rate.
To test how closely patients were following their prescribed eczema treatment plans, these studies often featured electronic monitoring caps on medications that automatically recorded the date and time the cap was removed. The results were fascinating, indicating that we are generally not the most accurate historians of our own medication use. The study participants typically self-reported themselves as nearly perfect at 100% adherence (successfully applying the eczema topical treatments as prescribed); however the electronic data told a different story, sometimes reporting as low as 32%. In your doctor’s office, overestimating how effectively you apply your prescription could be misinterpreted as a poor response to the treatment, and may encourage the use of stronger medications (with higher risks and higher price tags) than is actually medically necessary for your eczema.
So what’s actually going on, and how can we improve this situation?
Based on self-reporting data by atopic dermatitis sufferers, this drop-off in following physician’s instructions is certainly not intentional. The research generally showed higher rates of adherence in studies with shorter durations, with a slow decline over longer time periods. As the disease primarily affects children and teenagers, communication complications between pediatric sufferers and caregivers can pose special challenges in administering medications at specified intervals. Convincing a distracted child to interrupt playtime to get slathered in greasy ointments is a challenge parents and caregivers of children with atopic dermatitis know all too well. Follow that with the delicate social implications and desire to “fit in” felt by many teenage sufferers, coupled with the annoyance of messiness and straightforward forgetfulness, and the disconnect between intentions and reality becomes more relatable.
The Center’s review suggests that educational tools, such as written action plans like those pioneered within the asthma community, could have similar success rates within our dermatologic circles. More clarity in application instructions for patients and caregivers may also prove helpful. One study even used a fluorescent cream to help patients clearly see which areas they’ve been missing in their regular application, resulting in more thorough technique and higher rates of eczema treatment effectiveness. However these treatments are still quite often complex, inconvenient, and understandably messy; all reinforcing the need to involve the patient and caregiver in the treatment planning process to help address common fears and find a medication vehicle that will best fit within their desired lifestyle.
If you’re going to have to adhere to an atopic dermatitis treatment plan, you might as well get the most out of it by applying medications exactly as prescribed. If you’re unsure of your technique, or have concerns regarding the effectiveness of your current protocol, be sure to speak to your primary care provider.