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How primary care nurses can help eczema sufferers “ditch the itch”

Margaret Cox
Chief Executive Officer
The National Eczema Society

Julie Van Onselen
Independent Dermatology Nurse
The National Ezema Society

Eczema is a very common skin condition, which affects people of all ages and is frequently very distressing. Itch is the one symptom that rarely resolves in both the acute and chronic stage. Itching caused by eczema can be incessant, disturbing daily activities and sleep by constant scratching, in response to the itch. The first stage in the development of atopic and other types of eczema is skin barrier breakdown, caused by inflammation and dry skin, which results in itch. The itching leads to scratching, which releases more inflammatory mediators and leads to the development of eczema and more dry skin. The result is the development of the vicious "scratch-itch cycle", which can be very difficult to break and control.

"Ditch the Itch"
The National Eczema Society (NES) is a UK charity, and every year National Eczema Society Week heralds its flagship campaign, which aims to raise awareness of eczema, the work of the NES and to raise vital funds to enable this work to continue.

National Eczema Society Week is being held from 18-25 September 2010 and, this year, the NES wants to help people take back control of their skin, and their lives, by equipping them with comprehensive information on eczema in a bid to "ditch the itch".

The role of primary care nurses
Primary care nurses have enormous potential to provide eczema care and help to "ditch the itch" in their everyday practice. Atopic eczema usually develops for the first time between three to six months of age, and health visitors are ideally placed to diagnose the condition during skin examinations; the earlier atopic eczema is recognized and treated the better.

Nurse practitioners and practice nurses are experts at providing chronic disease management and support to patients with long-term conditions, such as asthma, diabetes and hypertension. Their skills should be harnessed and adapted to providing eczema care. Other community nurses, including district and school nurses, will also care for school children and older people with eczema on a daily basis. Primary care nurses have great potential to embrace eczema care and provide much-needed support and practical advice for these patients. Nurses are key to providing understanding and information in all aspects of eczema care.

People with eczema need prompt diagnosis for all types of eczema. Eczema and dermatitis are often terms used synonymously. Eczema generally refers to an endogenous cause (genetic, immunological and triggered by environmental factors), such as atopic eczema, seborrhoeic eczema, discoid eczema, gravitational eczema and pomphoylx. Dermatitis generally refers to an exogenous cause (irritant or allergen), such as irritant dermatitis, contact dermatitis and photosensitive dermatitis.

Once eczema is diagnosed, patients need to be offered a range of treatment options, together with support and information from healthcare professionals and the National Eczema Society.
Primary care nurses are ideally placed to help people with eczema "ditch the itch"; however, healthcare education and training in dermatology is sadly lacking. The National Eczema Society has two principal aims: first, to provide people with independent and practical advice about treating and managing eczema; and second, to raise awareness of the needs of those with eczema with healthcare professionals, teachers and the government.

The National Eczema Society
The National Eczema Society has a wealth of information resources for people with eczema and their families. These include factsheets on the types of eczema and many different treatment options; information booklets give comprehensive information on the types and causes of eczema, further treatments for moderate-to-severe eczema, contact dermatitis, psychological aspects, teenagers and eczema and dealing with itching and scratching.

The new-look Living with Eczema booklet, a guide for adults, looks at what causes eczema, the various treatments - conventional, complementary and alternative - how to reduce or control the itch and includes a range of practical tips. Factsheets and booklets can be accessed from the NES web site (see Resources at the end of this article).

People with eczema may also contact the NES helpline (0800 089 1122), which operates Monday to Friday from 8 am-8 pm and is the first point of contact for anyone affected by eczema. It provides support and guidance on eczema management and treatment. Membership benefits include Exchange, the National Eczema Society's quarterly magazine, which is produced to keep members up-to-date with the management and treatment of eczema, and to provide a forum for an exchange of news, ideas and information.

Support for healthcare professionals
Patient information is always best supported by support and advice from healthcare professionals, especially for those who are newly diagnosed or coping with a long-term condition.
The National Eczema Society recognizes that healthcare professionals, particularly primary care nurses, need support and education to help their patients with eczema. The National Eczema Society has a dedicated healthcare professional website offering free access to a wide range of educational resources, research news and downloadable PDFs of factsheets and information booklets. There are also useful links to other organisations and resources.

Registration for this web-based resource is free - simply click on the button marked "Healthcare professionals area" or visit www.healthcare.eczema.org. There is also a dedicated telephone and email helpline for healthcare professionals (see Resources).

Education and training
The National Eczema Society also holds professional study days around the UK, dermatology specialist and patients provide the training for a comprehensive one-day course is equipping healthcare professionals with knowledge and practical skills to start to provide eczema care.

This year, study days are in Blackburn (23 September 2010) and London (13 October 2010), and future days in 2011 include: Southampton (March 2011), Manchester (June 2011), Watford (September 2011) and Middlesborough (November 2011). For further information on any study days, please contact the North West office on 01925 766877 or email us (office.eczema@virgin.net).

By enabling primary care nurses, health visitors, GPs and pharmacists to benefit from the National Eczema Society's extensive knowledge and experience, a greater number of health care professionals can be informed and advised to support people with eczema and help to "ditch the itch".

Resources
National Eczema Society
W: www.eczema.org
Healthcare professional helpine: 0207 561 8230
Healthcare professional email helpline:
professional@eczema.org