Plea for eczema strategy to address ‘neglected disease’

Michelle Wisbey

6/09/2023 2:57:52 PM

Sufferers say they are lost in a ‘treatment maze’, left thousands of dollars out of pocket, sore, itchy, and still with no answers.

Boy undergoing wet wrapping therapy for eczema
Eczema sufferer Harry Fischer undergoing wet wrapping to treat his severe symptoms. (Image: supplied)

Pain, distress, soaring medical bills, and lifelong scars, that is the reality for many of Australia’s three million eczema sufferers.
For some, the financial burden is so great they are going without food to pay for treatment.
Despite the condition’s prevalence, patients say they have been left to fend for themselves within a health system ill-equipped to manage their symptoms.
They are also bearing the brunt of a nationwide shortage of specialists, with around 600 dermatologists meeting the needs of 26 million Australians.
On Wednesday, Eczema Support Australia released ‘The Burden of Eczema – Evidence for a National Strategy’, pleading with governments to urgently rollout meaningful support to patients.
The report is calling for 10 immediate changes, including standardised care, addressing ‘steroid phobia’, bolstering dermatology training for GPs, and establishing an eczema registry.
Dr Anneliese Willems, a member of RACGP Specific Interests Dermatology, provided input into the report said a national strategy is well overdue.
‘I’ve personally worked with patients who have suffered from severe eczema and the stories you hear are absolutely heartbreaking,’ she told newsGP.
‘One of the greatest challenges is seeing eczema as a uniform condition whereas really, there is such a broad spectrum of disease.
‘It’s especially important now given the newer therapies recently made available on the Pharmaceutical Benefits Scheme [PBS] which can offer significant improvement for some sufferers.’
Last year, upadacitinib (sold as Rinvoq) was added to the PBS, dropping the cost from up to $27,000 per year to $42.50.
Eczema costs the Australian economy about $4 billion each year, affecting one in every three children aged six and younger.
Adults with eczema are three times more likely to suffer depression than those without the condition, while more than 20% have considered suicide.
However, researchers say medical undergraduates in Australia receive little or no training in dermatology.
A 2016 survey of 18 medical schools found dermatology was part of the core training of 15 institutions, but a mean of just five lecture hours were provided over an entire degree.
In response, the report said professional development is desperately needed to improve GPs’ eczema health literacy to gain the knowledge, skills, and confidence to properly diagnose and treat patients.
Dr Willems said GPs provide the cornerstone of dermatology care in Australia and need to have a voice in creating reforms in the area.
‘With eczema, one of the greatest challenges is that to provide optimal care really takes a lot of time and longer consultations, and general practice is already chronically underfunded and under-resourced,’ she said. 
‘To optimise the care that Australian GPs can provide with eczema management, we really need streamlined referral pathways providing GPs with greater resources for patient education.
‘We have GPs seeing a large proportion of skin presentations but they’re not being given the education and resources that they need to optimally manage that.’
According to the report, three quarters of Australians with eczema said their family was impacted financially by the condition, with many having to use savings, borrow money, and spend less on food and other essentials to pay for eczema management.
Australasian College of Dermatologists President Dr Adriene Lee said moving forward, many issues identified in the report can be addressed with a coordinated national response.
‘Take for example widespread corticosteroid phobia, the common but misplaced fear of topical corticosteroids which often leads to the underuse of these valuable therapies, resulting in unnecessary disease flares,’ she said.
‘Until there is a coordinated effort to change these perceptions in general practice and pharmacy, Australians will experience avoidable and unnecessarily severe disease flares.’
Eczema Support Australia has written to Federal Health Minister Mark Butler and the Department of Health and Aged Care, pleading for the introduction of a National Eczema Strategy.
It has also launched an e-petition that will be presented to Parliament and closes on 6 October.
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Dr Suresh Gareth Khirwadkar   7/09/2023 6:09:06 AM

Always it’s ‘what drugs can we give’. Why not actually look at the root causes? I’ve helped countless patients resolve their eczema, some incredibly severe, by removing offending problems, often plants, from their diet.

But this breaks the current medical model that disease is just a lack of drugs.

A.Prof Christopher David Hogan   7/09/2023 10:01:01 PM

Another area suitable for expanding the scope of practice for GPs & no it’s not just drugs

Dr Nadine Elise Perlen   8/09/2023 8:58:55 AM

I agree with the above comment. I have a special interest in nutrition and gut health. I have treated many children and adults with eczema/dermatitis/ other skin inflammation by addressing the underlying immune triggers- usually dietary but maybe related to other environmental or stress factors. Smothering an inflammation, wherever it is in the body is not a healthy solution for skin or any other tissue inflammation if you don’t also address the underlying cause. Patients are right to be steroid avoidant if this is all that’s offered.

Dr Be   18/09/2023 9:49:09 PM

Why do we only have 600 dermatologists for 26 million australians?
why dont we allow more people get into dermatology training ?What's the problem?