Importance of Patient Education
We learned from our last blog posting that eczema is a chronic disease. Unfortunately there is no magic pill or treatment for chronic diseases, and there is no cure. Patients with any type of chronic disease learn about lifetime management of the symptoms associated with their disease. Therefore, chronic diseases need long lasting management plans tailored for each individual patient for the disease state that they are in.
We are fortunate that novel research in the area of atopic dermatitis has led to the discovery of many new management approaches, drugs and regimens. However, as treatment options and regimens become more complex, patient education becomes even more important. Proper patient education is paramount to ensure compliance. However, as the modes of how we deliver healthcare to our patients continues to change, office visits have become very brief, barely allowing a physician to fully explain the cause and management plan of a chronic disease such as eczema. Handouts and written instructions can help serve as reminders of the discussed management plan, but the sheer volume of information or the techniques or regimens can be confusing! At times, patients might not feel comfortable complying with recommendations but not have had the chance to explore the reasons for discomfort further. Especially for eczema, patients really benefit from more education with explanation and demonstration of techniques for treating eczema. Practically, this can be difficult when the provider has a long list of patients to see. It points to the need for a team of not only physicians and nurses, but also educators (whether these are the health care providers or other health care professionals).
Wet wraps for eczema is an example of a clinically proven and effective intervention, which is underutilized. When used in conjunction with topical steroids, wet wraps can rapidly control the symptoms and the flares of patients with moderate to severe eczema. Pediatric dermatologists have known this for years and now there is published evidence to support the efficacy of wet wraps for pediatric eczema. A recent study published from Mayo Clinic clearly demonstrated the effectiveness of wet wraps. In this study they reviewed the cases of 218 patients with atopic dermatitis (age <18 years) with a mean age of about 6 years, who required hospitalization for widespread eczema flare. Intensive treatment program was started for all patients with topical corticosteroids (triamcinolone and hydrocortisone) and wet wraps. For each hospitalized patient, on average wet dressings were applied over topical corticosteroids and daily moisturizer about 5-8 times per 24 hours for about 2 days. The wet wraps were removed every 3 hours for 30-45 minutes to allow the patient to walk around. In some patients, with suspected superinfection, antibiotics were also given. Major improvements were seen with 1-2 days. Majority of patients had over 75% improvement at time of discharge (1). This study clearly demonstrates the effectiveness of intense topical treatments with topical steroids and wet wraps. This is a very effective, safe and well tolerated technique that certainly needs to be used more often by patients. Interestingly, the authors of this paper did mention that the parents of the hospitalized kids with eczema, time and time again mentioned that they had been to multiple medical centers, but they had never been instructed about intensive topical treatments. This made me wonder why. Why do we underutilize such an effective technique? Of course there are number of reasons which include the labor intensive and time consuming nature of this technique, the skepticism that parents might have about it and the lack of cooperation from kids but a large part of it may be lack of education.
For those who read this blog, we would really appreciate your response on how we as doctors can help educate patients better in doing recommended treatments such as wet wraps. We would like to know what are the barriers preventing institution of wet wraps. Please comment if educational handouts, video demonstrations or training sessions would be helpful.
1. Wet dressing therapy in conjunction with topical corticosteroids is effective for rapid control of severe pediatric atopic dermatitis: experience with 218 patients over 30 years at Mayo Clinic. Dabade TS, Davis DM, Wetter DA, Hand JL, McEvoy MT, Pittelkow MR, el-Azhary RA, Davis MD. J Am Acad Dermatol. 2012 Jul;67(1):100-6. Epub 2011 Oct 5.