Skin SOS: Why Diagnosis, Treatment and Management of Dry Skin Conditions are holding us all back

As far back as 1998, according to the BMC Journal of Dermatology, treating dry skin conditions costs the NHS in excess of ￡100 million pounds. As we are now in 2021, it’s safe to say that this number has increased significantly. I understand that what I am about to express in the rest of this article may be seen as too simplistic a view, however speaking up is far more important in this instance.

I have come across many people in my professional life who suffer with several different types of dry skin conditions. Often, conversations I have during my consultations lead me to discover that several visits to the GP have already occurred, topical corticosteroids and several Diprobase and Doublebase bottles later (if you know, you know), there still doesn’t seem to be any lasting change or results.

This led me to wonder,

“If everyone was given more information and education by professionals, practitioners and clinicians would it relieve the burden on the NHS and ensure that the treatment of skin conditions is more efficient?”

I went on to explore things a bit further and look at how patients meet professionals and what’s going on. One thing that became very apparent is that situations actually start to go pear shaped for a lot of patients at the beginning of their journey for answers.

So this led me to ask:

What’s the problem with Diagnosis and Treatment of common dry skin conditions?

Where do I actually begin? My goal today is not to come for any ‘necks’ so to speak, but to take a more holistic approach to skin management. An important part of skin management is understanding the initial problem. I have come to understand that as professionals we don’t do a good job of educating those we help, treat or come into contact with. Hopefully, today that changes a bit. In my opinion and to be frank, I think we need to do better as professionals, practitioners and clinicians to help those who battle with skin conditions.

I decided to look a bit more closely at Eczema because it covers a multitude of blanket conditions.

What is Eczema?

Eczema is not a condition in itself, but describes a group of skin diseases that cause skin inflammation and irritation. That is a pretty mind-blowing piece of information to the majority of people (me included!)

From doing my research, it is commonly thought that there are 7 types of skin conditions that cause eczema but, I actually came across 11 which are:

1.    Atopic Dermatitis

2.    Allergic Contact Dermatitis

3.    Seborrheic Dermatitis

4.    Irritant Dermatitis

5.    Nummular Eczema

6.    Xerotic Eczema

7.    Lichen Simplex Chronicus

8.    Scabies

9.    Dyshidrotic Eczema

10. Statis Dermatitis

11. Fungal Infections

These skin conditions can of course be researched further for your information and to be fair, there may be more.

What causes eczema is a big question that often remains unanswered. In truth, results are often more important than answers, however, the two must be combined to achieve long lasting relief, reduction or elimination.

Many things can cause eczema, but it often requires investigation and some work.

Education is a great starting point for equipping those who are suffering with skin conditions. There are several reasons why asking questions are poignant to the diagnosis and treatment of eczema.

Firstly, managing dry skin and skin conditions all start on the basis of information turning into education. Understanding conditions gives patients autonomy and enables them to potentially make better decisions about their skin. People live in their skin 24/7, I think it’s only fair that they are given help to understand the ‘what’ and ‘why’. Asking questions is a way to get answers.

Secondly, according to the National Institute of Health and Care Excellence (NICE) Pathway for Treating Eczema, persons over the age of 12 should be treated on presenting with an issue!  

This makes no sense to me whatsoever! I’m sure there are reasons for this but I’m not confident that treating symptoms without understanding the causes is a winning long-term strategy. Please drop me a comment because this is a valid discussion for anyone involved, clinicians, patients, professionals, everybody.

Primary healthcare professionals in the UK use guidance pathways from NICE alongside their expertise to treat patients. I have had many complaints about patients feeling powerless. I've heard stories of these guidelines being relied on too heavily when treating patients, or better still, them not being used at all (that moment when your GP hops on to Google right in front of you!) and exploring Eczema and looking at the diagrams above specifically, I can see where the issues arise.

Are there any solutions?

Well, yes. There are always solutions.  One of the easiest ways to equip those who need answers is to offer questions! So, here are 10 questions that may help you get some answers on your next visit to any professional or clinician who is qualified to diagnose:

1. What type of eczema do I have?

2. What is the cause of my eczema?

3. Are there any lifestyle or environmental factors that can make my eczema worse?

4. What is the best way to manage the kind of eczema I have?

5. Do I require medication, if so why?

6. Why am I being prescribed this particular medication?

7. How does this medication work?

8. What results am I expecting to see from using this medication?

9. How long can I use this medication for?

10. Is it likely my eczema will return once I stop using this medication?

I hope you find some of these questions useful and it gives you some of your power back.

Getting off the constant merry-go-round of steroid creams, itch, emollients and having flareups can be very challenging. I realise that Eczema or any dry skin condition can be difficult to deal with. I believe there is still hope and that hope lies in a different approach to skin. The key, I believe, is to move away from only treating symptoms and move towards understanding causes and actually treating skin in all its anatomical and physiological glory!

Skin is an incredibly complex organ; its functions and behaviours are still yet to be completely understood. Let’s give it the respect it deserves.