Published on the 27 September 2017
Published on the 27 September 2017
So, how about we do some myth-busting? Sounds like fun to me.
Most of my clinical time is spent working my way through the myths and realities of eczema. It’s hard work, it can be repetitive, and often those I am educating challenge what I say, but logic and fact wins in the end. We all win, because we achieve great clinical outcomes.
Did you know, a parent of a young child with widespread eczema has been found to have the same degree of stress as a parent of a young child with Type 1 Diabetes?
Think about it: skin is your largest organ, it covers your entire body, you rely on it for many things, protection, thermoregulation, sensation, and it stops your other organs from spilling out too. We need it to be intact, flexible, comfortable and resilient.
These are based on my experience with thousands of consultations, number one being the most common. ‘Dr Google’ has a lot to answer for!
The most concerning advice or treatment from health professionals that my patients have experienced:
I’ll never forget the first two patients that started me thinking about eczema. Working in the emergency department you see so many types of presentations. It was in the ED that I saw Baby J.
Baby J was a six-week old boy. He was covered head to toe in a red, dry rash. Some areas were crusty and weeping. His arms, legs, face, scalp and entire torso were affected.
He had never slept more than 40 minutes in one stretch. Since birth! He had already been through three courses of antibiotics for the infection. That’s an awful lot to experience by six weeks! The parents were strung out, stressed, and exhausted.
Eczema was not my specialty at that stage, so I went and found the best Paediatrician I know, who was fortunately working at the time in the same building. We put a plan in place immediately (and there my education started). That night, he slept a four-hour stretch. Mum kept checking on him to make sure he was actually sleeping! She learned to sleep herself in the coming weeks. There were some setbacks, but overall, steady improvement, with no more antibiotics.
I had completed a lot of extra training and was extremely fortunate to have been supported and mentored by Paediatricians and Dermatologists for several years when I met Baby M in the early days of my Private Practice.
Baby M was a fourteen week old, with severe eczema from head to toe, and he was “failing to thrive”. He was booked in for insertion of a nasogastric tube to assist with feeding, the following week, to gain some weight. He was very small for his age; he had hardly gained any weight since birth.
His parents had heard about my clinic, and came along for some advice. I implemented a management plan immediately. I called his Paediatrician, asking for the nasogastric tube to be delayed a further week or two. I monitored him with weekly weigh-ins. He started to gain weight steadily as his eczema improved, with just a couple of short plateau periods. By 9 months of age, he was just below the 50th percentile. No nasogastric tube! His skin looked fantastic.
Yesterday alone, I saw four children under six months of age that were covered head to toe in eczema, one of whom was well below the 3rd percentiles.
Eczema is very common in dry climates, so being in Melbourne, my practice is incredibly busy.
Don’t under-estimate eczema; it can be a very serious problem. Myths and misconceptions in relation to eczema have a lot to answer for!
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Leanne Boase is a Nurse Practitioner with a background in critical care and paediatrics. She currently practices across three GP clinics in Melbourne. She has also built, owned, and operated her own GP practice and is now a director of the Prime Medical Property Group, developing and building properties in the health sector. Leanne also does business planning and is the author of "Medical Business Management", aimed at assisting health professionals to start their own businesses. Leanne is the current president and a fellow of the Australian College of Nurse Practitioners. She works as a casual academic. Her qualifications include a master of nursing (nurse practitioner) and a master of health science (education).