Guest: Dr. Saxon Smith
Presenter: Patrick Reyes
Guest Bio: Clin A/Prof Saxon Smith graduated from the University of Otago, Dunedin in 2000, holds a Masters Degree in Health Law from The University of Sydney and is a graduate of the Australian Institute of Company Directors and a fellow of the Australasian College of Dermatologists.
Dr Smith is active in clinical research and is currently completing a doctorate of philosophy (PhD) through the University of Sydney exploring the Assessment of treatment confounders and interventions to reduce treatment adherence confounders in paediatric atopic dermatitis. His other key academic interest is exploring attitudes towards sun protection and preventative health in the setting of skin cancer. He has published widely in Australia and internationally on topics including: Health policy; Ethics; Medico-Legal issues; and dermatology. He presents regularly at national and international conferences.
Segment overview: In today’s Health Supplier Segment, Dr. Saxon Smith joins us here today to discuss the Australian-first Eczema education Storybook for kids entitled Elliot’s Meditotz Adventure. The book was written by a team of Ecezema experts, Dr. Smith included, supported by Eczema Association of Australasia and the result of a collaborative effort between MSD and children’s healthcare education specialists Medikidz. The superhero in the story book, Elliot is Dr Saxon’s 5-year-old son who is living with eczema. In this interview, Dr. Smith will also be talking about the prevalence of Eczema in Australia, current guidelines for managing it and the effects of topical corticosteroids.
Health Professional Radio – Raising Awareness about Eczema
Patrick Reyes: Hello and welcome to Health Professional Radio. My name is Patrick Reyes and on today’s show we have Dr. Saxon Smith. Now he’s an Australian trained dermatologist and holds a fellowship with the Australasian College of Dermatologists. He graduated medicine from the University of Otago in New Zealand, he has a Master’s Degree in Health Law from the University of Sydney and a graduate of the Australian Institute of Company Directors, he’s also a consultant dermatologist in private practice in Gosford, a visiting medical officer at Royal North Shore Hospital and a clinical associate professor at the University of Sydney. He’s here today to talk about eczema and its prevalence especially amongst young kids. Welcome to the show Dr. Saxon.
Dr. Saxon Smith: Thank you for having me on.
P: Now can you tell us how significant or prevalent eczema is in Australia?
S: What we know is up to about 20 – 40% of children in Australia will get eczema in one way, shape or form and that prevalence is actually doubled in the last 20 years so it’s becoming more common.
P: I see and what are the current guidelines for managing eczema?
S: Well what we know with eczema is it’s a complex sort of condition which is both a genetic predisposition but also how the world interacts with that genetics so whether you have allergies, whether you’re in a sort of dry environment. So it’s actually really important to try and have a treatment plan that targets all of these aspects where appropriate. So in order to sort of combat the genetics sort of predisposition towards eczema, it really relates to making sure the skin is really well moisturized by using sort of soap-free washes to avoid the detergent effect or normal soaps, a regular moisturizer in a daily basis or twice daily basis if during winter in particular as well and also having sort of short lukewarm showers or having a bath…for younger children. So that makes the skin to be the most moisturized and most resilient that it can be. But there’ll be times when you’ll have the eczema flare up, you’ll have red itchy areas and that’s an inflammation process that needs an anti-inflammatory cream to be put onto that. One of the main anti-inflammatory cream were used, a topical corticosteroids and that’ll help … down that components but you need to maintain that moisturizer and soap-free bath … all the time. But we also know that children with eczema are more predisposed to infection as well and it’s related to the fact that there’s little proteins on the skin which act as a natural defense to the bacteria that cover us on a day to day basis and in children and adults with eczema, they have fewer of these little proteins they’re more likely to have issues with infection. But that infection might not make you unwell but it will certainly get into the…in the skin and make it bit more difficult to treat. So there are times when you might need to have antibiotics or other antibacterial preparations to control that as well.
P: I see. And if there are, can you tell us about the adverse effects of using topical corticosteroids?
S: What we know about topical corticosteroids is they are a key component in managing eczema. They used it as an anti-inflammatory to settle down that active eczema and what we know with topical corticosteroids is they’ve been around a very long time but there has been a lot of misinformation about the safety around topical corticosteroids and some of that is just that misinformation that’s out of the community. And there was research studies done many years ago, back in the 1960s when it was first started which looked at using sort of early topical steroids on the skin of normal people and by normal people I mean people without eczema or other sorts of skin conditions. And when they did that and used them at long periods of time, they were able to induce some side effects of people worry about with topical corticosteroids such as the thinning of the skin. But in reality is that was really sort of like an over dosage situation just like if you take Panadol inappropriately you can cause yourself harm. So with any kind of thing, any kind of medicated cream we know that it needs to be supervised by a doctor and coordinated. But what we did a few years ago at Royal North Shore Hospital we looked at a large group of children and these were children who used topical corticosteroids for long periods of time to control their eczema and we to see if we saw any problems with this so called skin thinning or other sort of side effects in those children and we’re really… in the fact that over a nine month period we didn’t see any troubles. So what it tells is that in that sort of situation when you’re using topical corticosteroids to … down the inflammation of the eczema only and when there’s no inflammation just to go back to the regular moisturizer alone that you don’t see any trouble and this led to a consensus that…which means a group of pediatric dermatologists from around Australia and New Zealand who got together late last year and published an article… looking at all the side effects around topical corticosteroids to basically reassure people that in this pediatric setting, it’s very unusual to see any real problems at all.
P: Alright. How can health care professionals best develop a framework so there’s a consistent approach to patient advice on the use of topical corticosteroids?
S: What we know from chatting with parents who have children who suffer from eczema they get a lot of information about topical corticosteroids from a range of different places this includes getting it from the internet, from the family and friends or random people in the street even sometimes but also from their general practitioner and their pharmacists and what we found is it there is a real spectrum in knowledge or differences that can exist between pharmacists, general practitioners and dermatologists. You also have great dermatologists, general practitioners and pharmacists that speak the same language and sing from the same song sheet as they say where around the safety and the effectiveness of topical corticosteroids. But we know that when you hit someone in that group who is not up to date with the latest information, who’s not up to date with the research that has been done for the last 5 to 10 years to show the safety of topical corticosteroids as well the effectiveness, that can dramatically impact upon that parent or patient around their feelings or their understanding around the safety and effectiveness of topical corticosteroids. And if you have confusion what this means to is people are less likely to use the topical steroids which means that less likely to get on top of their eczema and most like to have … eczema affects the whole family it’s not just the child who has the eczema. If there’s one person in the house who’s not sleeping because they’re scratching with their active eczema or not it means no one in the house is sleeping. That means they’re not performing well at school, it means the parents are not doing well at work or looking after the rest of the children the next day because everyone’s tired. So we have to remember that this is not just a skin condition it actually has huge impact on the family as well. So it’s important that we all think from the same song sheet around the safety. I’m very happy to share the information as we’re doing around the evidence and the evidence basis for this.
P: So there has been some varied advice on the application of topical corticosteroids, what are your thoughts from that?
S: One of the main reasons people who are afraid of using topical corticosteroids is they’re afraid of this thing called ‘skin thinning’ and part of the problem is that they used to get the prescription from the GP or their pharmacists and they’re told just use it sparingly and then they’ll get the prescription which has on a box written sparingly as well. What this does is create confusion because nobody actually knows what sparingly means. It’s a statement, it’s a word that means kind of use thinly but what is one person’s thinly compared to another person’s thinly? But by creating this confusion it means that parents and patients don’t use the steroid creams the way that they’ve been instructed or they should to help control their disease…anti-inflammatory to seal down the inflammation part of their eczema. So when you have that kind of confusion, it’s very important to go out and look for the evidence and so by my research team and I went to Royal North Shore Hospital, went to do that in fact and looked at the evidence around whether or not you see skin thinning from topical corticosteroids. And… you don’t see that when it’s applied appropriately under supervision with your doctor, we fairly admit that I have seen patients in adults man and not in children where they’ve used the topical corticosteroids without supervision on normal skin, that is to say the skin that isn’t inflamed and needing the anti-inflammatory settle down so in those patients can get themselves in trouble but they’re few and far between and really there’s just an overdose or an abuse in a matter of fact all of the medication and they’re not following the instructions that they should. So please really make sure that when you use the topical corticosteroids appropriately under supervision and using them what we call the fingertip unit which is a measure of our squeezing a length of the topical corticosteroid out of the tube of the tin onto a fingertip and using that to cover the area of a … hand space on a body… trouble … but what you will do is treat your disease effectively.
P: And what would you say is the biggest misconception about eczema?
S: The biggest misconception that I’ve discovered through the research that I’ve done talking with parents is that they worry about thinning of the skin but they’re also worried that it’s goanna do some detrimental effect to their child or it’s gonna stunt their growth, it’s going to affect their immune system – all of those sort of things. And what they’re doing there is mixing up the potential effects of oral steroids where you’re taking a tablet which is systemic meaning the whole body’s affected by that tablet versus a topical cream or an ointment which is applied directly to the affected area of the eczema and treats effectively that area only. When you use the creams and ointments, very little of any of this topical corticosteroids is actually absorbed systemically meaning further into the body so you’re not goanna see those effects that you can see with oral steroids and that’s why dermatologists in particular shy away from using oral steroids where possible for skin conditions because we’re able to use more effectively the topical of their variety with much better safety profile and effectiveness.
P: So I know a bit a new storybook that you’ve just released I believe called Elliot’s Meditotz Adventure which was written by a team of eczema experts including yourself. Could you tell us more about it?
S: So I, like many people in Australia have a child who has eczema. As I said 20 – 40% of children in Australia do get eczema and my son was just one of those. And I know the frustrations that a parent has trying to put their moisturizers and their topical steroids on their skin, how to manage the disease from time to time and it’s a frustrating battle that you have on a day to day basis. And one of the hard thing is trying to get your young child to understand why you’re doing this and so I had the opportunity to work with some medical doctor writers and we’ve created this book called Elliot’s Meditotz Adventure which is basically explaining in children’s terms with pictures and a good little story about what is happening with their skin when they have eczema and why these creams and moisturizers and the topical corticosteroids are so important to manage their skin so they can go out and have the fun adventures that they want to in their lives as little children. This is a wonderful opportunity that I was afforded and I was very grateful for that and they were able to use that to help basically educate my son and other children about their skin condition and the book is named after my little boy Elliot and that’s…it makes sense something that I was passionate about and I understand all too well the frustrations that parents have in these situation bcause I live it on a day to day basis like they do.
P: Sounds like a really wonderful book. Now how can everyone get their hands on a copy of the book?
S: So at present you can get it via the Eczema Association website and they’re making it available free at this point in time which is wonderful and so basically get it, share it and it’s a good way to help everybody understand and we’re from the same page about their child’s skin condition. And once children understand that their moisturizer helps and the topical steroids help the itchiness as well, they start to get to that they understand that this is something that needs to happen. But having a good little story book with just great little pictures and just helps them and speaks to them at their language and it’s not that parents telling them what to do because let’s face it all children rail against that from time to time but speaking to them in their language in a way that they understand it with pictures and a nice little story which is helps so much to get across that line and so it’s wonderful to be part of the team to put this together and I hope that others find it useful like I have with my son when I first read it to him, he really lit up and started to understand why we had to do this for him on a day to day basis.
P: Alright. Now what’s the message you ‘d like to leave our audience as being part of Health Professional Radio today?
S: Well obviously what we know is that eczema is a very common condition affecting 20 – 40% of children in Australia but most kids most of the time will grow out of their eczema and whilst that happening it is about managing it. People often try to find some type of cure or allergy or some basis that they fight this change one thing their life is gonna be very different cause it all go away. For what we know the eczema is much more complicated than that but what we also know it can be very well managed and it’s managed by looking after the skin to make it the best that it can be with regular moisturizer, soap-free wash and using…in the bath or short lukewarm showers if they’re showering and if the skin flares up for time to time with those red itchy patches we use topical steroid creams which are anti-inflammatory to settle down that inflammation process and then you dial in and out of those topical corticosteroids when you need to. And what we know by doing this in very simple ways we’re able to manage the vast majority of children but sometimes some children also need other help there are tablets and other options available to use too so if you’re worried, please see your doctor and look out for a good dermatologist to help you through all of these.
P: Alright. Well thank you for answering our questions today. It’s been a pleasure talking to you today.
S: Thank you for the opportunity to talk about a subject that affects me as well as many other parents that I see day to day to dermatologist as well.
P: Thank you. Now you’ve been listening to Health Professional Radio, I’m your Patrick Reyes and we’ve been in studio with Dr. Saxon Smith. And he was telling us about eczema and a new story book aimed to educate parents and kids about eczema. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.