Eczema and the older person.

Age-related changes lead to an increase in skin problems, and around 70% of older people have a treatable skin condition. However, ageing and poor physical health can make it difficult for older people to care for their skin. Eczema, a chronic inflammatory skin condition, where the skin becomes red, inflamed, itchy and scaly, can develop easily in older adults. This can, in turn, become infected and cause discomfort and health problems. This article explains how ageing affects the skin, how eczema can develop and how it can be treated, also touching upon the different types of eczema. It aims to equip community nurses with knowledge about this common condition and how to recognise and manage it.

User evaluation of patient counselling, combining nurse consultation and eHealth in hand eczema.

BACKGROUND AND OBJECTIVE: This study reports the findings from a user evaluation of a counselling programme for hand eczema patients in which face-to-face encounters were supplemented with user access to a new website. PATIENTS AND METHODS: Patients treated for hand eczema in two different settings were included consecutively. Website utilization was examined by use of the transaction log. Comparisons were made between participants who used the website and those who did not. The patients' perspectives were explored by the use of interviews. RESULTS: Among potential website users (n = 140), 88 patients (63%) had an average of 5.1 site visits. At follow-up, the website users had improved more in quality of life (p = 0.014), current burden of disease (p = 0.053), and itching (p = 0.042). The website users reported more changes in habits than did the non-website users (p = 0.024). No differences in clinical severity of hand eczema were found. The interviewees were generally satisfied with the counselling and the website. The strict log-on procedures were considered to be an obstacle to using the site. The consecutive inclusion of participants was considered to be a barrier to engagement in the dialogue forum. CONCLUSIONS: The website users benefited from the website, although this was not substantiated by clinical measurements. The trial design partly hampered website utilization. An initial feasibility study could have been warranted.

Supporting patients with eczema-introducing the TalkingEczema tool.

Julie Van Onselen discusses the TalkingEczema tool that empowers patients with eczema who self-care, and their clinicians, to improve the treatment and management of a condition that affects one in ten adults.

The management of eczema in children.

Eczema is very common in children and impacts significantly on the quality of life of children and their families and carers. Poor adherence remains the main cause of treatment failure. Rigorous and consistent use of treatments is key to relieving symptoms, but many parents experience significant barriers to application. Community practitioners are ideally placed to educate parents in the use of emollients, and where necessary topical corticosteroids, identify and discuss problems and help parents to develop strategies to overcome difficulties. Food allergy is associated with eczema, particularly in infants and the risk increases with severity. Community practitioners need to be confident in its recognition and management.

Effectiveness of the Healthy Skin Clinic--a randomized clinical trial of nurse-led patient counselling in hand eczema.

BACKGROUND: Hand eczema is a common disease, and continuous preventive skin protection and skin care must be adopted to prevent a chronic course. Hand eczema is not a uniform disease, and counselling must therefore be individually tailored. OBJECTIVES: To evaluate the effectiveness of a nurse-led counselling programme, the Healthy Skin Clinic, emphasizing the patient's self-management, resources, and risks. PATIENTS AND METHODS: Patients (n = 306) referred for diagnostic work-up and treatment of hand eczema were randomized and allocated either to the programme or to usual care. The primary outcome was clinical disease severity at follow-up. Secondary outcomes were quality of life, burden of disease, skin protective behaviours, and self-reported medication adherence. RESULTS: Patients in the intervention group had greater reductions in clinical severity and reported more beneficial behavioural changes at follow-up than those in the usual-care group. This was especially true of patients who were treated solely with topical corticosteroids and who had a primarily exogenous aetiology of hand eczema. However, the effect was very dependent on baseline disease severity. No differences in quality of life or burden of disease were found between the two groups. CONCLUSION: A tailored nurse-led programme of skin protection counselling may be recommended as an essential part of hand eczema treatment.

Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice.

AIMS: A discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators. BACKGROUND: Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions. DESIGN: A discussion paper. DATA SOURCES: A literature search of online databases was undertaken utilizing terms 'eczema OR atopic dermatitis', 'education', 'parent', 'nurs*', 'framework', 'knowledge', motivation', in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003-2013. IMPLICATIONS FOR NURSING: The framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema. CONCLUSION: Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions.

Living ordinary family life with an allergic child-the mother's perspective.

Ecocultural theory considering family as an entity may serve as a new point of view instead of "impact of disease"-perspective. Aims were to reveal ecocultural themes and activities of daily routines in the treatment of a child's food allergy and eczema. Interviews (N=24) were held with mothers with allergic children aged 12 months and mothers repeat interviews at 24 months. The theme; "living an ordinary family life", was implemented across the family activities of routines essential for treating the child's allergy. New or altered treatment regimens can be tailored to families on the basis of existing activities.

Developing a nurse-led integrated 'red legs' service.

This project was developed to set up a nurse-led service based on the needs of patients diagnosed with 'red legs'. These patients are often wrongly admitted into hospital for treatment of cellulitis. Representatives from the specialties involved in caring for those individuals with red legs were invited to participate with patients to create a stakeholder group whose purpose was to develop integrated care pathways focused on referral criteria, diagnostics and treatment to inform a new nurse-led service. There was a commitment to utilising a number of facilitation techniques and practice-development methods in the progression of the project with the support of the Foundation of Nursing Studies. Much of the prescribed care can be carried out by the patients at home and only 25% patients have required a follow-up appointment within the new service. The service has now been fully commissioned and a secondment opportunity has been developed to lead the new service. Significant savings have been demonstrated and regular revision of the integrated care pathways with all groups, including the patients, will take place.

Childhood eczema treatment: the barriers.

Childhood eczema has a significant impact on the quality of life of children and their families, yet the main cause of treatment failure is parents/carers not using prescribed topical treatments. This article reports the results of a study that explored carers' experiences of barriers to treatment adherence and how they sought to overcome these. We found that regular application of topical treatments can be highly challenging, particularly in families where child resistance develops. Our findings are considered alongside research into other long-term childhood conditions.

Skin care in the older person: identifying and managing eczema.

Eczema is a common skin condition in older people. Eczema is a long-term condition and older people may have had atopic eczema for many years; it may also be an acute condition, caused by a drug reaction. Many older people experience eczema and dermatitis for the first time as a consequence of ageing skin or triggered by environmental factors. Community nurses need to be able to assess older people's skin and recognize any signs and symptoms of eczema to ensure prompt treatment and good ongoing skin care.

Assessment and management of atopic eczema in children.

Atopic eczema is a chronic inflammatory itchy skin condition caused by a defect in skin barrier function. It is common in infants and children and may continue into adulthood. Assessment of eczema in children must be holistic, taking into account physical and psychosocial factors. There is no cure for eczema and treatments aim to control the disease. First-line treatment consists of emollients, but many children will also require the use of topical corticosteroids and other treatments as appropriate. Healthcare professionals have an important role to play in educating children, and their parents and carers, in the management of atopic eczema to prevent exacerbation of the condition and improve quality of life.

Managing eczema.

Eczema is an extremely common condition, with atopic eczema affecting at least 10% of infants at some stage. Nurses have a vital role in supporting patients and families by providing information about the condition and explaining the correct technique for applying topical medication. This article describes the different types of eczema and discusses the principles of care. Although treatment plans vary depending on the type of eczema, the underlying principles are the same.

A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist.

Background We hypothesized that a nurse practitioner would improve the quality of life of a child with eczema more than a dermatologist because of a structured intervention and more consultation time. Objectives To compare the level of care by nurse practitioners with that by dermatologists in children with eczema. Methods New referrals aged < or = 16 years with a diagnosis of eczema were recruited. In a randomized, parallel-group study with a follow-up period of 1 year, 160 participants were randomized either to conventional care from a dermatologist or to care from a nurse practitioner. The primary outcome measure was change in quality of life at 12 months, as assessed by the Infants' Dermatitis Quality of Life Index (IDQOL) for children aged < or = 4 years, and by the illustrated version of the Children's Dermatology Life Quality Index (CDLQI) for children aged 4-16 years. Secondary outcomes were changes in IDQOL and CDLQI at 4 and 8 months, family impact of childhood atopic dermatitis (Dermatitis Family Impact Questionnaire, DFI), eczema severity (objective SCORAD) and patient satisfaction (Client Satisfaction Questionnaire-8, CSQ-8) at 4, 8 and 12 months. Results The mean IDQOL in the dermatologist group improved significantly from 11.6 [SD 8.1; 95% confidence interval (CI) 9.0-14.2] at the baseline to 5.6 (SD 3.9; 95% CI 4.3-7.0) at 12 months with a mean change from the baseline of -6.5 (SD 6.6; 95% CI -14.2 to -8.9; P < 0.001). The mean IDQOL in the nurse practitioner group improved significantly from 10.7 (SD 4.9; 95% CI 9.1-12.3) at baseline to 5.7 (SD 5.4; 95% CI 4.0-7.5) at 12 months with a mean change from the baseline of -4.9 (SD 5.5; 95% CI -6.8 to -3.0; P < 0.001). The between-groups difference was (-)1.7 (95% CI -4.6 to 1.2; P = 0.26). The mean CDLQI in the dermatologist group improved significantly from 12.1 (SD 6.3; 95% CI 9.9-14.2) at baseline to 5.6 (SD 4.2; 95% CI 4.2-7.1) at 12 months with a mean change from the baseline of -5.9 (SD 6.0; 95% CI -8.0 to -3.9; P < 0.001). The mean CDLQI in the nurse practitioner group improved significantly from 10.0 (SD 4.4; 95% CI 8.5-11.4) at the baseline to 4.9 (SD 3.5; 95% CI 3.7-6.1) at 12 months with a mean change from the baseline of -5.2 (SD 4.0; 95% CI -6.6 to -3.8; P < 0.001). The between-groups difference was (-)0.7 (95% CI -3.3 to 1.7; P = 0.55). The between-groups comparison was not significant for the IDQOL and the CDLQI at baseline or 4, 8 and 12 months. Both treatment groups showed significant improvement in DFI and objective SCORAD at 12 months. The between-groups comparison was not significant at baseline or 4, 8 and 12 months. Significantly higher satisfaction levels were observed at 4, 8 and 12 months in the nurse practitioner group. Conclusions The level of care provided by a nurse practitioner in terms of the improvement in the eczema severity and the quality of life outcomes was comparable with that provided by a dermatologist. In addition, the parents were more satisfied with the care that was provided by a nurse practitioner.