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Inside this Issue:

1. One of 2.2 million U.S. nurses beats "hand eczema" - now she s helping others find answers and "skin solutions."

An interview with Heather Blackwell, a Dermatologist Assistant and Nurse, describes her experience with hand eczema and steroids. She explains the consequences of traditional steroid treatment and her recommended solution for nurses and patients to manage the hand eczema problem.
Click here to see the entire article.

 

2. Massage Therapy Effective Against Atopic Dermatitis.

Children with atopic dermatitis eczema showed improvement in their condition after a month of massage therapy, said Dr. Lawrence Schachner of the University of Miami and his associates. In a study of 20 children aged 2-8 years with atopic dermatitis, half underwent standard care, which consisted mainly of emollients and topical corticosteroids; the other half received standard therapy plus a 20-minute massage each day, the investigators said (Pediatr. Dermatol. 15[5]:3 90- 95, 1998).
Click here to see the entire article.

 

3. Protèque's Recommended Internet Link.

http://www.helix.com/helix/resc/trends/pharmacy/oct97/ce_text.htm

Excellent indepth education for physicians and patients using low to high potency corticosteroids including their proper use and side effects. Title: Corticosteroids for Atopic Dermatitis. Continuing Education Program: Oct 1997: Therapeutic Management of Atopic Dermatitis, by Dennis P. West, PhD, FCCP, Professor of Dermatology, Director Dermatopharmacology Program, Department of Dermatology, Northwestern University Medical School, Chicago, IL. An extract of that program includes:

Reported side effects of topical corticosteroid use include "cutaneous and/or local effects" such as: "acneiform eruption, including folliculitis, rosacea... periocular and perioral dermatitis... atrophy of the epidermis and dermis, skin fragility (elderly or sun-damaged skin, intertriginous areas, and the face are most susceptible)... delayed wound healing... gluteal granulomas... purpura... telangiectases and erythema... striae, hypopigmentation, hypertrichosis, masking or aggravation of dermatophyte infection, secondary infection or aggravation of existing infection, and contact dermatitis... due to preservatives or other ingredients of the vehicle [or]... due to the corticosteroid molecule, in which case cross-reaction may occur with corticosteroid molecules of similar structure.

"Systemic Side Effects"

Systemic side effects are "seen most frequently from prolonged and extensive use in children or with the use of very-high-potency topical corticosteroid compounds" and include: "cataracts and glaucoma with periorbital use... adrenal suppression (hypothalmic-pituitary-adrenal axis)... growth retardation (infants and young children)... however... catch-up growth is expected when corticosteroid use is discontinued... Continuous long-term treatment near puberty should be avoided. If growth is suppressed during what would normally be a prepubertal growth spurt, epiphyses may close during puberty before catch-up can occur." Systemic side effects from topical CS may also include hypertension as well as Cushing's syndrome.


Adapted from Drake et al. (Reproduced with permission from Mosby-Yearbook, Inc.)

 

Newsletter - February 2000

Heather Blackwell is a Dermatologist Assistant to Dr. Puente at Raleigh Dermatology and Skin & Cosmetic Solutions in Raleigh NC. 919-876-9576. The practice specializes in cosmetic dermatology and skin disease solutions.

When did you first experience hand eczema?
I had it all my life, but it became more severe in nursing school. Every winter the condition got progressively worse in my first nursing job at a convalescent nursing home, while taking care of 58 elderly patients.

How did you know you had eczema?
I found out in nursing school. I had all the typical symptoms - dryness, redness, itching, cracking, occasional bleeding. Like other people, I used typical hand lotions. They were greasy and I would usually end up washing it off because it felt so tacky. Nothing really helped.

How many nurses do you know have hand eczema?
A majority. Just about all nurses have it to varying degrees if they wash their hands the way you're supposed to.

Is there any risk associated with having eczema as a nurse?
Of course. With cracking and bleeding there is a portal of entry for bacteria and viruses. That puts both the nurse and the patients at risk.

Did you use steroids and did they work?
I did and they worked. They are not easy to use. A lot of time you have to wait. It is not like putting on a lotion throughout the day. You can use them to get it under control, but they are not safe long term. As soon as I came off the steroid cream, it would flare as bad or worse. It was just a roller coaster kind of cycle.


Why can't you use corticosteroids long term to manage your hand eczema?

You risk the thinning of the skin as a long-term side effect. Also, from a patient care standpoint it is not the best thing to be transferring the topical corticosteroid to the patient's skin, especially touching a patient's face. Most of the steroids are in a delivery vehicle that leaves a sticky, dirty film especially after contacting all the materials a nurse has to handle all day.

Did patients notice your condition?

Oh yes. The bleeding and the scabs were very unsightly, unclean and non-sterile looking to a patient.


If I had been using Proteque starting in nursing school I wouldn't have the permanent red rings you see around the nail base, which cosmetically does not look nice.

Which patients do you recommend use Proteque?
Atopic and contact dermatitis patients exposed to chemicals, soaps and water - painters, dentists, nurses, seamstresses, mechanics, new moms. Also, accountants, lawyers, and postal workers who handle a lot of paper. Paper absorbs the skin's natural protective oils. It also contains residual bleaches and formaldehyde from the paper processing, especially recycled paper. We had one seamstress allergic to formaldehyde in the fabric. Proteque is a new product used as an effective preventive maintenance product for all those patients. "Since we have had Proteque in the office none of the nursing staff suffers from hand eczema any more. Nobody is."

What would you tell nursing students?

Most nursing students are starting to experience severe dry chapped skin for the first time and it progressively gets worse with time and continued exposure. If I were to go back to my nursing school I would tell them to start using a skin protectant now. Don't let yourself get into the cycles of the post corticosteroid flares; don't wait till it's cracking; don't wait till there's scars. Maintain it now and don't get to that point.

How can other nurses help dermatitis and eczema suffers?
Share educational materials provided by dermatologists with patients and staff, who can pass them along to coworkers and their employers. That's what nurses do everyday -- try to teach and help others.

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2. Massage Therapy Effective Against Atopic Dermatitis

Children with atopic dermatitis eczema showed improvement in their condition after a month of massage therapy, said Dr. Lawrence Schachner of the University of Miami and his associates.

In a study of 20 children aged 2-8 years with atopic dermatitis, half underwent standard care, which consisted mainly of emollients and topical corticosteroids; the other half received standard therapy plus a 20-minute massage each day, the investigators said (Pediatr. Dermatol. 15[5]:3 90- 95, 1998).

In a one-time session, a therapist taught parents a massage technique that involved stroking the child's face, chest, stomach, legs, and arms. Children were seen by the investigators just twice: on day 1 and 1 month later.
Children who received massage therapy experienced a significant improvement in redness, lichenification, scaling, excoriation, and pruritus; children in the control group significantly improved only on the scaling measure.

Children who received massages also were less anxious, and their affect and activity levels improved.

Massage therapy not only made the parents feel less anxious about their child's condition, it made them feel like a participant in their child's care. Dr. Schachner and his associates also pointed out the cost effectiveness of massage therapy, noting the one-time training cost of $30.

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Click to see the December '99 Newsletter.

Editor's Note: Each month we'll share a story (that can help others) of a patient or doctor who has successfully managed eczema or dermatitis. Send your story via Fax: 305-223-5510 or E-mail: patty.brachman@proteque.com We look forward to hearing from you.

Readers of this newsletter can get more information by exploring the Consumer Education or Physician Education sections including education and links to other sites. Go to our homepage at www.proteque.com

Do you have a question about controlling eczema or dermatitis? E-mail us at patty.brachman@proteque.com or call 800-953-9250 toll free. We’ll pass the question along to our panel of medical experts and post the answer on our web site.

 


 

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