Australian adults facing eczema control

Adults suffering from red, flaking, weeping and itchy skin on the face and eyelids are set to benefit from the Government's reimbursement of Australia's first non-steroid topical treatment for eczema on the Pharmaceutical Benefits Scheme (PBS).

Elidel® cream (pimecrolimus 1%) is now subsidised for adults with facial eczema, as well as for children as young as three months of age, where the use of steroid creams is inappropriate.1

According to leading dermatologist, Dr Michael Freeman, Director of Dermatology, Gold Coast Hospital, Queensland, the expanded listing of the steroid-free cream on the PBS is a positive step for adult eczema sufferers, many of whom endure a significant physical and psychosocial toll caused by the highly visible skin disease.2

"Adults with visible eczema, particularly those who have it on the face, experience considerable distress and disruption to their daily lives.

"During flares people avoid everyday activities, suffer from sleep disturbances and have to take time off work," Dr Freeman said.

The cost of eczema is not only emotional and physical, but also financial and sufferers can spend up to $1,200 annually on treatments, depending on the severity of their eczema.3

Dr Freeman said: "Elidel works more safely to control eczema in delicate skin areas of the body and unlike steroid creams, does not risk thinning or weakening of the skin.

"The new adult PBS listing of Elidel means that anyone over three months of age with facial eczema can now control the skin disease in this sensitive area where steroid use is not recommended, or has failed to relieve eczema symptoms."

The new adult reimbursement of Elidel comes at a time when doctors are rethinking the causes and treatment of eczema.

A recent international report published in the Journal of Allergy and Clinical Immunology4 suggests that a defective skin barrier, which can allow the entry of irritants and allergens into the skin, is a primary cause of eczema.4

"Controlling external factors such as diet, avoiding allergens and irritants, replacing all soaps and detergents with non-soap alternatives, increasing the use of moisturisers and avoiding prolonged use of strong steroid creams, is vital to reducing further damage to the outer layers of skin," said Prof Dédée Murrell, Head of Dermatology at St George Hospital, Sydney.

A new clinical trial involving Elidel use in adults with facial eczema who were intolerant of, or used large amounts of steroid creams, has shown a significant decrease in eczema severity, as well as an improvement of skin thinning on the face.1,5

Elidel has been shown to offer eczema control by halving the number of flares, reducing the use of steroid creams and providing long-term control of the skin disease.6

"Now adult patients who have facial eczema will greatly benefit from Elidel's PBS listing as the treatment will not cause the same thinning of the skin as topical corticosteroids and will actually give the skin a chance to recover," Prof Murrell said.

"With summer here and the potential aggravation of the sun and water on the face, good control of facial eczema is paramount and Elidel offers this to patients.

"Adult patients should see their GP or dermatologist for advice on how to recognise and manage their eczema symptoms by following a simple Eczema Control Plan," said Prof Murrell.

The Eczema Control Plan promotes patient education, understanding and appropriate management of eczema using a multi-therapy treatment approach.

"An Eczema Control Plan includes the use of moisturisers, topical corticosteroids and Elidel at appropriate times, allowing patients to effectively control their facial eczema," Prof Murrell said.

President of the Eczema Association of Australasia Inc (EAA) and long-term eczema sufferer, Ms Cheryl Talent, says: "Eczema is a serious skin disease which has been shown to be comparable to, or even worse than living with conditions such as insulin-dependent diabetes.

"Most sufferers, particularly adults, feel that controlling their eczema would be the single most important improvement to their quality of life."

Elidel belongs to a group of non-steroid medications known as topical calcineurin inhibitors (TCIs). It works on the skin and is specific to the cells which cause redness and itching very early on in the eczema cycle.7

Eczema is a common, recurring, non-infectious, inflammatory skin disease in which the skin becomes red, dry, itchy or scaly and may even weep, bleed or crust over. The disease varies in frequency and severity among different age groups, but often appears in childhood. People who do not outgrow eczema either by childhood or puberty, will continue to live with the condition life-long.8

References
1. PBAC Public Summary Document. www.health.gov.au/internet/wcms/publishing.nsf/content/ pbac-psd-mtjuly06.
2. Zuberbier T et al. Patient perspectives on the management of atopic dermatitis. (ISOLATE) J Allergy and Clin Immunol 2006; 118: 226-32.
3. Kemp A. Cost of illness of atopic dermatitis in children. A societal perspective. Pharmacoeconomics 2003; 21 (2): 105-113.
4. Cork et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene environment interactions. J Allergy Clin Immunol 2006; 118: 3-21.
5. Weise-Riccardi et al. Randomized vehicle-controlled trial of pimecrolimus cream 1% in adult patients with mild to moderate head and neck atopic dermatitis intolerant of, or dependent on TCS. Journal of Investigative Dermatology 2006; 126:46.
6. Meurer et al. Pimecrolimus cream in the long-term management of atopic dermatitis in adults: a six-month study. Dermatology 2002; 205: 271-277.
7. Hultsch et al. Immunomodulation and safety of topical calcineurin inhibitors for the treatment of atopic dermatitis. Dermatology. 2005; 211: 174-187.
8. Kissling S et al. Follow-up of atopic dermatitis after early childhood. Hautarzt. 1993; 44: 569-573.