The National Eczema Association

The National Eczema Association (NEA) is a nonprofit organization dedicated to improving the lives of individuals affected by eczema. It serves as a hub for education, advocacy, and community support, offering resources for patients, caregivers, and healthcare providers. NEA's mission is to empower the eczema community through knowledge and collective action, striving for a world without eczema.

Understanding Eczema

Eczema, also known as atopic dermatitis, is a group of inflammatory skin conditions that cause dryness, itchiness, and irritation. Its symptoms can range from mild to severe and often appear differently depending on skin tone. For lighter skin, eczema commonly appears as red or inflamed areas. For darker skin tones, it can manifest as brown, purple, gray, or ashen patches, making diagnosis more complex for people of color.

There are seven main types of eczema, with atopic dermatitis being the most common. Other types include contact dermatitis, dyshidrotic eczema, seborrheic dermatitis, neurodermatitis, nummular eczema, and stasis dermatitis. The condition’s causes vary, stemming from genetic factors, environmental triggers, or immune system overactivity.

Eczema Management: Challenges and Solutions

Effective eczema management involves identifying triggers, maintaining a consistent skincare routine, and using prescribed treatments such as corticosteroids, antihistamines, or biologics. Yet, many patients struggle with tracking their symptoms, leading to missteps in care or delays in adjustments to their treatment plans.

This is where EczemaWise comes in. The app addresses key challenges by enabling users to:

• Log symptoms and track progress over time.

• Identify environmental and lifestyle triggers.

• Monitor the effectiveness of treatments.

• Share detailed reports with their healthcare providers.

For people like me, someone who has lived with atopic dermatitis since childhood, these features create an opportunity to engage actively in our care and reduce the frequency and severity of exacerbations.

How EczemaWise Works

EczemaWise simplifies the complexities of eczema care through a user-friendly interface. Here’s how it can be used effectively:

1. Daily Symptom Tracking: You can log details such as itch intensity, flare-up frequency, and skin appearance. This helps build a pattern of symptoms, which can guide adjustments in treatment.

2. Trigger Identification: The app allows you to note environmental factors such as weather changes, stress levels, or exposure to specific allergens. Recognizing these triggers is vital for long-term disease management.

3. Treatment Monitoring: You can document medications, creams, or therapies, and evaluate their effectiveness.

4. Custom Reports: EczemaWise generates detailed summaries that patients can share with their healthcare providers. These insights make clinical visits more productive and assist with developing personalized care plans.

5. Reminders and Notifications: The app sends reminders for applying treatments, ensuring consistency in care routines which reduces the risk of irritation, inflammation, and hyperpigmentation. Shout out to Dr. Alexis Stephens for this catchy, but useful way to remember the mechanisms of action that lead to post-inflammatory hyperpigmentation (PIH), a condition that tends to negatively impact patients with skin of color (SOC) more than the disease itself. I have personally experienced PIH. I manage my atopic dermatitis and PIH with the support of my Dermatology Physician Assistant, Leah Waller, PA-C, in Reston, Virginia.

The Role of Healthcare Providers

EczemaWise isn’t just a tool for patients. Dermatology Nurse Practitioners can benefit by accessing comprehensive data about our patients’ conditions, which facilitates informed clinical decisions. The National Eczema Association offers a Guide for HCPs, helping us integrate EczemaWise into our practice.

Key benefits for Dermatology Nurse Practitioners include:

• Improved communication with patients through shared data.

• Enhanced ability to identify triggers and monitor treatment adherence.

• Support in developing personalized treatment strategies.

Addressing Eczema in Skin of Color

Eczema can present unique challenges in people of color due to differences in how symptoms appear and the underrepresentation of darker skin tones in dermatology education. For instance, eczema in Black or Brown individuals may present as hyperpigmented or ashen areas, which can be mistaken for other differentials like allergic or irritant contact dermatitis, psoriasis, seborrheic dermatitis, and lichen simplex chronicus to name a few.

EczemaWise provides an opportunity to bridge this gap by encouraging patients to document their symptoms visually and textually. This aids Dermatology Nurse Practitioners in understanding and diagnosing eczema accurately across all skin tones.

Atopic dermatitis (AD) prevalence varies widely across the globe and has been on the rise in recent years. Data from the International Study of Asthma and Allergies in Childhood (ISAAC), which analyzed over 385,000 participants in 60 countries, revealed a prevalence range from 0.2% to 24.6%. Regions like Africa and Oceania reported higher rates, while lower rates were observed in areas such as Northern/Eastern Europe and the Indian subcontinent. Variability also exists within countries and cities, particularly in Africa, where prevalence ranges from 4.7% to 23.0%.

In the Asia-Pacific region, approximately 17.8% of children aged 6-7 years have been diagnosed with AD, with prevalence varying significantly across countries. Despite this variability, U.S.-based studies consistently show that African American (AA) children have a higher AD prevalence compared to European American (EA) children. For example, the 2005-2006 National Health and Nutrition Examination Survey reported AD rates of 19.3% for AA, 16.1% for EA, and 7.8% for Hispanic children. Even when accounting for socioeconomic and environmental factors, AA children are 1.7 times more likely to develop AD and three times more likely to receive an AD diagnosis during a dermatology visit than their White peers.

Clinical Trials and Regulatory Considerations

Clinical trials must include patients from diverse racial and ethnic backgrounds to ensure treatments are safe and effective across populations. Differences in inflammatory pathways, disease severity, and lesion morphology have been observed among racial groups, affecting outcomes and treatment responses. For instance, regulatory authorities in some countries require that pivotal trials include representative subjects from their populations to meet approval standards. Incorporating diverse participation into phase 3 trials is essential for creating equitable care strategies. Specifically, when it comes to creating more inclusive clinical trials we must:

• Ensure inclusion criteria reduces barriers that would prevent historically underrepresented groups from being able to participate for the entirety of the clinical trial

• Ensure data collection includes sexual orientation and gender identity

• Ensure consent forms are available in a variety of languages. Note, Spanish is no longer considered a foreign language.

• Ensure digital content and web-based components of the study, as applicable, are compliant with American Association of Disabilities (ADA).

Presentation of AD in Skin of Color

Although the fundamental features of AD, such as pruritic and scaly plaques, are consistent across ethnicities, nuances in lesion appearance and distribution are influenced by skin pigmentation:

• Erythema in darker skin often appears as violaceous or is missed entirely, leading to underestimation of severity in common scoring systems like SCORAD or EASI.

• Lesion distribution varies, with Asian patients exhibiting more well-demarcated scaling, and African-descent patients showing perifollicular papules or extensor involvement rather than flexural dermatitis.

• Unique presentations in darker skin include lichen planus-like AD and prurigo nodularis, associated with increased pruritus and scratching.

Impact of Dyspigmentation

Post-inflammatory dyspigmentation (hypopigmentation or hyperpigmentation) is more pronounced in skin of color, often lasting for weeks to months. This can cause significant distress, sometimes outweighing the eczema itself. Chronic excoriation may lead to permanent depigmentation, highlighting the importance of early and effective treatment to minimize long-term effects.

EczemaWise can play a pivotal role in addressing these disparities by encouraging detailed documentation of symptoms and facilitating conversations about skin-specific concerns between patients and providers.

Comprehensive Eczema Support

Living with eczema can feel overwhelming, but apps like EczemaWise empower patients globally to take control of their condition. By tracking symptoms, recognizing triggers, and fostering collaboration with the healthcare team, this tool helps create personalized treatment plans that improve quality of life.

In addition to EczemaWise, the National Eczema Association also provides resources such as:

• A Provider Finder to locate dermatologists with expertise in eczema.

• A directory of products with the Seal of Acceptance™, indicating their safety for sensitive skin; and how to apply.

• Advocacy opportunities and community support for individuals with eczema and their families.

• The Ecz-clusion List

• Patient fact sheets and surveys

• Continuing education credits

• Videos: patient testimonials and webinars

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Patients and providers alike are encouraged to utilize these resources to complement EczemaWise and ensure holistic care.

For more information, consult the National Eczema Association and this article, Ethnicity, Race and Skin Color: Challenges and Opportunities for Atopic Dermatitis Clinical Trials.

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Frequently Asked Questions About EczemaWise

EczemaWise is available for free on iOS, Android, and as a web-based tool, making it accessible to a broad range of users. It adheres to industry-standard privacy regulations to ensure the safety of patient data. Shared-decision making and provider-patient rapport is supported by the user-friendly platform which makes it easy for patients to log detailed symptom data, learn which details to share and questions to ask. Overall, this leads to more informed decisions. While the app is designed for eczema, users may include notes about other health conditions that may be contribute to the overall health of their skin.

EczemaWise offers a practical, evidence-based solution to bridge gaps in care. To learn more and download EczemaWise, visit eczemawise.org. For additional resources on eczema and skin health, explore the National Eczema Association’s full range of support materials.

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References

Bissonnette, R., Jankicevic, J., Saint-Cyr Proulx, E., & Maari, C. (2023). Ethnicity, Race and Skin Color: Challenges and Opportunities for Atopic Dermatitis Clinical Trials. Journal of clinical medicine, 12(11), 3805. https://doi.org/10.3390/jcm12113805

Kaufman, B. P., Guttman-Yassky, E., & Alexis, A. F. (2018). Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Experimental dermatology, 27(4), 340–357. https://doi.org/10.1111/exd.13514

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Kimberly Madison, DNP, AGPCNP-BC

I am a nurse practitioner with a passion for writing, entrepreneurship, education, and mentorship. I created this blog to share my journey as source of motivation and as a blueprint as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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