New Research into Atopic Eczema

Viewpoint at Glenashdale Falls

Sannox Bay

Atopic Eczema - What's New? A review of the condition was published in the July edition of CED (Clinical and Experimental Dermatology) by Dr Donna Torley from the department of dermatology at the Southern General in Glasgow (my local hospital). A systematic review of the key findings from 24 summaries published between August 2010 and December 2011. Here are some of the key findings:

Epidemiology: antibiotic use in early life may increase risk of atopic eczema whereas exposure to dogs and consumption of unpasteurised milk may reduce risk. There is no strong evidence that exclusive breastfeeding, hydrolysed protein formulas, soy formulas or fatty-acid supplements help to prevent atopic eczema.

Treatment: In patients with moderate to severe disease, pro-active treatment with topical corticosteroids and calcineurin inhibitors can be used to prevent flares. An example of this which has been tried is 'weekend therapy' which consists of preventative topical therapy being applied on two consecutive days each week (such as the weekend) to prevent flares.

Patient education about the condition produced mixed results with no high quality randomised trials to compare effectiveness and make reliable conclusions. Also in treatment, tacrolimus was shown to have a comparable efficacy to mild to moderate topical corticosteroids. There was little evidence found to support the use of coal tar in the management of the condition. Again, the lack of large and well designed randomised controlled trials led the authors to conclude that there was no clear evidence for the efficacy of homeopathy, botanical extracts or Chinese herbal medicines in the treatment of atopic eczema.

Also, a couple of photos from last weekend in Arran - great weather, food and company meaning a fantastic weekend away!

What an amazing few weeks!

It's been a busy few weeks and lots going on: Glastonbury festival at the end of June, then Liverpool for the British Association of Dermatologist's (BAD) annual conference in July and Amy and I are off to Arran this weekend. 

A moment of praise for Andy Murray on winning Wimbledon. He's an inspirational character to me and I admire him for his drive and determination to succeed, particularly in the face of previous disappointments such as the Wimbledon final which he lost in 2012. While several of the top tennis players such as Nadal and Federer started winning Grand Slams when they were younger (Nadal age 19, Federer age 21, Djokovic age 20), Murray has pushed ahead when many had written him off and his constant desire to improve has seen him finally deliver the success which he so rightly deserves. 

Improving patient safety and delivering better standards of care for patients in NHS Scotland is something which I am passionate about. I believe that there are two aspects to this for everyone who works in healthcare. One is personal improvement - looking at how we can get better at what we do as individuals. This helps to set example and is a good way to develop leadership. One of the speakers at the BAD last week was Professor Wendy Reid, who is Medical Director of HEE (Health Education England). She spoke about the importance of doctors acting as clinical leaders in hospital and how we are in a position where can initiate change. The other is looking at the wider picture, and how we change the cultures and systems that exist to create a safer environment. I feel that as junior doctors who regularly move between hospitals and departments, we have a unique opportunity to share our ideas and experiences. I hope to share some of the ideas I have and experiences (both good and bad ones) when I move to my next hospital job in August.

I was sent round an email for induction for the new job last week and the consultant who sent the email sent a link to the following video on youtube. It's a good one to watch - because it accurately depicts a realistic hospital scenario where a patient is identified as having sepsis. The sepsis 6 bundle is just one of the initiatives which has been worked on by healthcare improvement scotland (the project which I worked on in Ninewells on venous thrombo-embolism prevention was with them also). They have a youtube channel and there are several other videos there which explain who they are and what they aim to achieve and I would recommend that anyone interested have a watch.

http://www.youtube.com/watch?v=CrUHnYIZbpM