November is Eczema Awareness Month—and the new Canadian Skin Patient Alliance survey shows why the conversation matters: nearly half of patients say eczema severely disrupts their lives, 52% report feeling socially isolated, and while 79% find current treatments inadequate only 6% are on advanced therapies like biologics. In this Q&A Dr. Gurbir Dhadwal, a Surrey-based dermatologist, breaks down the gaps in care and realistic treatment options, while Judy Tutkaluk shares her lived experience—from years of frustrated searches for relief to the hope education and access brought her. —Noa Nichol
Judy Tutkaluk
Can you share a bit about your eczema journey—when it began, how it progressed, and the moments that made you realize this was more than a “skin problem”?
My eczema journey began in childhood, really, it is something that I’ve lived with my whole life.
My earliest memory is laying in bed, my legs itching and burning, with a vacuum hose blowing cold air on my legs. How? My mum put the vacuum hose on our old metal Electrolux in backward, so that the air would blow out, instead of in. The cool air would give me some relief.
As a child, it was on my legs and arms. As I got older, it seemed to come and go, when I was a teenager, it would appear as big circles on the inside of my elbows, which was terribly embarrassing. Then it went away, and started on one finger. Over the years, it spread to all my fingers and my hands, and finally a few years ago, moved into my finger nails as well. Occasionally a flair up would occur on my arms or inside elbows, but primarily, it has affected my hands for the last 40 years or so.
More than a skin problem: for many years, I’ve tried explaining, mostly to family doctors, its coming from inside me! I came to this realization because of what I call “weeping”. There were times when my skin would be unbearably itchy, which would cause me to rub it furiously (I avoided “scratching” as this just tore my skin). When this situation arose, there were several tiny bumps on my skin. After rubbing vigorously, these would “weep” or leak a liquid (I’m not sure what that was), but after weeping, new cracks or cuts would form on my hands and/or fingers. Because of these bumps and liquid along with the itch, I was convinced it was something from inside me.
The survey highlights inadequate treatment options for many—what treatments did you try, which helped or hurt, and what was your experience trying to access specialists or newer therapies?
Throughout my life, I tried various treatments, prescription and some not, to try to alleviate the symptoms, but never really addressing the root problem.
As a young child, there was some type of tar-like paste/cream that was applied to my legs. I am sure it wasn’t tar, but it had a medicated tar-like smell to it. That didn’t work.
I used various prescription eczema creams and lotions; I tried allergy shots as at one point it was believed that allergies were the cause; I took antihistamines; I took Benadryl to try to stop or reduce the itch. One doctor suggested soaking my hands in ICE cold water, another suggested soaking my hands in WARM SALT water – both of those suggestions were awful – totally triggered bad weeping! Another suggestion was put Vaseline on my hands in cotton gloves for the night – another “weeping” disaster! Of course, various over the counter creams and lotions, most of which burned my skin and made things worse. Some helped moisten my hands without burning but only for a short while.
Many years ago (possibly 20…?) a dermatologist told me that I was on the best/strongest eczema cream and there was nothing else. He suggested I avoid washing my hands with soap, as it tends to be an irritant!?! Yes, soap can be a problem, but I need to wash my hands. I felt so terrible, so deflated, so discouraged.
Nothing I tried seemed to work, or provide any sort of lasting relief. Nothing.
Then when visiting my new family doctor, when asking for a renewal for my medicated cream, I asked if there was anything else that I could do. She said there were new medications available but it would be best to see a dermatologist. She said she didn’t know how long of a wait there would be, but I said, no problem, please put in the request.
Last year, I was fortunate enough to see a dermatologist who understood, who cared about my experience. Also, he understood that the problem was coming from inside me, in my body!! At first, I tried a broad-based immune suppressant to reduce the inflammation. While this medication initially helped me a lot, unfortunately, it was deemed unsafe for me as it resulted in serious issues with my liver. Then I was prescribed a new biologic, which as I understand it, targets the inflammation caused by my immune system. I am glad to say it works like a charm, a real game changer for me.
Many people with eczema describe feeling isolated or misunderstood—how did eczema affect your relationships, work/school life, or confidence, and what helped you navigate those challenges?
Eczema impacts your whole life. I know that may sound difficult to believe, but it does.
My home life: taking care of my children when they were babies and little children; cleaning and cooking. Why? Soaps, food (ie: peeling potatoes or apples) and cleaning products all triggered reactions in my skin. My immune system would go into overdrive… I had to wear gloves for cleaning and medical style gloves for food preparation.
Sleeping: I would wear cotton gloves at night to reduce the scratching at night. I would often wake because of my hands, sore and/or burning.
Social: I was embarrassed for others to see my hands, it was awful to have cracked hands, and finger nails that looked like I had some terrible fungus or something. I often had band aids on different fingers to hide some of the cuts. Also, I avoided wearing any jewellery that drew any attention to my hands, and often couldn’t even wear my wedding band because of swollen or cracked fingers.
It was also frustrating at times, when people noticed my hands/skin, and offered their experience on how to fix dry skin issues. I was tired of trying to explain, it wasn’t just dry skin!
Work: typing could be painful from cracks on my finger tips; of difficult when wearing band-aids. I can’t tell you how many times I had to reprint documents or reports because a cut on my hand left a blood spot or smear on it. So embarrassing, especially if I didn’t notice and someone questioned it!
What day-to-day coping strategies, small habits, or support resources made the biggest difference for you—things other patients could try right away?
Coping strategies: wear latex/medical examination gloves while preparing any food; never use soap at a rest stop, gas station or restaurant, no matter how terribly people stare at you, if necessary, use the cleaning disinfectant wipe cloths; never use sanitizer, even if it is alcohol free. Always use gloves when working in garden or yard, if hands get hot, put a new pair on – if you don’t you could trigger a weeping episode. Sometimes, put cotton gloves under the cleaning gloves or garden gloves, it helps reduce the weeping episodes.
Find soap and shampoo that are mild and not overly fragrant or perfumed. Nothing that can send you immune system into overdrive.
If you could speak directly to clinicians, policymakers, or the general public during Eczema Awareness Month—what’s the one thing you wish they truly understood about living with eczema, and what change would mean the most to you?
Living with eczema impacts your life, it can be discouraging, depressing and painful. Talk to people who live with it, everyone has a different story and experience.
But it doesn’t have to be that way. There are medications now that can help, like the biologic that I am using.
People living with eczema need to know there ARE options that CAN help.
Family doctors should NOT hesitate to refer their patients to a qualified dermatologist who CAN provide help.
These drugs can be cost prohibitive, but there ARE support programs.
POLICYMAKERS – people living with eczema need support. There are drugs that CAN make a difference to their quality of life. These drugs need to be made more widely known and available, whether through insurance programs or government funded programs.
Dr. Gurbir Dhadwal
The CSPA survey found nearly 50% of patients say eczema “severely disrupts” their lives—can you unpack what that looks like in day-to-day terms—sleep disturbance, work/school impact, or other hidden burdens clinicians should watch for?
I think the chronic itch associated atopic dermatitis is under appreciated. The impact on quality of life of the itch is associated with impacts similar to those of chronic pain. Patients sleep less and experience less restful sleep. This is associated with development of ADHD and poor school performance in children and difficulty with functioning at work in adults. Atopic dermatitis and sleep disruption is associated with significantly higher rates of depression and with suicidal thoughts. Clinicians should be asking about severity of itch, sleep loss, and screening for mental health issues.
Over half of respondents report feeling misunderstood or socially isolated—how can dermatologists and primary-care teams better screen for and address the emotional and mental-health fallout of chronic eczema?
This ties into the first question, patients are often open to talk about severe the impact on their quality of life and mental health but are often not asked; dermatologists and primary-care teams should try to ask about severity of itch, sleep loss, and screening for mental health issues.
The survey shows 79% find current treatments inadequate, yet only ~6% use advanced options like biologics—what are the main barriers to access and uptake in Canada—awareness, eligibility, cost, wait times—and how could those be fixed?
In Canada the largest barrier is in the public system most provinces only cover a single biologic therapy and two oral advanced systemic therapies. In British Columbia the situation is even more difficult for patients where the public system only covers two oral advanced systemics and no biologic therapies for atopic dermatitis. We need to have access to more advanced systemic options as different patients have different needs. A further barrier is the public systems in Canada largely requires patients to fail older systemic therapies before becoming eligible for advanced therapies. Many of these older systemic therapies have side effects that patients are unwilling to accept, and the patient is left with untreated atopic dermatitis.
Some primary care doctors are also not aware that there are new safe options, so they may not refer patients on to dermatology
For families and patients trying to manage flares at home—what practical, evidence-based strategies do you recommend to improve sleep and reduce symptom severity, and when should someone move from basic care to seeking specialist referral?
For general skin care, it is important to use a gentle cleanser rather than a traditional soap and to use a moisturiser regularly. Although many patients and families use antihistamines to treat the itch, the data does not support antihistamines actually helping the itch of the atopic dermatitis. The antihistamines can make people sleep but the sleep is not restful and sedating antihistamines likely disruption school performance in children and driving/work performance in adults.
Beyond moisturisers and gentle cleanser, it is important to seek medical care to directly treat the eczema to help improve symptoms and sleep loss.
If someone is not responding to topical therapy, this is often the trigger for referral on to a Dermatologist as this would be when one would consider systemic therapies.
During Eczema Awareness Month—what concrete policy or system changes would you prioritize to close treatment gaps—things like public funding for advanced therapies, provider education, or expanded telederm services—and how can journalists help amplify those asks?
I think the important system changes would be public funding of more advance therapies, eliminating step through of older therapies that patients are unwilling to take due to their side effect profiles and educating patients that there are new advanced therapies. Often patients have in the past been told there are no options to treat their atopic dermatitis and then stop following up with primary care. Once there is awareness of new safe and effective options, it can help then re-engage with the health care system. I also think it is important for journalists to educate the general public how much the itch of atopic dermatitis is debilitating. It is equivalent to being in constant pain and patients consequently have high rates of mental health issues and cannot function at work or in school. Often the people making funding decisions around medications have no sense of the severity of some peoples atopic dermatitis, and would never imagine that the impacts are like those of patients with chronic pain.
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