Skin Conditions and Mental Health

Rachael Maskell Excerpts

Tuesday 25th January 2022 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

Thank you for calling me in this debate, Mr Gray. I also thank the right hon. Member for Gainsborough (Sir Edward Leigh) for bringing this issue to the Floor of the House.

I want to raise the case of one of my constituents who experienced topical steroid withdrawal and the side effects of that as a result of the treatment she received for her eczema. I very much concur with the conclusions of the right hon. Member for Gainsborough on the steps that now need to be taken, not least in instituting mental health support in the care pathway.

Having been prescribed topical corticosteroid medicines over a long time, my constituent experienced a very severe reaction upon withdrawal that caused far worse symptoms than those her eczema preparations were intended to treat. The nerve pain was unbearable and inescapable; the skin split and bled; it was sore and painful. The oedema impacted on her care and was debilitating in itself. Those symptoms, exacerbated by the insomnia she experienced and by not going out—being housebound—therefore had a massive toll on her mental health.

The Medicines and Healthcare products Regulatory Agency and the Commission on Human Medicines have reviewed the impact of withdrawal and the over-prescribing of those preparations, which they often are because people need to treat their skin condition continually. As a result of an investigation under the yellow card system, they identified how poorly managed the condition is and how little known.

It comes back to the need for education around dermatology. At each GP practice, there should be a doctor who not only specialises in dermatology but has a good understanding of topical steroid withdrawal, who can therefore manage the pathway of patients. Patients should regularly see their GP for a review of the application of their medicine. It is even harder to trace what happens because there is no coding for this condition. We need to see coding to help to trace exactly what is happening. However, without proper research and investment in research into dermatological conditions, alternative preparations for the treatment of skin conditions are not being advanced at the pace that they should.

The debilitating process that my constituent suffered over not just days and weeks but months and years had a massive impact on her mental health. Depression is one of the side effects listed for these preparations. However, there is no point listing such conditions in the small print; we need to ensure that those side effects do not happen in the first place. We therefore need to ensure a proper review process within the education given to patients and the availability of other services.

That is why I support IAPT—improving access to psychological therapies—services being made available to people undergoing this treatment so that they can get the support they need. It is also worth noting that 81% of the people who experience topical steroid withdrawal are women; I notice that imbalance across healthcare and I will raise it every time. We continually fail on women’s health, and that needs to be looked at specifically.

Finally, I would like to say that there is good support from charitable organisations. Globally, the International Topical Steroid Awareness Network is looking at this issue, as well as Scratch That—I know it is quite a name for a charity—which does fantastic work supporting people and building a network, particularly to help people with their mental health issues. It suggests that it can advance support by building a community, but also by giving people hope. People with a debilitating illness often particularly need hope. I trust that a proper pathway for people with TSW—but, more importantly, prevention—will be developed.