Download Paediatric Atopic Eczema

Teledermatology and
One Stop Assessment and Treatment Service (OATS)
Paediatric Atopic Eczema
Dr Monir Miah
020 7635 1019
[email protected]
www.dmchealthcare.co.uk
Top Tips For Use In Primary Care
Key Facts:
• Eczema affects around 20% of children.
• Usually starts in children between 3-12 months.
50% resolve by age 6, 90% by teenage years.
• A UK study of 1760 children with eczema found
that 84% had mild disease, 14% were classified as
moderate, and 2% had severe disease.
• Most treatments can be initiated successfully in
the community
• Treatment is for control not cure.
Top Tips For Use In Primary Care
• Topical steroids can be used without thinning the
skin if used appropriately.
• Poor compliance and steroid phobia are
commonest reasons for treatment failure.
• Weekend pulsed therapy with topical steroids in
children with stable eczema can significantly
increase disease free days and the time between
disease exacerbations.
• Infections with Staph aureus can cause disease
flares and treatment resistance.
Management of AE in the community
Advise patients and carers to:
• Use cotton clothing and bedding. Avoid wool
next to skin.
• Avoid hairy pets.
• Avoid close contact with people who have
active cold sores.
• Keep cool (fans on/radiators off).
Management of AE in the community
• Use ointments not creams when possible, and
apply in direction of hair growth.
• Use sparingly means put enough on to make
the skin glisten (fingertip unit rule).
• ‘Do not use on broken skin’ does not apply to
eczema – even if skin is scratched and
bleeding you can still treat safely.
• 1% hydrocortisone is safe to put on the face
despite what it says on the packaging.
Management of AE in the community
Emollients and Bathing :
• Avoid common skin irritants.
• Moisturise with a bland non perfumed
emollient 3-6 daily.
• Wash hair separately.
• Bathing is recommended once a day.
Management of AE in the community
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Ointments are more inert.
Use the greasiest moisturiser that is tolerated.
Give more than one moisturiser.
Give large quantities if possible (500g every 12 weeks if very dry skin).
• Never use aqueous cream as moisturiser
Management of AE in the community
Corticosteroids :
• Topical corticosteroids are grouped by
potency, and should be tailored to the severity
of the eczema.
• Flares are managed with short courses of
topical steroids.
• A proactive approach of twice weekly
application of a potent topical corticosteroid
(weekend therapy).
Management of AE in the community
Corticosteroids:
• Reduction of Itch is a key symptom for
evaluating response to treatment.
• The BNF defines recurrent eczema as >/= 4
flares a year.
Management of AE in the community
Antimicrobial treatments:
• Eczema flares are often attributable to
infection.
• Signs of bacterial infection include weeping,
crusts, pustules, failure to respond to
treatment, and rapidly worsening eczema.
• Combined corticosteroid and antimicrobial
ointments (e.g Fucidin HC) can be used for
short periods (1-2 weeks) in infected eczema.
Management of AE in the community
• Treat large areas of infected eczema with
flucloxacillin for 1-2 weeks.
• Consider 3 month prophylactic oral
flucloxacillin bd in patients with recurrent
infected exacerbations.
• An antiseptic soap substitute (e.g Dermol 600
lotion) may be useful in decreasing the
severity and recurrence of eczema.
Management of AE in the community
Antihistamines:
• Sedating oral antihistamines at night may be
useful during flares with sleep disturbance
and is safe in under 2s (as an off licence
prescription).
Management of AE in the community
Allergens and eczema:
• Children with atopic eczema are more likely to have
Type 1 allergic reactions, but this is separate from their
eczema.
• Type I allergy tests (Skin prick and RAST) may have high
false positives, and do not always reflect the allergen's
effect on atopic eczema.
• Occasionally food can flare eczema in a delayed fashion
occurring 6-24 hours after consumption of the food
allergen (eg milk, eggs or wheat). This usually occurs in
under ones. All Type 1 allergy tests are negative as the
exact mechanism for this allergy is not known.
When to refer patients to secondary
care dermatology
• Eczema herpeticum (emergency referral by telephone)
• Acute erythrodermic eczema (emergency referral by
telephone)
• Eczema not satisfactorily controlled by the above
measures
• Severe eczema or uncontrolled recurrent infected
eczema
• Refer patients with suspected moderate or severe Type
1 food allergy, multiple food allergies or growth
retardation to a paediatric allergist.
Thank you
Contact details:
020 7635 1019
[email protected]
www.dmchealthcare.co.uk