Download Atopic Eczema

Nice guide lines 2007
ATOPIC ECZEMA
Diagnosis
 Itching plus 3 or more of
 Visible flexural dermatitis involving skin creases,
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cheeks or extensor surfaces
History of flexural dermatitis involving skin
creases, cheeks or extensor surfaces
History of dry skin in last year
History of atopic disease (asthma rhinitis eczema)
in first degree relative aged < 4yrs
Onset under 2 yrs (use only in those > 4 yrs at
diagnosis
Assessment of severity
 Clear – normal skin no evidence of active atopic
eczema
 Mild – areas of dry skin, frequent itching +- small
areas of redness
 Moderate - areas of dry skin, frequent itching,
redness, +- excoriation and localised thickening.
 Severe – widespread areas of dry skin, incessant
itching, redness (+- excoriation, extensive skin
thickening, bleeding, oozing, cracking.
Impact on quality of life
 None – no impact on quality of life
 Mild – little impact on everyday activities,
sleep and psychosocial well being
 Moderate - Moderate impact on everyday
activities, psychosocial well being, frequently
disturbed sleep
 Severe – severe limitation of everyday
activities and psychosocial well being, loss of
sleep every night
Holistic approach
 Take account of
 Physical severity of eczema
 Impact on quality of life
 Psychosocial functioning
 Any loss of sleep
 No direct correlation between physical
severity of eczema and impact on quality of
life
Management
 Identify trigger factors
 Irritants – soaps and detergents
 Contact allergens
 Food allergens
 Inhalant allergens
 Skin infections
 Refer for specialist advice when necessary
Stepped treatment
 Tailor treatment to severity
 Start with emollients – should be used even when
skin clear
 Mild disease – emollients + mild steroid creams
1% hydrocortisone
 Moderate disease – emollients + moderate steroid
creams. Topical calcineurin inhibitors, bandages.
 Severe disease – potent steroid creams (short
periods only) topical calcineurin inhibitors,
bandages, phototherapy, systemic therapy
Management
 Use topical antibiotics + steroid for localised
infection for no longer than 2 weeks
 Non-sedating antihistamines if eczema is
severe or severe itching or urticaria
 Sedating antihistamines children aged > 6/12
during acute flares if sleep disturbance for
child or carers.
 Recognise indications for referral
Indications for referral
 Immediate (same day)
 if eczema herpeticum suspected
 Urgent (within 2 weeks)
 If severe and not responded to optimal
treatment for 1 week
 Treatment of bacterial infected eczema
has failed
Indications for referral
 Routine referral
 Diagnosis uncertain
 Eczema on face not responded
 Eczema is associated with sever recurrent
infections
 Contact allergic eczema suspected
 Causing serious social or psychological problems
for child or carers
 Eczema not controlled to the satisfaction of carers
or child
Education and information
 Explain cause and course of disease
 Demonstrate quantities and frequency of
treatments
 Inform symptoms and signs of bacterial
infections
 How to recognise eczema herpeticum
 Ask about use of complementary therapies
explain have not be assessed for safety. Should
continue to use emollients as well as
complimentary therapies
Overcoming
 Discuss parental anxieties about treatments
explain benefits of steroids outweigh possible
harms
 Written care plans including management of
flare ups and infections
 Explain when topical steroids and other
treatments are indicated