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Guidelines for the management of atopic eczema in children

Guidelines for the management of atopic eczema in children

Postby eczemaliving » Wed Oct 23, 2019 8:57 am

History and examination
Focused history
• Age on onset
• Triggers
• Family history of atopy
• Quality of life assessment (sleep disturbance/school attendance/poor concentration) Examine
• Distribution, severity, morphology – dry skin, redness, excoriation, lichenification, co-existing infection Exclude
• Symptoms or signs suggestive of eczema herpeticum (acute tender punched out lesions) – contact Dermatology SPR on call for advice
• Symptoms or signs of secondary bacterial infection – send bacterial swab and consider oral antibiotics (Flucloxacillin first line if no penicillin allergy)

Image

General considerations

Ensure liberal supply of emollient of preference (250-500g every week). The choice of emollient should be according to patient preference –

    see CCG emollient guidelines
    Emollients should be applied in a downward direction following the direction of hair growth with clean hands.
    Emollient sprays can be useful for children during school hours and before swimming but be careful with slipping
    Avoid irritants (e.g soaps/ SLS/bubble baths) and prescribe a soap substitute to wash as well as a bath oil

Reduce Staph. aureus load (e.g bleach baths twice a week, Dermol washes) especially if history of recurrent infections

Guidance for prescription and management

Mild eczema

For acute flares apply a topical steroid (e.g.
Hydrocortisone) daily for at least two weeks

Consider maintenance treatment with twice

weekly consecutive days applications

Moderate eczema

For acute flares apply a topical moderately
potent steroid (e.g. clobetsone) daily for at least
two weeks.
Consider topical calcineurin inhibitors e.g.

tacrolimus ointment (can contact via KINESIS

(Advice & Guidance) for specialist advice if

needed). Consider maintenance treatment with

twice weekly consecutive days applications.
Moderate eczema
For acute flares apply a topical moderately
potent steroid (e.g. clobetsone) daily for at least
two weeks.
Consider topical calcineurin inhibitors e.g.
tacrolimus ointment (can contact via KINESIS

(Advice & Guidance) for specialist advice if
needed). Consider maintenance treatment with
twice weekly consecutive days applications.


Severe eczema

For acute flares apply a topical potent steroid
(e.g. mometasone) daily for at least two weeks.
Consider topical calcineurin inhibitors e.g.
tacrolimus ointment(can contact via KINESIS

(Advice & Guidance) for specialist advice if

needed). Consider maintenance treatment with

twice weekly consecutive days applications.

Image

1. In general use steroid ointments rather than creams
2. Use mild potency steroids for the face and neck apart from short term use of moderate potency (eg Eumavate) for severe flares
3. Use moderate potency for short periods eg 14 days for vulnerable sites such as groin and axillae
4. Topical tacrolimus and pimecrolimus are licensed for 2 years and over in moderately severe eczema
1. Advise cautious use at initiation due to known irritation (‘stinging-like’), should lessen with recurrent use
2. Increase the surface area as tolerated
3. Avoid use prior to exposure to sunlight
5. Antihistamines are not effective in the management of atopic dermatitis in children and should not be prescribed routinely
6. Wet wrapping should only be initiated by clinicians trained in their use or via Specialist Derm CNS advice
7. In those patients using wet wraps, should be advised to avoid if clinical signs of infection
8. Consider a diagnosis of food allergy and referral to Allergy Services for testing and dietician input if
1. reacted previously to a food with immediate symptoms,

2. moderate or severe atopic eczema that has not been controlled by optimum management, particularly if associated with gut dysmotility (colic, vomiting, altered bowel habit) or failure to thrive
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Re: Guidelines for the management of atopic eczema in childr

Postby alvinrr » Sat Feb 08, 2020 3:32 am

I hope my child won't have this kind of skin problem.
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Re: Guidelines for the management of atopic eczema in childr

Postby alvinrr » Fri Mar 06, 2020 4:17 pm

The most common form of eczema is called atopic dermatitis. Children with eczema develop red, dry, itchy patches on the skin that result from inflammation. Itching may be severe and constant. With frequent scratching, the skin may develop blisters, oozing, crusting, or sores from infection.

Depending on the severity of symptoms, atopic dermatitis can be treated with topical medications, which are applied to the skin; phototherapy, a form of light treatment; and immunosuppressant drugs that curb the immune system. Read more about common treatments for children with atopic dermatitis.

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Re: Guidelines for the management of atopic eczema in childr

Postby avriellea29 » Thu Mar 12, 2020 8:51 am

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Re: Guidelines for the management of atopic eczema in childr

Postby bodav142774 » Fri Mar 20, 2020 4:05 am

Thanks for posting this guidelines. Business Brokering
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Re: Guidelines for the management of atopic eczema in childr

Postby horeakaii » Mon Apr 20, 2020 4:44 pm

My son had this condition since last year and it really is a struggle dealing with it.

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Re: Guidelines for the management of atopic eczema in childr

Postby JamesP » Mon May 18, 2020 2:45 pm

My daughter has this condition and it has been quite difficult. We have tried altering her diet among other strategies.

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Re: Guidelines for the management of atopic eczema in childr

Postby saeed20 » Fri May 29, 2020 2:16 pm

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Re: Guidelines for the management of atopic eczema in childr

Postby JamesP » Thu Jun 25, 2020 12:32 am

Thanks for this great resource. I keep coming back to this page to see which new symptoms might be related to my daughter's eczema.

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Re: Guidelines for the management of atopic eczema in childr

Postby lakendria » Mon Jun 29, 2020 11:01 am

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