Atopic Eczema
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Transcript Atopic Eczema
Nice guide lines 2007
ATOPIC ECZEMA
Diagnosis
Itching plus 3 or more of
Visible flexural dermatitis involving skin creases,
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