Eczema, Atopic (Paediatric)

Presentation

Atopic eczema may present as cradle cap in babies, before spreading to face, skin creases and extensor limb surfaces  then  flexural sites .  Rapid and early control is beneficial to long term outlook. May improve with advancing age.

 

 

 

 

Eczema Herpeticum

consider if any acute vesicular and painful flare.

Management

Topical Steroids:

  • Prescribe a mild (face) and moderate (body) steroid in ointment form.
  • Consider potent topical steroid to body in over 2’s
  • Advise on fingertip units .
  • Simultaneous application of emollients and topical steroid may reduce potency of steroid , advise a delay before steroid
  • Reduce topical steroid to twice weekly maintenance when improved.

Emollients:

Consider Prescribing  an ointment  to use in the evening (if steroid used, apply after a suitable interval ) and a cream  to use in the morning. Ointments may cause less ‘stinging’ in inflamed skin. Discuss with  patient/parent  which  he/she prefers and will use regularly.

Prescribe adequate quantities of emollients for daily use

Soap substitutes and bath emollients:

Soaps, shower gels and bubble baths are very irritant and should ALWAYS be avoided.

Prescribe a bath additive or shower emollient instead which can also be used to wash hair.

 

Eczema Herpeticum

  • Stop topical steroids/tacrolimus and urgent referral
  • Urgent viral PCR swab if available.
  • consider if any acute vesicular and painful flare.
Referral

Eczema not controlled (2+flares per month) despite maintenance and flare treatment with hydrocortisone to face and moderately potent steroid (up to 1 year) or potent steroid (in 1 year+) to trunk/limbs.

Eczema causing severe psychological or social difficulties

Diagnosis uncertain

History of GI symptoms with severe widespread eczema not responding to topical steroids start on extensively hydrolysed formula and refer.

Eczema Herpeticum:

Contact Dermatology department immediately for advice.

Therapeutic Tips
    • Systemic antibiotics are only indicated if patient is systemically unwell
    • Reassure patients that topical steroids are safe and effective if used as described.
    • Ointments are preferable to creams.
    • The vast majority of children with mild-moderate eczema that respond to treatment do not have food allergy.
    • Light cotton or silk garments are available on prescription and can prevent scratching, help treatments to soak in and avoid staining of bedding and clothing.
    • consider eczema herpeticum where there is an acute blistering flare of eczema, pain, fever and patient is unwell.
Patient Information

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