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By National Collaborating Centre for Women's and Children's Health (Great Britain)

ISBN-10: 190475242X

ISBN-13: 9781904752424

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Additional info for Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth Up to the Age of 12 Years

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Chapter 7 Treatment Stepped approach to management How should flares of atopic eczema be defined/recognised, what pattern do they take and how useful is this to clinical practice? Why this is important Atopic eczema is an episodic disease punctuated by flares and remissions in most cases. It is important to be able to recognise the onset of a flare for children and their parents so that treat­ ment can be given promptly and effectively thus improving quality of life and care. It would also aid decisions on clinical treatment strategies and provide an effective outcome measure for research purposes.

Why this is important Around 70–80% of parents and carers of children with atopic eczema are concerned about the side effects of topical corticosteroids and this often prevents adherence to therapy (at least 25% of parents and carers report non-usage because of anxiety). Despite the fact that topical cortico­steroids have been in clinical use since 1962, there are limited data on their long-term effects (greater than a few weeks) on skin thickness, hypothalamic–pituitary–adrenal (HPA) axis suppression and other side effects.

Healthcare professionals should be aware that in Asian, black Caribbean and black African children, atopic eczema can affect the extensor surfaces rather than the flexures, and discoid (circular) or follicular (around hair follicles) patterns may be more common. 4). There is not necessarily a direct relationship between the severity of the atopic eczema and the impact of the atopic eczema on quality of life. 4 Holistic assessment Skin/physical severity Impact on quality of life and psychosocial wellbeing Clear Normal skin, no evidence of active atopic eczema None No impact on quality of life Mild Areas of dry skin, infrequent itching (with or without small areas of redness) Mild Little impact on everyday activities, sleep and psychosocial wellbeing Moderate Areas of dry skin, frequent itching, redness (with or without excoriation and localised skin thickening) Moderate Moderate impact on everyday activities and psychosocial wellbeing, frequently disturbed sleep Severe Severe Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation) Severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep Healthcare professionals should explain the overall physical severity of a child’s atopic eczema to the child and their parents or carers.

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Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth Up to the Age of 12 Years by National Collaborating Centre for Women's and Children's Health (Great Britain)

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