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Management of Eczema Practical approach Heulwen Wyatt R.G.N. R.S.C.N. Dip. Prof. Prac. (Derm) MSc Clinical Nurse Specialist in Paediatric Dermatology.

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Presentation on theme: "Management of Eczema Practical approach Heulwen Wyatt R.G.N. R.S.C.N. Dip. Prof. Prac. (Derm) MSc Clinical Nurse Specialist in Paediatric Dermatology."— Presentation transcript:

1 Management of Eczema Practical approach Heulwen Wyatt R.G.N. R.S.C.N. Dip. Prof. Prac. (Derm) MSc Clinical Nurse Specialist in Paediatric Dermatology

2 Atopic Eczema Increasing incidence Affects approximately 1:5 children Familial tendency Associated with asthma and hayfever Most outgrow by the age of 7yrs

3 Normal Barrier Function

4 Increased trans-epithelial water loss

5 Role of steroids

6 Role of Emollients

7 Moisturisers Emollients tend to increase the efficiency of the epidermis Barrier function Enhance the effects of emollients with occlusion - bandages, wet wraps

8 Bath Oils or Soap Substitutes Bath additives – use daily Oily preparations Float on water or emulsion Increasingly soap substitutes preferred

9 Steroids Available in 4 strengths mild - e.g. hydrocortisone moderate - e.g. eumovate potent - e.g. cutivate, betnovate very potent - e.g. dermovate

10 9 month baby Seen 2 months ago and given 500g Aqueous cream, 60g Hydrocortisone 1% cream. Never clear, awake every night. What would you prescribe?

11 Treatment Swabs, Flucloxacillin Eumovate ointment 200g for 4 week peroid 1kg emollient Soap substitute or bath oil TIP - split base of earlobe first sign eczema in many babies - avoid soaps

12 Aqueous Cream Not suitable as a moisturiser Only prescribe as a soap substitute

13 Facial Eczema in Children Calm down skin with steroids Immunomodulators Reduce stinging by using both steroids and immunomodulators for five days Remember – Tomato sauces and baby wipes!!

14 How would you approach management? 2 year old with extensive low grade eczema Skin very dry Mum states he’s allergic to all moisturisers as skin goes red and he screams Refuses to go in bath

15 Top Tips Explain that very dry skin takes pale scaly apearance Any water based emollients may sting dry skin Ointment soap substitute before bath

16 Don’t Don’t alter diet Don’t use soaps Don’t bother with housedust mite measures Don’t advise allergy tests

17 Olive Oil Contraindicated on the skin Damages the barrier function of stratum corneum Use mineral oil or sunflower oil

18 7yr old with eczema since aged 1 Used Eumovate ointment daily for 2 weeks Scratching at night Has ointment emollient but won ’ t use it as makes skin feel sticky.

19 Treatment Viscopaste bandages Coban or actifast Offer variety of emollients - cream form Antibiotics?

20 Occlusive bandages Hands before treatment and one week after treatment with occlusive bandages, eumovate and flucloxacillin

21 Hands Viscopaste to individual fingers or wet mitts over emollients

22 Generalised severe eczema If good compliance and appropriate treatment, consider wet wraps TIP - check for scabies!

23 Wet Wraps Steroids and emollients under damp bandages Ready made garments

24 Prognosis Poor: Severe disease in childhood, family history, asthma, rhinitis, late onset (after 2 yrs), atypical pattern, hand involvement, xerosis

25 STEROIDS - cream or ointment? Ointment (oil based) - steroid of choice. Less additives. Helps re-hydrate the skin. Cream (water based) - use on weeping eczema or when cosmetic acceptability is an issue.

26 Steroid Quantities 1 finger tip unit (f.t.u.) = 1/2g = 2 adult hand ’ s worth of eczema

27 Steroid quantities Twice daily application of steroid all over 6 month old = 9.5g daily = 66.5g weekly 4 year old = 19.25g daily = g weekly 7 year old = 24.5g daily = 171.5g weekly

28 Typical Daily Routine Wash (soap substitute) Steroid to all patches Moisturiser all over Moisturiser all over Moisturiser all over Bath with oil / soap substitute Steroid to all patches Moisturiser all over

29 Typical Month ’ s Prescription Example - extensive flare of moderate eczema in a 3 year old Moisturiser - 1.5kg Soap substitute - 500g Bath oil - 500mls Steroid - 300g +/- antibiotics, bandages etc

30 What would you do? Known eczema patient. Flare last three days. Treated with cutivate. Generally unwell.

31 Eczema Herpeticum Dermatology emergency Stop steroids Acyclovir - oral or iv Opthalmic opinion Admit if unwell

32 Happy customers


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