Moisturisers Emollients tend to increase the efficiency of the epidermis Barrier function Enhance the effects of emollients with occlusion - bandages, wet wraps
Bath Oils or Soap Substitutes Bath additives – use daily Oily preparations Float on water or emulsion Increasingly soap substitutes preferred
Steroids Available in 4 strengths mild - e.g. hydrocortisone moderate - e.g. eumovate potent - e.g. cutivate, betnovate very potent - e.g. dermovate
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?
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
Aqueous Cream Not suitable as a moisturiser Only prescribe as a soap substitute
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!!
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
Top Tips Explain that very dry skin takes pale scaly apearance Any water based emollients may sting dry skin Ointment soap substitute before bath
Don’t Don’t alter diet Don’t use soaps Don’t bother with housedust mite measures Don’t advise allergy tests
Olive Oil Contraindicated on the skin Damages the barrier function of stratum corneum Use mineral oil or sunflower oil
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.
Treatment Viscopaste bandages Coban or actifast Offer variety of emollients - cream form Antibiotics?
Occlusive bandages Hands before treatment and one week after treatment with occlusive bandages, eumovate and flucloxacillin
Hands Viscopaste to individual fingers or wet mitts over emollients
Generalised severe eczema If good compliance and appropriate treatment, consider wet wraps TIP - check for scabies!
Wet Wraps Steroids and emollients under damp bandages Ready made garments
Prognosis Poor: Severe disease in childhood, family history, asthma, rhinitis, late onset (after 2 yrs), atypical pattern, hand involvement, xerosis
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.
Steroid Quantities 1 finger tip unit (f.t.u.) = 1/2g = 2 adult hand ’ s worth of eczema
Steroid quantities Twice daily application of steroid all over 6 month old = 9.5g daily = 66.5g weekly 4 year old = 19.25g daily = 134.75g weekly 7 year old = 24.5g daily = 171.5g weekly
Typical Daily Routine 07.20 Wash (soap substitute) 07.30 Steroid to all patches 08.00 Moisturiser all over 12.00 Moisturiser all over 15.30 Moisturiser all over 18.30 Bath with oil / soap substitute 18.45 Steroid to all patches 19.15 Moisturiser all over
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
What would you do? Known eczema patient. Flare last three days. Treated with cutivate. Generally unwell.
Eczema Herpeticum Dermatology emergency Stop steroids Acyclovir - oral or iv Opthalmic opinion Admit if unwell