1. Paediatric Atopic Eczema
Teledermatology and
One Stop Assessment and Treatment Service (OATS)
Paediatric Atopic Eczema
Dr Monir Miah

2. Top Tips For Use In Primary Care
Key Facts:
Eczema affects around 20% of children.
Usually starts in children between 3-12 months. 50% resolve by age 6, 90% by teenage years.
A UK study of 1760 children with eczema found that 84% had mild disease, 14% were classified as moderate, and 2% had severe disease.
Most treatments can be initiated successfully in the community
Treatment is for control not cure.

3. Top Tips For Use In Primary Care
Topical steroids can be used without thinning the skin if used appropriately.
Poor compliance and steroid phobia are commonest reasons for treatment failure.
Weekend pulsed therapy with topical steroids in children with stable eczema can significantly increase disease free days and the time between disease exacerbations.
Infections with Staph aureus can cause disease flares and treatment resistance.

4. Management of AE in the community
Advise patients and carers to:
Use cotton clothing and bedding. Avoid wool next to skin.
Avoid hairy pets.
Avoid close contact with people who have active cold sores.
Keep cool (fans on/radiators off).

5. Management of AE in the community
Use ointments not creams when possible, and apply in direction of hair growth.
Use sparingly means put enough on to make the skin glisten (fingertip unit rule).
‘Do not use on broken skin’ does not apply to eczema – even if skin is scratched and bleeding you can still treat safely.
1% hydrocortisone is safe to put on the face despite what it says on the packaging.

6. Management of AE in the community
Emollients and Bathing :
Avoid common skin irritants.
Moisturise with a bland non perfumed emollient 3-6 daily.
Wash hair separately.
Bathing is recommended once a day.

7. Management of AE in the community
Ointments are more inert.
Use the greasiest moisturiser that is tolerated.
Give more than one moisturiser.
Give large quantities if possible (500g every 1-2 weeks if very dry skin).
Never use aqueous cream as moisturiser

8. Management of AE in the community
Corticosteroids :
Topical corticosteroids are grouped by potency, and should be tailored to the severity of the eczema.
Flares are managed with short courses of topical steroids.
A proactive approach of twice weekly application of a potent topical corticosteroid (weekend therapy).

9. Management of AE in the community
Corticosteroids:
Reduction of Itch is a key symptom for evaluating response to treatment.
The BNF defines recurrent eczema as >/= 4 flares a year.

10. Management of AE in the community
Antimicrobial treatments:
Eczema flares are often attributable to infection.
Signs of bacterial infection include weeping, crusts, pustules, failure to respond to treatment, and rapidly worsening eczema.
Combined corticosteroid and antimicrobial ointments (e.g Fucidin HC) can be used for short periods (1-2 weeks) in infected eczema.

11. Management of AE in the community
Treat large areas of infected eczema with flucloxacillin for 1-2 weeks.
Consider 3 month prophylactic oral flucloxacillin bd in patients with recurrent infected exacerbations.
An antiseptic soap substitute (e.g Dermol 600 lotion) may be useful in decreasing the severity and recurrence of eczema.

12. Management of AE in the community
Antihistamines:
Sedating oral antihistamines at night may be useful during flares with sleep disturbance and is safe in under 2s (as an off licence prescription).

13. Management of AE in the community
Allergens and eczema:
Children with atopic eczema are more likely to have Type 1 allergic reactions, but this is separate from their eczema.
Type I allergy tests (Skin prick and RAST) may have high false positives, and do not always reflect the allergen's effect on atopic eczema.
Occasionally food can flare eczema in a delayed fashion occurring 6-24 hours after consumption of the food allergen (eg milk, eggs or wheat). This usually occurs in under ones. All Type 1 allergy tests are negative as the exact mechanism for this allergy is not known.

14. When to refer patients to secondary care dermatology
Eczema herpeticum (emergency referral by telephone)
Acute erythrodermic eczema (emergency referral by telephone)
Eczema not satisfactorily controlled by the above measures
Severe eczema or uncontrolled recurrent infected eczema
Refer patients with suspected moderate or severe Type 1 food allergy, multiple food allergies or growth retardation to a paediatric allergist.

15. Thank you
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