64
SKIN CARE TODAY
2015,Vol 1, No 1
FOCUS ON CHILDHOOD ECZEMA
i
has not been controlled by optimal
treatment should be referred for
specialist investigation to identify
possible food and other allergies.
Identifying triggers can be very
useful for those with moderate-to-
severe eczema (a list of triggers was
given in Statement 1.) However,
managing eczema simply by avoiding
triggers is only part of the story and
certain triggers cannot be ignored.
For instance, any suspicion of cows’
milk allergy must be explored in
babies under six months who have
severe eczema that fails to respond
to treatment (NHS Choices, 2014).
In these cases, a 4–8-week period of
replacing formula milk with a low
allergenic‘hydrolysed’formula (such
as Nutramigen
®
[Mead Johnson
Nutrition]; or Neocate
®
[Nutricia])
can be prescribed.
Apart from cows’milk, the most
common foodstuffs which may
worsen eczema through a delayed
allergic reaction are eggs or wheat
(Motala, 2015). There are other
types of food, e.g. tomatoes, which
can have a contact irritant effect on
eczema, often seen as a flare around
the mouth in weaned toddlers who
are‘teething’or‘drooling’a lot.
Some carers — suspecting that
food is a significant component in
children’s eczema — may attempt an
exclusion diet without expert input.
Since a well-balanced diet is critical
for a growing child, they should be
encouraged to discuss this before
taking action and referred for dietetic
advice if appropriate.
QUALITY STANDARD
STATEMENT 7
Children with atopic eczema who have
suspected eczema herpeticum should
receive immediate treatment with
systemic aciclovir and be referred
for same-day specialist dermatological
advice.
Eczema herpeticum (British
Association of Dermatologists [BAD],
2014) is an infection usually caused
by the herpes simplex virus and
manifests through the widespread
development of cold sores. It can be
potentially fatal if untreated. Eczema
is an umbrella term for a range of
skin conditions and some genetic
variants have a greater susceptibility
to eczema herpeticum (Healio, 2014).
Infection
Eczematous skin is more susceptible
to infection because of breaks in
the skin. Infections can be viral (like
eczema herpeticum), fungal
or bacterial.
At every consultation, patients
should be educated in how to
recognise the signs and symptoms
of bacterial infections (
staphylococcus
and/or
streptococcus)
, which
commonly cause eczema to flare,
including:
i
‘Weeping’ or leakage of fluid
i
Pustules
i
Crusts
i
Where atopic eczema fails to
respond to therapy
i
Rapidly worsening atopic eczema
i
Fever
i
Discomfort, such as pain, swelling
or‘heat’.
Clinicians should be aware of how
to access appropriate treatment when
a child’s atopic eczema does become
infected. However, it is usually only
when these infections become severe
or frequent that a referral might
be required.
AREAS NOT COVERED BY THE
QUALITY STANDARDS
Preventing eczema was not
considered to be within the scope of
Table 4:
3UDFWLFDO WLSV IRU HPROOLHQW XVH IRU FDUHUV 16*&&( F
Emollients are an important part of managing the dry skin associated with atopic eczema
Emollients will help to protect the skin from outside irritants such as cold weather, water and detergents
If a child does not like a particular emollient or it irritates the skin, a different one should be tried
Nurses can demonstrate how to put the emollient on
If any other treatment is being put on the skin at the same time of day, it does not matter which is applied
first. At least 30 minutes should be left between applying emollients and other treatments
Always keep plenty of emollients. Get a refill from the doctor or chemist when a tub is quarter-full
Emollients need to be used regularly throughout the day and not only when the skin looks bad
As with other creams, apply in the direction of the hair as it lies on the skin. This prevents folliculitis
(blocked and inflamed hair follicles)
When using a bath oil or shower product, use a bath mat to prevent slipping
Aqueous cream should not be used as a leave-on emollient or as a wash product
Table 5:
5HIHUUDO FULWHULD IURP WKH 1,&(
FKLOGKRRG HF]HPD JXLGHOLQH
5HIHUUDO LV UHFRPPHQGHG IRU FKLOGUHQ ZLWK DWRSLF HF]HPD LI
The diagnosis is, or has become, uncertain
Management has not controlled the atopic eczema satisfactorily based on a subjective assessment by
the child, parent or carer (for example, the child is having 1–2 weeks of flares per month, or is reacting
adversely to many emollients)
Atopic eczema on the face has not responded to appropriate treatment
The child or parent/carer may benefit from specialist advice on treatment application (for example,
bandaging techniques)
Contact allergic dermatitis is suspected (for example, persistent atopic eczema or facial, eyelid or
hand atopic eczema)
The atopic eczema is giving rise to significant social or psychological problems for the child or parent/carer
(for example, sleep disturbance, poor school attendance)
Atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia
Did you know:
(
czema may cause
food allergies as well as
sometimes being driven by
them (Lo, 2014).
