Management of Eczema
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Transcript of Management of Eczema
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
Atopic Eczema
• Increasing incidence• Affects approximately
1:5 children• Familial tendency • Associated with
asthma and hayfever• Most outgrow by the
age of 7yrs
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
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
Generalised severe eczema
• If good compliance and appropriate treatment, consider wet wraps
• TIP - check for scabies!
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
• 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