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ECZEMA
NICE
Guidelines 2007
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Management:
General Measures
1. Adopt an holistic approach
– severity
– quality of life
– impact on activities / sleep
2. Identify and manage trigger factors
– irritants
– skin infections
– food / inhalent allergens
3. General measures
– keep fingernails short
– Avoid perfumed / lathering products
– ? Role for antihistamines
Management -
a stepped approach
1. EMOLLIENTS
• moisturising, washing, bathing
• combination of products or one for all
2.TOPICAL STEROIDS
• Tailor potency to severity & body site
• Short term use
3. INFECTIVE EXACERBATIONS
• Recognition
1. How to access appropriate treatment
• Special reference to recognition of eczema herpeticum
•EDUCATION
1. Patient & Parents
• Verbal & Written
• Practical demonstrations
Other Forms of Rx
• Antihistamines
– Not for routine use
– trial of non sedating if severe itching
– consider 1-2 week trial of sedating if significant sleep
disturbance
• Bandages & Dressing
– localised medicated or dry dressings
– NOT for infected areas
• Topical calcineurin inhibitors
– tacrolimus and pimecrolimus
– NOT for mild eczema or as 1st line
– Children aged >2 yrs
• Phototherapy & Systemic treatments
Management -
Dermatological Referral
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Infected Eczema
• Lesions can become infected
– staphylococcus +/or streptococcus (usually)
• Characterised by:
– weeping,
– crusts, pustules,
– failure to respond to treatment,
– fever,malaise and possibly sepsis
• Start treatment as soon as possible and continue for 48
hrs after symptoms subside
• Topical antibiotics for localised infection
• Systemic antibiotics if widespread or not responding
– Flucloxacillin (Erythromycin / Clarithromycin)
• If coexisting with a flare,consider topical steroid or
steroid/abx combinations (eg fucibet)
Eczema Herpeticum
• Consider HSV infection
– areas of rapidly worsening, painful eczema
– fever, lethargy, distress
– clustered cold sore - like blisters
– punched out erosions which may coalesce & crust
– not responding to usual treatment
• Treat with systemic aciclovir immediately
– +/- antibiotics
• Consider opthalmological / dermatological advice
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NICE Guidelines 2007
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NICE Guidelines 2007
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ALLERGY
• Consider food allergy
– immediate reaction to a food
– moderate / severe uncontrolled atopic eczema
– above + history of gut dysmotility or failure to thrive
• Consider inhalent allergy
– seasonal flares
– associated asthma, rhinitis
– >3 yrs with facial eczema
• consider allergic contact dermatitis
– previously controlled
– reaction to topical treatments
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ALLERGY 2
• Offer 6-8 week trial of extensively hydrolysed or amino
acid formula in bottle fed infants < 6 months with
uncontrolled > moderate eczema
• Avoid partially hydrolysed, soya protein or other species
milk if suspect CMPI
• It is not known if altering a breastfeeding mother’s diet is
effective in reducing the severity of symptoms but can
consider a trial if strongly suspect
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• NICE Guidelines 2007
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Acknowledgements
• NICE Guideline- CG57
• emedicine.org
• Cks.nhs.uk