Julie Van Onselen provides a guide to understanding more about childhood atopic eczema and assessment
Atopic eczema is a genetic skin condition with an immunological basis, triggered by environmental factors, which usually starts in childhood.
Around 20% of children aged under 11 years are affected by the condition, and 60% of those with atopic eczema develop it in the first six months of life. Atopic eczema can continue into adulthood as a long-term relapsing and remitting chronic condition, which can be severe and debilitating.
This learning module reflects the new NICE guidance and will help you understand more about childhood atopic eczema and assessment, and gain confidence on advising and supporting parents/carers and children with atopic eczema.
Atopic eczema is a long-term condition, so at any severity, there are chronic, acute and sub-acute stages.
The acute stage is often described as an eczema flare; the skin is inflamed, with superficial oedema and vesicles, causing weepy skin, and itch is predominant, causing irritability and sleep loss. In the acute stage, skin infections may be present and exacerbating the eczema flare.
In the sub-acute stage, the eczema flare subsides and oedema and vesicles diminish, but inflammation remains, crusting and scaling are often present, itch is still present, and sleep is often disturbed.
In the chronic stage, inflammation is no longer present, but itch is still a feature and may become a habit, leading to lichenification; the skin remains dry and often scaly.
All children with atopic eczema should have regular reviews with a healthcare professional.
When atopic eczema is diagnosed a holistic assessment should include full skin examination, areas of the body affected by eczema, severity and eczema stage should be recorded. A detailed patient history should be taken to include general health, past medical history, current medications, and triggers – such as irritants/allergies.
Always ask general questions on skin care – past and current topical treatments, including any health remedies and personal hygiene products. It is important to ask about regular skin care routines and how skin treatments are applied, how long for and effectiveness of treatment.
- All primary care health care professionals will see children and their parents/carers with atopic eczema
- It is important to be aware of evidence-based treatment pathways, know how to support patients and educate on treatment
- If atopic eczema is not responding to primary care treatments, or the child quality of life is severely impacted, a secondary care referral should be made
Julie Van Onselen, dermatology lecturer practitioner, Dermatology Education Partnership Ltd.
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