Eczema_in_Children_Flashcards
What is the prevalence of eczema in children?
Eczema occurs in around 15-20% of children and typically presents before 2 years of age.
What are the features of eczema in children?
Features include an itchy, erythematous rash, with repeated scratching exacerbating the affected areas. Distribution varies with age: face and trunk in infants, extensor surfaces in younger children, and flexor surfaces and creases in older children.
How is eczema managed in children?
Management involves avoiding irritants, using simple emollients (e.g., 250g/week), applying emollients before topical steroids with a 30-minute interval, and using creams or ointments appropriately. Wet wrapping and, in severe cases, oral ciclosporin may also be used.
What precautions should be taken with emollients for eczema?
Emollients can become contaminated with bacteria; therefore, fingers should not be inserted directly into pots. It is preferable to use brands with pump dispensers.
summarise
Eczema in children
Eczema occurs in around 15-20% of children and is becoming more common. It typically presents before 2 years but clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age
Features
itchy, erythematous rash
repeated scratching may exacerbate affected areas
in infants the face and trunk are often affected
in younger children, eczema often occurs on the extensor surfaces
in older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
Management
avoid irritants
simple emollients
large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1
if a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid
creams soak into the skin faster than ointments
emollients can become contaminated with bacteria - fingers should not be inserted into pots (many brands have pump dispensers)
topical steroids
wet wrapping
large amounts of emollient (and sometimes topical steroids) applied under wet bandages
in severe cases, oral ciclosporin may be used
A 3-year-old boy is presented at the dermatology clinic for a review of his eczema. He has recently commenced treatment with topical betamethasone 0.1% cream, which is applied as per the dermatology nurse’s instructions alongside emollients. However, he is still reporting symptoms of itchiness. His mother also expresses frustration about having to frequently clean his sheets, which become covered in cream.
On examination, you note areas of dry erythematous rash on the boy’s elbows and legs, with evidence of excoriation.
What is the next best step in managing this patient?
Increase the topical corticosteroid dose
Oral antihistamines
Reassurance
Topical tacrolimus
Use wet wraps
Use wet wraps
Wet wrapping may be helpful in severe childhood eczema: large amounts of emollient (and sometimes topical steroids) applied under wet bandages
Important for meLess important
Using wet wraps is an efficient method for administering emollients and topical steroids, particularly overnight, to maximise their therapeutic effects in the management of paediatric eczema. Employing this technique may not only enhance the child’s eczema treatment but also alleviate the mother’s concerns regarding soiled bed linen. However, it is imperative that wet wrap therapy be commenced following adequate training and should be avoided if there are any signs of infection.
Increasing the dose of topical corticosteroids is not warranted at this point, given that the patient is already receiving a potent topical corticosteroid regimen.
Oral antihistamines, while not commonly advocated for routine use in atopic eczema management, may occasionally be considered if there are significant symptoms such as severe urticaria or if sleep disturbance due to itching is a concern.
Reassurance alone does not suffice in this scenario, as the patient continues to exhibit moderate-to-severe eczema despite treatment with a potent topical corticosteroid; therefore, an escalation in management is necessary.
Topical tacrolimus is used as a second-line agent for uncontrolled moderate-to-severe atopic eczema. In this patient, it is more ideal to follow conservative measures before progressing to more advanced therapeutic options.
buzz words
dermatology clinic
topical betamethasone 0.1% cream
emollients
itchiness.
covered in cream.
dry erythematous rash o
elbows and legs
evidence of excoriation.
