Date: 18 September 2017
Category: Childhood Eczema
We see patients with eczema in our regular clinics and base their treatments on the best available evidence. We also seek funding for skin disease research projects which we either run or participate in, in order to generate new evidence. We write full reports of the research projects in the public domain, ensuring that other people working in our specialism – and patients - know the latest evidence.
About one in five school age children have some degree of eczema and for a variety of reasons, this proportion is increasing. Most have mild to moderate eczema and this is managed by their GP practice. We only see about 5% of the children with eczema – typically those whose condition is more severe or who have not been able to establish a good method of keeping their eczema under control.
A tiny proportion of the children we see have really severe eczema which needs systemic treatment with strong medication. But for most – although their eczema cannot be cured – it can be managed by a combination of good education, nurse support, and ensuring that the existing treatments are explained properly.
Most of the children we see have two or three visits with the dermatology team: a doctor and an eczema specialist nurse. We allow 45 minutes for a first consultation and much of that time is used to help the parents understand their child’s condition and working on a written treatment plan.
The most common scenario is a child whose eczema is not under control because they have not been prescribed an effective anti-inflammatory treatment. There is a lot of concern in the community about using steroid creams on a child’s skin and it’s true that if you use very strong corticosteroids it will make the skin thin. But eczema is an inflammatory condition so you need a certain amount of the anti-inflammatory benefit of the steroid creams in order to establish control, getting both the surface skin and the deeper layers of skin free of redness and itching. This initial ‘get control’ treatment period usually takes between and two and three weeks, although for some with much thicker eczema-affected skin, it may take several weeks.
After ‘getting control’ and the skin is clear, families are then encouraged to ‘keep control’ by using a technique called ‘weekend treatment’ (two consecutive evenings each week) applying steroids to previously active ‘hotspots’ on the skin. The rest of the time the child can use emollients, but emollients and steroid creams aren’t applied at the same time. Used in this way, potential side effects of steroid creams such as skin thinning are incredibly rare.
It’s important to recognise that children can take part in their care from a very young age – putting emollients on, and other wraps and dressings when needed – and it’s important that they gradually become responsible for managing their skin condition. We do know this can be a struggle with teenagers!
A very small number of children have more severe eczema that will need more intensive treatments. The systemic drugs we prescribe for these children are stronger and some research is progressing on which one is the best choice for these children.
Skin conditions are in the top four reasons for consulting a GP and we know that eczema causes a lot of discomfort and affect children and their families in many ways. We recently developed our ‘top ten tips’ for managing eczema and hope that readers will find these useful. We would also urge families to visit the website of the Nottingham Support Group for carers of children with eczema and Healthtalk where they will find a wealth of information and advice.
There are still gaps in the evidence about eczema but it is pleasing that the National Institute for Health Research has invested, and is investing, well in eczema research, and rightly so.
Hywel Williams, Professor of Dermato-Epidemiology, and Kim Thomas, Professor of Applied Dermatology Research, see patients with eczema in their clinics and base their treatments on the best available evidence.
Hywel Williams is Professor of Dermato-Epidemiology and Kim Thomas is Professor of Applied Dermatology Research, both at the University of Nottingham. They are Co-Directors of the Centre of Evidence Based Dermatology, University of Nottingham. Hywel and Kim are supported by Natasha Rogers, Research Scientist (Communications and Impact).