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How NIHR research fits with NICE guidelines for childhood eczema

Eczema is a complex inflammatory skin condition influenced by an interaction between genetic and environmental factors. Eczema can range from quite mild, with dry, flaky and itchy skin, to severe weeping and bleeding. Whilst there is no cure for eczema, there are a range of treatment options that aim to reduce inflammation as well as any infection. GPs, practice nurses and dermatologists work with patients and their families to identify the most beneficial approach.

NICE clinical guidelines for childhood eczema recommend a stepped approach where the treatment is tailored to the severity of the eczema:

  • mild eczema: moisturisers (emollients) and mild topical corticosteroids
  • moderate eczema: moisturisers, moderate topical corticosteroids, bandages
  • severe eczema: moisturisers, stronger topical corticosteroids, topical tacrolimus ointment, bandages, phototherapy (UV light).

“Not all children respond to the same treatments in the same way so we have to keep things under review. Our eczema specialist nurse works closely with the families on that. It’s important that as the children get older – into the teenage years – they take ownership of their condition and the treatment, to get the best outcomes. The specialist nurse plays a key part in helping that process, too.”
Dr Sarah El-Heis, Dermatology Clinical Research Fellow in an NHS Secondary Care Trust

Self-care, such as reducing scratching and avoiding triggers like perfumed soap and heat, is always important. Moisturisers should be unperfumed and used liberally and regularly every day to prevent the skin from becoming dry. The NIHR review on moisturisers found that whilst no particular moisturiser was most effective, during a flare-up combining a moisturiser with a topical active treatment (a corticosteroid applied to the skin) had a better outcome than just using the active treatment alone. Moisturisers are an important part of the treatment plan and individuals with eczema may try different ones to find out which works best for them.

As eczema in an inflammatory condition, it is important to get eczema under control with topical active treatment. The strength of the topical corticosteroid ointment or cream depends on the severity of the eczema. Specialist dermatological advice is important when strong topical corticosteroids are required because these can have side-effects.

NICE recommend oral antibiotics to treat infections. The NIHR study found that antibiotics should only be prescribed with severely infected eczema as there is no benefit to using antibiotics for mild to moderate eczema. Antihistamines may be prescribed for severe itching, particularly at night.

The POEM (Patient Oriented Eczema Measure) is a tool recommended by NICE that has been developed to measure the severity of childhood eczema. The POEM can be completed by a healthcare professional or by a parent and their child and discussed with a clinician.  http://www.nottingham.ac.uk/research/groups/cebd/resources/poem.aspx

It is important to have regular reviews with a GP to ensure an optimal treatment path is being achieved.

The NICE Guidelines were checked for new evidence in 2016, and a further review is scheduled for 2019. 

“We also have to think beyond the clinic and the medication regime for the rest of the children’s lives. We talk a lot with parents about ways to manage the impact of eczema on their child’s life. This includes clothing options, ways to manage sleeplessness and the range of alternative therapies that parents might consider. We often write to schools to explain a child’s medication and support needs - this is such a big part of a child’s life, it’s important they are well supported there as well as at home.”
Dr Sarah El-Heis, Dermatology Clinical Research Fellow in an NHS Secondary Care Trust

You can find the latest NICE guidelines on childhood eczema at: https://www.nice.org.uk/guidance/cg57 

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