NICE guidance on atopic eczema in children

Atopic eczema, also known as atopic dermatitis, usually presents in early childhood and follows a relapsing-remitting course. In many cases the condition has a significant detrimental effect on the child’s quality of life and may also have a negative impact on the child’s parents or carers.

KEY RECOMMENDATIONS

• Adopt a holistic approach to assessment, noting that there is not necessarily a direct relationship between severity of eczema and impact upon quality of life.
• Seek to identify potential trigger factors, such as irritants, skin infections or allergens including contact, food or inhalants.
• Use a stepped approach to treatment (see below).
• Offer children a choice of unperfumed emollients to use for everyday moisturising, washing and bathing; prescribe leave-on emollients in large quantities.
• Tailor corticosteroid treatment to the severity of the eczema.
• Offer children and their parents or carers advice on how to recognise and manage flares of atopic eczema, bacterial infection and eczema herpeticum.
• Spend time educating children and their parents or carers about eczema and its treatment, providing verbal and written information as well as practical demonstrations.

Criteria for diagnosis of atopic eczema are also outlined in the guideline, as are, the circumstances under which a child should be referred for specialist dermatological advice.

STEPPED APPROACH TO TREATMENT – BODY*
Step treatment up or down according to severity. Treat areas of differing severity independently.

• Clear/no evidence of active eczema – emollients.
• Mild – emollients alone or in combination with mild-potency topical corticosteroids.
• Moderate – emollients, moderate-potency topical corticosteroids, tacrolimus, bandages.
• Severe – emollients, potent topical corticosteroids, tacrolimus, bandages, phototherapy, systemic therapy.

*Refer to full guidance for information on stepped treatment approach for the face and neck.

The full guideline is available at www.nice.org.uk