Atopic eczema in children

1. Atopic eczema in children Implementing NICE guidance 2007 NICE clinical guideline 57

2. Changing clinical practice • NICE guidelines are based on the best available evidence • The Department of Health asks NHS organisations to work towards implementing NICE guidelines • Compliance with developmental standards will be monitored by the Healthcare Commission

3. What this presentation covers • Background • Key priorities for implementation • Implementation advice • Costs and savings • Resources from NICE

4. Background:why this guideline matters • Guideline covers children from birth to 12 years old • Atopic eczema develops in early childhood • Up to one in five school children have atopic eczema • Significant impact on quality of life: • can affect sleep and concentration • causes discomfort, school absence, low self-esteem

5. Key priorities for implementation • Assessment of severity, psychological and psychosocial wellbeing and quality of life • Identification and management of trigger factors • Treatment • Education and adherence to therapy • Indications for referral

6. Assessment of severity, psychological and psychosocial wellbeing and quality of life • Holistic assessment should be undertaken at each consultation, taking into account: • physical severity • impact on quality of life • There is not necessarily a direct relationship between severity of atopic eczema and impact on quality of life.

7. Identification and management of trigger factors • Identify potential trigger factors including: • irritants • skin infections • contact allergens • food allergens • inhalant allergens.

8. Treatment: stepped approach to management • Use emollients all the time • Use a stepped approach for managing atopic eczema: • • tailor treatment step to severity • • step treatment up or down as necessary • Provide: • • information on how to recognise flares • • instructions and treatments for managing flares

9. Treatment: emollients • Emollients should be used continuously, even when skin is clear and: • suited to the child’s needs and preferences • unperfumed • used every day • prescribed in large quantities (250–500 g/week) • easily available to use at nursery, pre-school or school.

10. Treatment: topical corticosteroids • Potency should be tailored to severity: • mild potency for face and neck, except for 3–5 days of moderate potency for severe flares • moderate or potent preparations for short periods only for flares in vulnerable sites • do not use very potent preparations in children without specialist dermatological advice

11. Treatment: infections • Offer information on how to: • recognise symptoms and signs of bacterial infection • recognise eczema herpeticum • access appropriate treatment when eczema becomes infected.

12. Education and adherence to therapy • Spend time educating children and their parents or carers about atopic eczema and its treatment. • Provide written and verbal information with practical demonstrations about: • how much of the treatments to use • how often to apply treatments • when and how to step treatment up or down • how to treat infected atopic eczema.

13. Indications for referral • Referral for specialist dermatological advice is recommended for children with atopic eczema if: • the diagnosis is, or has become, uncertain • management has not controlled the atopic eczema satisfactorily • atopic eczema on the face has not responded to appropriate treatment [continued]

14. Indications for referral (2) • the child or parent/carer may benefit from specialist advice on treatment application • contact allergic dermatitis is suspected • the atopic eczema is giving rise to significant social or psychological problems for the child or parent/carer • atopic eczema is associated with severe and recurrent infections

15. Implementation advice • Feedback to NICE suggests that there are likely to be 3 key areas for successful implementation: • Educate health professionals • Inform and support children and families • Schools and childcare

16. Educate healthcare professionals • Education should be available for primary care healthcare professionals including: • diagnosing children with dark skin • importance of emollients – use and application • appropriate management • when it is appropriate to refer to specialist services. • Obtain information on allergies

17. Inform and support children and families • Use the stepped-care table in the quick reference guide • Information should cover how to manage the condition, emollients, infections, trigger factors and the management of flares • Showing photos of infected eczema may help recognition • Consider providing information and practical demonstrations in a group setting • Community pharmacists should have enoughinformation to enable them to advise

18. Schools and childcare • Provide information or training for school staff about atopic eczema • Consider using a healthcare plan to help children manage the condition at school • Early years providers should contact their local training provider for training on the management of eczema • Obtain National Eczema Society activity packs

19. Resources from NICE • Implementation advice • Costing tools • costing report • costing template • Audit support • www.nice.org.uk/CG057

20. Access the guideline online • Quick reference guide – a summary • NICE guideline – all of the recommendations • Full guideline – all of the evidence and rationale • ‘Understanding NICE guidance’ – a version for patients and carers • www.nice.org.uk/CG057