Nice guide lines 2007
Download
1 / 12

Atopic Eczema - PowerPoint PPT Presentation


  • 100 Views
  • Uploaded on

Nice guide lines 2007. Atopic Eczema. Diagnosis. Itching plus 3 or more of Visible flexural dermatitis involving skin creases, cheeks or extensor surfaces History of flexural dermatitis involving skin creases, cheeks or extensor surfaces History of dry skin in last year

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Atopic Eczema' - mannix-sanford


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Nice guide lines 2007

Nice guide lines 2007

Atopic Eczema


Diagnosis
Diagnosis

  • Itching plus 3 or more of

    • Visible flexural dermatitis involving skin creases, cheeks or extensor surfaces

    • History of flexural dermatitis involving skin creases, cheeks or extensor surfaces

    • History of dry skin in last year

    • History of atopic disease (asthma rhinitis eczema) in first degree relative aged < 4yrs

    • Onset under 2 yrs (use only in those > 4 yrs at diagnosis


Assessment of severity
Assessment of severity

  • Clear – normal skin no evidence of active atopic eczema

  • Mild – areas of dry skin, frequent itching +- small areas of redness

  • Moderate - areas of dry skin, frequent itching, redness, +- excoriation and localised thickening.

  • Severe – widespread areas of dry skin, incessant itching, redness (+- excoriation, extensive skin thickening, bleeding, oozing, cracking.


Impact on quality of life
Impact on quality of life

  • None – no impact on quality of life

  • Mild – little impact on everyday activities, sleep and psychosocial well being

  • Moderate - Moderate impact on everyday activities, psychosocial well being, frequently disturbed sleep

  • Severe – severe limitation of everyday activities and psychosocial well being, loss of sleep every night


Holistic approach
Holistic approach

  • Take account of

    • Physical severity of eczema

    • Impact on quality of life

    • Psychosocial functioning

    • Any loss of sleep

  • No direct correlation between physical severity of eczema and impact on quality of life


Management
Management

  • Identify trigger factors

    • Irritants – soaps and detergents

    • Contact allergens

    • Food allergens

    • Inhalant allergens

    • Skin infections

  • Refer for specialist advice when necessary


Stepped treatment
Stepped treatment

  • Tailor treatment to severity

    • Start with emollients – should be used even when skin clear

    • Mild disease – emollients + mild steroid creams 1% hydrocortisone

    • Moderate disease – emollients + moderate steroid creams. Topical calcineurin inhibitors, bandages.

    • Severe disease – potent steroid creams (short periods only) topical calcineurin inhibitors, bandages, phototherapy, systemic therapy


Management1
Management

  • Use topical antibiotics + steroid for localised infection for no longer than 2 weeks

  • Non-sedating antihistamines if eczema is severe or severe itching or urticaria

  • Sedating antihistamines children aged > 6/12 during acute flares if sleep disturbance for child or carers.

  • Recognise indications for referral


Indications for referral
Indications for referral

  • Immediate (same day)

    • if eczema herpeticum suspected

  • Urgent (within 2 weeks)

    • If severe and not responded to optimal treatment for 1 week

    • Treatment of bacterial infected eczema has failed


Indications for referral1
Indications for referral

  • Routine referral

    • Diagnosis uncertain

    • Eczema on face not responded

    • Eczema is associated with sever recurrent infections

    • Contact allergic eczema suspected

    • Causing serious social or psychological problems for child or carers

    • Eczema not controlled to the satisfaction of carers or child


Education and information
Education and information

  • Explain cause and course of disease

  • Demonstrate quantities and frequency of treatments

  • Inform symptoms and signs of bacterial infections

  • How to recognise eczema herpeticum

  • Ask about use of complementary therapies explain have not be assessed for safety. Should continue to use emollients as well as complimentary therapies


Overcoming
Overcoming

  • Discuss parental anxieties about treatments explain benefits of steroids outweigh possible harms

  • Written care plans including management of flare ups and infections

  • Explain when topical steroids and other treatments are indicated


ad