Excerpt

Atopic eczema (atopic dermatitis) is a chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases. It is typically an episodic disease of exacerbation (flares, which may occur as frequently as two or three per month) and remissions, except for severe cases where it may be continuous. Certain patterns of atopic eczema are recognised. In infants, atopic eczema usually involves the face and extensor surfaces of the limbs and, while it may involve the trunk, the napkin area is usually spared. A few infants may exhibit a discoid pattern (circular patches). In older children flexural involvement predominates, as in adults. Diagnostic criteria are discussed in Chapter 3. As with other atopic conditions, such as asthma and allergic rhinitis (hay fever), atopic eczema often has a genetic component. In atopic eczema, inherited factors affect the development of the skin barrier, which can lead to exacerbation of the disease by a large number of trigger factors, including irritants and allergens. Many cases of atopic eczema clear or improve during childhood while others persist into adulthood, and some children who have atopic eczema `will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the ‘atopic march’. The epidemiology of atopic eczema is considered in Chapter 5, and the impact of the condition on children and their families/caregivers is considered in Sections 4.2 and 4.3.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1. Atopic eczema
  • 1.2. Aim of the guideline
  • 1.3. Areas outside the remit of the guideline
  • 1.4. For whom is the guideline intended?
  • 1.5. Who has developed the guideline?
  • 1.6. Other relevant documents
  • 1.7. Guideline methodology
  • 1.8. Schedule for updating the guideline
• 2. Summary of recommendations and treatment algorithm
  • 2.1. Key priorities for implementation (key recommendations)
  • 2.2. Summary of recommendations
  • 2.3. Key priorities for research
  • 2.4. Summary of research recommendations
  • 2.5. Treatment algorithm
• 3. Diagnosis
  • Studies considered in this chapter
  • Overview of available evidence
  • Evidence statement for diagnosis
  • Cost-effectiveness
  • From evidence to recommendations
• 4. Assessment of severity, psychological and psychosocial wellbeing and quality of life
  • 4.1. Assessment of severity
  • 4.2. Assessment of psychological and psychosocial wellbeing
  • 4.3. Assessment of quality of life
• 5. Epidemiology
  • Studies considered in this chapter
  • Overview of available evidence
  • Evidence statement for epidemiology
  • Cost-effectiveness
  • From evidence to recommendations
• 6. Identification and management of trigger factors
  • 6.1. Potential trigger factors
  • 6.2. Identification of trigger factors
  • 6.3. Management of trigger factors
• 7. Treatment
  • 7.1. Emollients
  • 7.2. Topical corticosteroids
  • 7.3. Topical calcineurin inhibitors
  • 7.4. Dry bandages and medicated dressings (including wet wrap therapy)
  • 7.5. Antihistamines and other antipruritics
  • 7.6. Treatment for infections associated with atopic eczema
  • 7.7. Stepped approach to management
  • 7.8. Phototherapy and systemic treatments
  • 7.9. Complementary therapies
  • 7.10. Behavioural therapies
  • 7.11. Recommendations for treatment
• 8. Education and adherence to therapy
  • 8.1. Education
  • 8.2. Adherence to therapy
• 9. Monitoring growth
  • Studies considered in this chapter
  • Overview of available evidence
  • Evidence statement for monitoring growth
  • Cost-effectiveness
  • From evidence to recommendations
• 10. Indications for referral
  • Studies considered in this chapter
  • Evidence statement for indications for referral
  • From evidence to recommendations
• Appendix A. Declarations of interest
• Appendix B. Clinical questions
• Appendix C. Diagnostic accuracy of clinical tests for identifying trigger factors
• Appendix D. Cost-effectiveness of educational interventions for atopic eczema in children
• References
• Search strategies
• Evidence tables
• Excluded studies

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.