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Eczema

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Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Principles of Management

Local clinicians recommend the following guidelines provided by the PCDS website:

Eczema - atopic

Eczema - discoid

Eczema - contact dermatitis

Eczema - Hand and foot

NICE Clinical Knowledge Summaries offer a scenario based assessment approach for the management of Atopic Eczema. This includes a supporting evidence stepped approach and useful pathways.

See also the following local prescribing guidelines for advice on use of :

Emollients

Topical Steroids

Calcineurin Inhibitors (tacrolimus and pimecrolimus)

Food allergy (including cow’s milk protein allergy) Please see the following local guidelines:

Adults - Immunology & Allergy including identifying and managing suspected food allergies.

Children - Food Allergy

Children - Milk Related Problems

To aid correct referral process, if a food allergy is strongly suspected then follow guidelines above. If a referral is required for further allergy testing or patch testing then refer to secondary care initially. The Community Dermatology Service does not offer food allergy testing. However, they can see children with confirmed allergies and help with management of their skin condition(s).

Red Flag

Eczema herpeticum (widespread herpes simplex) is a potentially life threatening condition. If suspected then discuss with on call dermatologist and/or admit to Hospital for confirmation of diagnosis and antiviral treatment.

Infected Eczema: if infected eczema is not responding to oral antibiotic treatment and the patient is systemically unwell then discuss with secondary care dermatologist if required. Please ensure a skin swab is taken.

Community Dermatology Services - Bristol & SGlos

Community Dermatology Services are now available to all patients registered with a GP in BNSSG. The service provides individually tailored care and education. Stepped care plan is dependent on severity of eczema to echo available guidelines as provided here. If nil improvement or poor engagement, refer to Sirona Community Dermatology Service for habit reversal support.

Primary Care Dermatology Society and Clinical Knowledge Summaries have advice on management which should be followed prior to consideration of referral.

This is a non-urgent Service; therefore contact secondary Care Dermatology Services if more urgent support and care is required.

Secondary Care Referral

If Clinicians do not have a primary care service available or secondary care referral is indicated then consider:

Dermatology Advice & Guidance via eRS (now available for children as well as adults)
Dermatology referral via eRS

Resources

13.1 Dry and scaling skin disorders (Remedy BNSSG ICB)

Resources

NICE (National Institute for Health and Care Excellence).

Specific clinical guidelines for under 12’s with Atopic Eczema. nice.org.uk/guidance/Cg57

NICE Pathway for Eczema: pathways.nice.org.uk/pathways/eczema

National Eczema Society: https://eczema.org/

Advice on Self Care and other useful resources for health care professionals (Patient support groups and helpline)

British Association of Dermatologists: https://www.bad.org.uk/ Information and guidance.

Habit reversal support: Can work well along with topical treatments in management of chronic Atopic Eczema. Can engage patient more in managing their own skin condition and thinking about triggers and the Itch-Scratch cycle. Sign posting patient can be useful. atopicskindisease .com/

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.