In this section
RCH: Consider Criteria Led Discharge
Note: This guideline is currently under review.
Atopic eczema (AE) or atopic dermatitis (AD) is a dry, itchy, inflammatory, chronic skin disease that typically begins in early childhood, affecting around 30% of children. This condition can worsen and cause intractable pruritus, soreness, infection and sleep disturbance. The onset of eczema is usually before 12 months and it follows a remitting and relapsing course. Most children will "grow out of" eczema before five years of age. There is no cure of AE, however if treated and managed well the disease has less impact on daily living and is less likely to have a negative effect on quality of life for the patient and family.
Following this link to create a personalised Eczema Treatment Plan.
The UK Diagnostic Criteria for atopic eczema are:
Must have itch
Plus 3 or more of the following:
Patient assessment should be undertaken by either a medical officer or an eczema nurse consultant/ practitioner to grade the degree of eczema severity (mild, moderate or severe) and the presence or absence of infection. Use SCORAD (scoring atopic dermatitis) index calculator to calculate the severity score.
Eczema Treatments fall into two categories
1. Every day treatments and avoidance of triggers (these treatments are ongoing regardless of the presence or absence of eczema)
2. Flaring treatments these treatments should be used as soon as there is a flare (an acute deterioration), such as increasing erythema and itch, and weaned?? when the symptoms are controlled.
All patients should have an Eczema Treatment Plan completed before they go home. To complete an Eczema Treatment Plan.
Secondary bacterial infection of eczema is a common complication, it should be suspected if there is crusting, weeping, erythema, cracks, frank pus or multiple excoriations and increased itch suggest bacterial infection. The usual organism is Staphylococcus aureus.
Secondary herpes simplex 1 infection is characterised by a sudden onset of grouped, small white or clear fluid filled vesicles, satellite or "punch out" lesions, pustules, and erosions. It is often tender, painful and itchy.
The principles of managing infected eczema are:
(Allergy Skin Prick Testing (SPT) is indicated if:
Refer to immunologist, allergist or dermatologist for (SPT) and a dietician if food allergies are proven on SPT or RAST test.
For further assistance:
Home and community care (HACC)- RCH only
Royal District Nursing Service
Community Eczema Program/Workshop. Clinics are located in Collingwood, Kensington and Broadmeadows. Patients are seen by a nurse consultant within 14 calendar days.
Click here for referral form
For further assistance the Dermatology Registrars and Nurse Practitioners can be paged via switchboard.
Summary points for parents:
See parent resources below
Eczema Management Evidence Table
Please remember to read the disclaimer.
The development of this nursing guideline was coordinated by Emma King, Nurse Practitioner, Dermatology Department, and approved by the Nursing Clinical Effectiveness Committee. Updated May 2013.