In this section
Criteria Led Discharge
Definition of Terms
Follow up Recommendations
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.
Provide evidence based strategies for the management of AE in order to improve eczema and reduce impacts on patient and family quality of life.
The UK Diagnostic Criteria for atopic eczema are:
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 stopped when the symptoms are controlled and then again re started if flaring again.
Topical steroids and anti-inflammatory creams
Tar creams for lichenification (thickening of the skin). Tar creams should not be applied to the face, groin and flexures.
Medication such as antibiotics or antivirals for treating organisms causing secondary infected eczema. Usually orally however intravenous may be needed for severely infected eczema and when septic.
Intranasal bactroban ointment twice daily for five days if nasal swabs are positive for Staphylococcus aureus.
Wet dressings are to be applied as soon as possible for severe eczema. For moderate eczema apply immediately or within 1 day of starting the topical steroids (if the eczema has NOT cleared)
Wet dressings to re-hydrate and calm the skin using Tubifast
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 as the skin is not intact and thus more vulnerable to infection. A common bacteria Staphylococcus aureus is normal flora found on the skin. Infection can make eczema worse and more difficult to treat.
Infection should be suspected if there is crusting, weeping, erythema, cracks, frank pus or multiple excoriations and increased soreness and itching which may suggest bacterial infection. A common causative organism is Staphylococcus aureus.
Secondary viral infection caused by herpes simplex virus (HSV) is characterized 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. Other viruses that may cause the eczema to flare are molluscum contagiosum and coxsackie A6 virus (hand foot and mouth disease).
The principles of managing infected eczema are:
NOTE: most patients with viral infected eczema, invariably also have a bacterial skin infection as well. Assess using appropriate skin swabs to identify a bacterial infection and begin antibiotics as instructed above.
In the event of an immediate reaction (such as urticaria and angioedema) to a food and/or severe persistent eczema in a baby, refer for specialist allergy evaluation. Visit ASCIA for more information: https://www.allergy.org.au/images/pcc/ff/ASCIA_FAST_FACTS_Eczema_and_Food_Allergy_2020.pdf
Refer to immunologist, allergist or dermatologist for Skin Prick Test (SPT) and a dietician if food allergies are proven on SPT or ImmunoCAP IgE test.
A medical referral is required:
Home and community care (HACC)- RCH only
Royal District Nursing Service
For further assistance the Dermatology Registrars and Dermatology Nurse Practitioners/Consultants can be paged via switchboard 9345 5522.
Summary points for parents:
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 March 2018.