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Atopic eczema is a chronic inflammatory itchy skin condition. It is typically an episodic disease of exacerbations (flares, which may occur as frequently as two to three/month) and remissions. In some cases it may be continuous.
Atopic eczema often has a genetic component that leads to the breakdown of the skin barrier. This makes the skin susceptible to trigger factors, including irritants and allergens, which can make eczema worse.
It does not cover children with infantile seborrhoeic eczema, juvenile plantar dermatosis, primary irritant and allergic contact dermatitis, napkin dermatitis, pompholyx or photosensitive eczema, except when these conditions occur in association with atopic eczema.
Healthcare professional should adopt a holistic approach when assessing a child's atopic eczema at each consultation, taking into account the severity of the atopic eczema and the child's quality of life, including everyday activities and psychosocial wellbeing.
History should include:
Assessment of severity of eczema (see chart below)
Skin/physical severity | Impact on quality of life and psychosocial wellbeing | ||
Clear | Normal skin | None | No impact on quality of life |
Mild | Areas of dry skin, infrequent itching (with and without small areas of redness) | Mild | Little impact on everyday activities and sleep. |
Moderate | Areas of dry skin, frequent itching, redness (with or without excoriation and localised skin thickening) | Moderate | Moderate impact on everyday activities and wellbeing, frequently disturbed sleep. |
Severe |
Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation)
|
Severe | Severe impact on everyday activities and wellbeing, and nightly loss of sleep |
Infantile seborrhoeic eczema, primary irritant and allergic contact dermatitis and napkin dermatitis
Eczema Herpeticum – Signs of eczema herpeticum are areas of rapidly worsening, painful eczema, clusters of blisters and punched out erosions, fever and lethargy. If eczema herpeticum is suspected aciclovir should be started immediately and referred for same-day specialist dermatological advice.
Microscopy, culture and sensitivity (MC&S) swabs should only be taken from infected lesions of atopic eczema if other micro-organisms other than Staphylococcus aureus and streptococcus are suspected. Flucloxacillin should be used as first line treatment.
Immediate (same day) referral:
Urgent referral (within 2 weeks)
Routine referral
Paediatric dermatology and paediatric allergy work closely together
Referral to paediatric allergy clinic may also be necessary
e-Referral Service Selection
e-Referral Service Selection
NICE Guidelines - Atopic eczema in under 12s: diagnosis and management
This guideline has been signed off on behalf of NHS Devon.
Publication date: 6 July 2016
Reviewed: April 2024