12 JCN 2016, Vol 30, No 5

SKIN CARE

The clinical presentation of infantile atopic eczema is mostly active on the face and the

flexures of the skin, mainly the neck, wrists, ankles, the periorbital skin and antecubital fossa. It is characterised by symptoms of intensive pruritus leading to excoriations, caused by dryness of the skin, scaling, erythema and lichenification. Lichenified eczema is the thickening of the skin as a result of continuous scratching and inflammation (National Eczema Society, 2015).

Complications of infantile eczema can be triggered by bacterial infections, most commonly staphylococcus aureus. In some cases, this infection can develop into impetigo, causing sores and blisters (Berth-Jones et al, 2006). Eczema herpeticum, commonly known as herpes simplex virus, is another type of infection that requires urgent intervention. It can present itself with vesicles and erosions that can rapidly deteriorate (Lin, 2011). The National Institute for Health and Care Excellence (NICE) (2007) guidelines recommend that parents of children

The nursing management of infantile eczema

Vilma Conceicao

with eczema should be educated about the condition to be able to identify early signs of infection and seek medical advice. It is evident that this condition has a negative impact on the individual’s and family’s quality of life.

AETIOLOGY

The aetiology of atopic eczema is extremely complex and not yet understood. It is associated with environmental and genetic factors that make children more predisposed to developing eczema. Children of parents who have asthma or hay fever have a higher risk of developing the disease.

Although there is still much to learn about the disease, it is believed that environmental factors such as pet hair; house dust mites; pollen; and certain foods, such as cow’s milk, can contribute to the development of the condition (NICE, 2011).

Genetically, the mutations in the filaggrin gene are linked to atopic eczema. Filaggrin plays an important role in the epidermal barrier and is critical to the conversion of keratinocytes to the lipid squames that compose the stratum corneum, or the outermost barrier layer of the skin. Any dysfunction in this barrier allows increased exposure to irritants that

may trigger the development of atopic eczema. The mutations in the filaggrin gene are likely to underlie almost half of eczema cases (Lawton, 2014).The relevance of this finding is that it reinforces the importance of regular use of emollients in the management of the condition.

MANAGEMENT

It is imperative to initiate treatment of atopic eczema with an emollient that works by repairing the levels of moisture on the first layer of the skin. These should be used liberally and frequently; at least three times a day (NICE, 2007). The emollient therapy includes using bath additives with bath oils and soap substitutes that contain antimicrobials. Maintaining this regimen should reduce the incidence of eczema flare and help to reduce the bacterial colonisation on the skin. The protective actions of the emollient can also be increased by using bath additives.

As part of combined emollient therapy, topical corticosteroids are also introduced to control flares, however, to treat moderate-to-severe eczema, it is important to consider their side-effects and possible long-term cutaneous adverse reactions (Carr, 2009). In more severe cases such as lichenified eczema, dermatologists can also use narrowband UVB (phototherapy), which is a specific ultraviolet wavelength used to treat the condition.

Although this type of therapy is just as effective as the use of topical steroids, it is not often recommended as the risks of side-effects are high. This treatment can be time-consuming for children and their families as they have to attend at least three sessions a week (British Association of Dermatologists [BAD], 2013).

Vilma Conceicao, dermatology specialist nurse, Royal Free London NHS Foundation Trust

Atopic eczema, also referred to as dermatitis, is an inflammatory chronic skin disease that commonly develops in childhood. This condition ranges from birth to 12 years old and affects both genders equally. Atopic eczema affects people of all ages but children in particular. The prevalence rate for atopic eczema is around 15–20% in children and 2–10% in adults (Scottish Intercollegiate Guidelines Network [SIGN], 2011), and accounts for 30% of all dermatological consultations in primary care (Shamssain, 2007).

KEYWORDS:Dermatology Eczema Infants Dermatitis

© 2016

Wou

nd C

are Peo

ple Lt

d

Nourish and protect sensitive baby skinSpecially formulated for babies, with natural oatmeal, the new AVEENO® Baby range helps nourish and protect skin from the fi rst use, to keep it looking and feeling healthy as it develops.

UK/AV/16-7646a

Specially formulated for babies, with natural oatmeal, the new AVEENO® Baby range helps nourish

®

Naturally Beautiful Babies

new

© 2016

Wou

nd C

are Peo

ple Lt

d

SKIN CARE

14 JCN 2016, Vol 30, No 5

Bandages can also be used to manage lichenification and reduce pruritus, which facilitates the absorption of steroids and improves their efficacy, however, if there are any signs of infection, these should be discontinued (Carr, 2009).

EDUCATION

Lack of knowledge about therapy leads to poor adherence, and subsequently to treatment failure. The National Eczema Society is an important source of support, providing information and practical advice about treating and managing the disease. Community nurses can also be key in monitoring and explaining the importance of adhering to prescribed therapy, although many parents are often reluctant about the use of topical steroids because of potential side-effects (Moore et al, 2006). It is important to highlight that topical steroids will significantly improve the individual’s quality of life and that early treatment can control the disease as well as the development of other conditions.

Unfortunately, a cure for atopic eczema has yet to be found, but individuals experiencing the disease can still lead a normal life. It is extremely important to have a full understanding of the condition, its causes, treatments and how to manage it well. This knowledge will help to control its exacerbation and alleviate its symptoms. Parents must be educated about the variety of treatments and what factors cause their children’s eczema to flare and it is important that more research is carried out and that new preventative methods are discovered. JCN

REFERENCES

Berth-Jones J, Tan E, Maibach H (2006) Eczema and Contact Dermatitis. Available online: www.fastfacts.com (accessed October 10, 2016)

BAD (2013) Atopic Eczema. Available online: www.bad.org.uk (accessed October 10, 2016)

Penzer R (2012) In practice: managing and prescribing atopic eczema. Available online: www.magonlinelibrary.com (accessed October 11, 2016)

Carr J ( 2009) Evidence-based management of childhood atopic eczema. Br J Nurs 18(10): 603–8

Call 08450 606707 to speak directly with a Customer Care Advisoror visit our website at: www.activahealthcare.co.uk1 Wellington Court, Newborough Road, Needwood, Burton on Trent, Staffordshire DE13 9PS.Activa® is the registered trademark of Activa Healthcare Ltd. ADV236 V1.2

Cellona® Shoe NEW

safety and stabilityNOW

available on GP10 & FP10

The Cellona® Shoe provides stability,protection and comfort for patientswith bandaged feet. Easily adjusted toeither open-toe or closed-toe wear, theCellona® Shoe comes in a range of sizesfrom Child’s size 7½ to Men’s size 13.

Cellona Shoe half page advert (JCN) ADV236 V1.2.qxp_Cellona Shoe half page advert (JCN) 25/07/2016 14:43 Page 1

Lawton S (2014) Atopic eczema: the current state of clinical research. Br J Nurs 23(20): 1061–6

Lin CY (2011) Eczema herpeticum. Available online: www.dermnetnz.org (accessed October 13, 2016)

Moore E, Williams A, Manais, Varigos G (2006) Nurse-led clinics reduce severity of childhood atopic eczema : a review of literature. Br J Derm 155: 242–48

National Ezcema Society (2015) About eczema. Available at: www.eczema.org/about-eczema (accessed October 13, 2016)

NICE (2007) Atopic eczema in Children. Management of atopic eczema in children from birth up to age of 12 years old. NICE guidelines. Available online: www.nice.org (accessed October 10, 2016)

Shamssain M (2007) Trends in the prevalence and severity of asthma, rhinitis and atopic eczema in 6- to 7- and 13- to 14-yr-old children from the north-east of England. Pediatr Allergy Immunol 18(2): 149–53

SIGN (2011) National clinical guideline 125. Management of atopic eczema in primary care. Available online: http://sign.ac.uk/pdf/sign125.pdf (accessed October 13, 2016)

© 2016

Wou

nd C

are Peo

ple Lt

d

DEBRISOFTING.™

EFFECTIVE DEBRIDEMENT. HEALTHY TISSUE.

Everything you love aboutDebrisoft® – in a Lolly!

NEW

For effective wound bed and skin preparation, nothing else works like Debrisoft.® Its unique, patented Monofi lament Fibre Technology™ can now be used to debride hard-to-reach areas of wounds and skin such as cavities and skin folds.

NEW Debrisoft® Lolly has a sterile, single-use monofi lament fi bre

head with a handle providing a gentle, safe and precise method

of debridement.

• Lifts, binds and removes barriers to healing such as

superfi cial slough and debris, including biofi lm, quickly and easily

• Ideal for cavities, surgically invasive wounds and hard-to-

reach areas

• Will not damage new granulation tissue and epithelial cells

ADV251 V1.3

PART OF THE DEBRISOFT® RANGE. FOR FREE SAMPLES OR TO ARRANGE A VISIT, CALL 08450 606707. WWW.DEBRISOFT.CO.UK

DEBRISOFTING.™DEBRISOFTING.™™DEBRISOFTING.

Available ondrug tariff

© 2016

Wou

nd C

are Peo

ple Lt

d