What is this about?
NICE has published a clinical guideline on the management of atopic eczema in children from birth up to 12 years.
What do NICE say?
The NICE guideline provides recommendations on the diagnosis, assessment, identification and management of trigger factors, treatment, education and adherence to therapy, and indications for referral. In the absence of good clinical trial evidence with which to evaluate the comparative effectiveness of interventions, much of the advice is based on expert/consensus opinion.
A stepped approach to treatment is recommended, with the level of treatment depending on the severity of the condition.
With regard to topical treatments:
Unperfumed emollients are recommended for routine use on the whole body even when the eczema is clear, with the choice depending on the child’s needs and preferences. A recent Drug and Therapeutics Bulletin questioned the use of bath emollients, in view of their cost and lack of evidence for effectiveness; however, NICE considers these one of the options to consider. As with all medicines, where there is no evidence to distinguish treatments regarding safety or effectiveness, choice should be based on both cost and individual patient preference (listen to the NPC podcast on Barber’s boxes).
Topical corticosteroids are also recommended following discussion of the risks and benefits with children, parents or carers and tailoring the potency to the severity of the condition and site of application. The preparation with the lowest acquisition cost is recommended within any particular class of potency (see BNF). Potent topical corticosteroids should not be used on the face or neck or in children under 12 months without specialist dermatological supervision. Very potent preparations should only be used with specialist dermatological advice.
Tacrolimus and picrolimus are not recommended for mild atopic eczema or as a first-line treatment for any severity. They are one of the options to consider for moderate or severe eczema (picrolimus on head and neck only) in children aged 2 years or older, consistent with previous NICE guidance, in accordance with their license indications (see summaries of product information).
Further details of these and other treatment recommendations (e.g. use of bandages and dressings, treatment of infections, phototherapy and systemic treatments, and use of oral antihistamines), can be found in the NICE guideline. A quick reference guide is available, which contains a management algorithm. There will soon be a range of educational materials on NPC on the management of common skin conditions such as eczema.
Action:Prescribers are advised modify their management of children with atopic eczema, as appropriate, in line with this NICE guideline.