Thursday 13 Dec 2007 @ 16:02
National Institute for Health and Clinical Excellence (NICE)
National Institute for Health and Clinical Excellence (NICE)
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NICE guideline to improve management and treatment of children with atopic eczema
New guidelines launched recently by the National Institute for Health and Clinical Excellence (NICE) are set to improve the management and treatment of atopic eczema in children. The guideline, produced for NICE by the National Collaborating Centre for Women and Children’s Health NCC-WCH), includes the most comprehensive review and analysis of available evidence on ways to improve the quality of life of both children and their parents when managing this very common condition.
The main objective of this guideline is to provide guidance on the routine management of atopic eczema in primary care for children from birth up to 12 years of age. Key recommendations from the guideline include the following:
• Healthcare professionals 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 sleep, and psychosocial wellbeing.
• Healthcare professionals should use a stepped approach for managing atopic eczema in children. This means tailoring the treatment step to the severity of the atopic eczema.
• Healthcare professionals should offer children with atopic eczema a choice of unperfumed emollients to use every day for moisturising, washing and bathing. This should be suited to the child’s needs and preferences, and may include a combination of products or one product for all purposes and should be easily available to use at nursery, pre-school or school.
• Healthcare professionals should spend time educating children with atopic eczema and their parents or carers about atopic eczema and its treatment.
• When clinically assessing children with atopic eczema, healthcare professionals should seek to identify potential trigger factors including: irritants, such as soaps and detergents, skin infections, contact allergens, food allergens and inhalant allergens.
Atopic eczema is estimated to affect 1 in 5 school children in the UK. It is a common cause for consultation in general practice and accounts for at least 15–20% of paediatric dermatological consultations. Atopic eczema may have a profound psychological/psychosocial impact on the lives of children and their families and carers, affecting their quality of life in various ways. For example, highly visible symptoms can affect a child’s self-esteem and self-confidence, and sleep disturbance due to itchy skin can disrupt the whole family’s sleep patterns. Concerns about potential side effects of drug treatments can also be an issue. Parents and children who don’t have enough information about the treatments that have been prescribed may not continuing with therapy. Psychological and psychosocial support and education can, therefore, play an important role in the management of atopic eczema in children.
Conventional management of atopic eczema involves advice on the avoiding things that make the condition worse, the use of emollients to cleanse and moisturise the skin, and the use of topical corticosteroids (corticosteroids applied to the skin) to reduce irritation and inflammation. Corticosteroids may be used in combination with antiseptic agents or antibiotics if the skin is infected.
Professor Peter Littlejohns, NICE Clinical and Public Health Director and Executive Lead for this guideline, says: “The publication of this guideline will improve the management of atopic eczema in children from birth up to the age of 12 years in primary, secondary and community care. For the first time, people suffering from this condition will benefit from a consistent approach to managing their condition, regardless of where they live.”
Dr Sue Lewis-Jones , Consultant Dermatologist and Chair of the Guideline Development Group at NICE says: ”Atopic eczema is a chronic skin disease affecting about 1 in 5 children in the UK which is associated with itching and dry skin so that even mild disease can make the lives of the child and their families miserable. There is much confusion, fear and ignorance about eczema and available treatments amongst the public and healthcare professionals. In recognition of this and to improve knowledge and self-management, the guideline development group has
recommended a stepped approach to treatment, tailored to disease severity and based upon much greater and regular use of emollients.”
Amanda Roberts, patient and Guideline Development Group member, says: “This NICE Guideline empowers both children and their carers, giving them ownership of the treatment of their skin. By identifying the best way of approaching the treatment of eczema, these NICE guidelines deliver hope to the child with eczema. The earlier that a child’s eczema gets successfully treated the better chance that long term damage to the skin is avoided – good news for the child, the carer and the health care professionals.”
Dr Sarah Purdy, General Practitioner and Guideline Development Group member, says: ”Eczema can be a devastating condition that affects 1 in 5 children in the UK. Since 80% of cases presenting to GPs are for mild eczema, this guideline will not only help to reduce unnecessary referrals to hospital services, but will also assist primary care clinicians to deliver evidence based care with a positive, supportive approach that is so vitally important for children with eczema and their families.“
Sandra Lawton, Nurse Consultant Dermatologist and Guideline Development Group member, says: “This guideline will ensure that healthcare professionals spend more time at every consultation educating children and their parents or carers about atopic eczema and its treatment. By prioritising time for assessment and including practical demonstrations on how much of the treatments to use, how often to apply treatments, when and how to step treatment up or down, and how to treat infected atopic eczema, the guideline sets an invaluable precedent on the role that healthcare professionals should play in improving patient care.”
Notes to Editors
1. The guidance, together with a costing template and costing report, are available at www.nice.org.uk/CG57. In addition, the following implementation tools will be available on the website shortly: a slide set; key messages for local discussion, implementation advice; practical suggestions on how to address potential barriers to implementation and audit criteria.
About NICE
2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
3. NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
The main objective of this guideline is to provide guidance on the routine management of atopic eczema in primary care for children from birth up to 12 years of age. Key recommendations from the guideline include the following:
• Healthcare professionals 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 sleep, and psychosocial wellbeing.
• Healthcare professionals should use a stepped approach for managing atopic eczema in children. This means tailoring the treatment step to the severity of the atopic eczema.
• Healthcare professionals should offer children with atopic eczema a choice of unperfumed emollients to use every day for moisturising, washing and bathing. This should be suited to the child’s needs and preferences, and may include a combination of products or one product for all purposes and should be easily available to use at nursery, pre-school or school.
• Healthcare professionals should spend time educating children with atopic eczema and their parents or carers about atopic eczema and its treatment.
• When clinically assessing children with atopic eczema, healthcare professionals should seek to identify potential trigger factors including: irritants, such as soaps and detergents, skin infections, contact allergens, food allergens and inhalant allergens.
Atopic eczema is estimated to affect 1 in 5 school children in the UK. It is a common cause for consultation in general practice and accounts for at least 15–20% of paediatric dermatological consultations. Atopic eczema may have a profound psychological/psychosocial impact on the lives of children and their families and carers, affecting their quality of life in various ways. For example, highly visible symptoms can affect a child’s self-esteem and self-confidence, and sleep disturbance due to itchy skin can disrupt the whole family’s sleep patterns. Concerns about potential side effects of drug treatments can also be an issue. Parents and children who don’t have enough information about the treatments that have been prescribed may not continuing with therapy. Psychological and psychosocial support and education can, therefore, play an important role in the management of atopic eczema in children.
Conventional management of atopic eczema involves advice on the avoiding things that make the condition worse, the use of emollients to cleanse and moisturise the skin, and the use of topical corticosteroids (corticosteroids applied to the skin) to reduce irritation and inflammation. Corticosteroids may be used in combination with antiseptic agents or antibiotics if the skin is infected.
Professor Peter Littlejohns, NICE Clinical and Public Health Director and Executive Lead for this guideline, says: “The publication of this guideline will improve the management of atopic eczema in children from birth up to the age of 12 years in primary, secondary and community care. For the first time, people suffering from this condition will benefit from a consistent approach to managing their condition, regardless of where they live.”
Dr Sue Lewis-Jones , Consultant Dermatologist and Chair of the Guideline Development Group at NICE says: ”Atopic eczema is a chronic skin disease affecting about 1 in 5 children in the UK which is associated with itching and dry skin so that even mild disease can make the lives of the child and their families miserable. There is much confusion, fear and ignorance about eczema and available treatments amongst the public and healthcare professionals. In recognition of this and to improve knowledge and self-management, the guideline development group has
recommended a stepped approach to treatment, tailored to disease severity and based upon much greater and regular use of emollients.”
Amanda Roberts, patient and Guideline Development Group member, says: “This NICE Guideline empowers both children and their carers, giving them ownership of the treatment of their skin. By identifying the best way of approaching the treatment of eczema, these NICE guidelines deliver hope to the child with eczema. The earlier that a child’s eczema gets successfully treated the better chance that long term damage to the skin is avoided – good news for the child, the carer and the health care professionals.”
Dr Sarah Purdy, General Practitioner and Guideline Development Group member, says: ”Eczema can be a devastating condition that affects 1 in 5 children in the UK. Since 80% of cases presenting to GPs are for mild eczema, this guideline will not only help to reduce unnecessary referrals to hospital services, but will also assist primary care clinicians to deliver evidence based care with a positive, supportive approach that is so vitally important for children with eczema and their families.“
Sandra Lawton, Nurse Consultant Dermatologist and Guideline Development Group member, says: “This guideline will ensure that healthcare professionals spend more time at every consultation educating children and their parents or carers about atopic eczema and its treatment. By prioritising time for assessment and including practical demonstrations on how much of the treatments to use, how often to apply treatments, when and how to step treatment up or down, and how to treat infected atopic eczema, the guideline sets an invaluable precedent on the role that healthcare professionals should play in improving patient care.”
Notes to Editors
1. The guidance, together with a costing template and costing report, are available at www.nice.org.uk/CG57. In addition, the following implementation tools will be available on the website shortly: a slide set; key messages for local discussion, implementation advice; practical suggestions on how to address potential barriers to implementation and audit criteria.
About NICE
2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
3. NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
