Paeds3_Atopic Dermatitis - Danielle Greenblatt
Speaker key
IV Interviewer
DG Danielle Greenblatt
DG My name is Danielle Greenblatt and I’m a consultant dermatologist at the Royal Free Hospital with an interest in paediatric dermatology. My talk was about atopic dermatitis in primary care.
IV Why have you chosen to speak about atopic dermatitis?
DG Skin problems in children are extremely common and perhaps the most frequent diagnosis seen in both primary and secondary care is that of atopic dermatitis. We know that the incidence of atopic dermatitis is increasing worldwide and it now affects approximately one in five children living in the UK.
IV How do children tend to present?
DG So children often present with an itchy rash and in the acute phases we see ill-defined areas of erythema with oedema, weeping, vesiculation. As eczema becomes more chronic, it’s accompanied by xerosis, thickening of the skin or lichenification and hyperpigmentation. The distribution of eczema varies according to the child’s age.
IV Are there any differential diagnoses?
DG Yes, there are a number of other diagnoses which can masquerade as eczema, including infections such as tinea and scabies infection; allergic contact dermatitis also needs to be excluded; and more rare conditions such as immunodeficiencies in childhood.
IV When should we consider allergy testing in children with atopic dermatitis?
DG Allergy testing is important to consider in young infants who are born with atopic dermatitis with onset within the first three months of life. Food allergies and sensitisation can be relevant to driving their eczema if a child has severe eczema with early onset. In older children who have ongoing eczema, food allergy testing may be relevant. Also, aeroallergens need to be considered.
IV What treatments are possible in primary care?
DG A stepped approach to managing eczema is recommended by the NICE Guidelines. So treatment consists of emollients and this is supplemented by use of topical steroids and calcineurin inhibitors as a second-line agent. Multiple different emollients are available in primary care and they are differentiated by whether they are more greasy or more creamy and it’s often patient and parent preference as to which is chosen. With regards to topical steroids, steroids should be chosen based on the severity of the child’s eczema being mild, moderate or severe. And the potency of the topical steroid should be adjusted to suit this. Calcineurin inhibitors are licensed for use as a second-line treatment in moderate to severe eczema and they are particularly helpful for delicate sites such as around the eyes, on the face and neck.
IV When should a GP refer on?
DG It’s important to consider onward referral in the setting of a child who has severe eczema which is failing to respond to treatment. If the eczema is recurrently infected, if there are associated psychosocial concerns, if there is a difficult facial eczema or if you are suspicious of an associated allergic contact dermatitis – those would be good reasons to refer a child into secondary care.
IV Where can GPs find out more?
DG The NICE Guidelines were published in 2007 and are available online. The American Academy of Dermatology has also recently published guidelines on eczema management in children. Online, the National Eczema Society is a great resource available for professionals and for patients and their families. I’m happy to be contacted via email at .
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