If used correctly, the structured approach recommended in this guidance should allow improved quality of care and more cost effective clinical management of atopic eczema. The approach requires an initial investment in time to assess the child’s atopic eczema adequately and discuss parental anxieties about treatments, emphasising that the benefits of topical corticosteroids outweigh possible harms. Written care plans should cover treatment of flares and episodes of infected eczema to educate parents on when topical corticosteroids (and other treatments) are appropriate. This investment should, however, lead to longer term benefits, empowering children with atopic eczema and their parents or carers to take control of management, and potentially reducing the need for frequent monitoring and thus the workload of healthcare professionals.
To support implementation, NICE and the guideline development group have developed a version of the guidance (available from December 2007 at www.nice.org.uk/CG057PublicInfoEnglish
) that can be given to children with atopic eczema and their parents or carers).
Further information on the guidance
A study conducted in the United Kingdom in 2003 reported a lifetime prevalence of atopic eczema in 12 year olds of 23%.1
Similar lifetime prevalence figures were reported in two other studies conducted in the United Kingdom (20% in children aged 3-11 yearsw1
and 25% in children aged 8 yearsw2
), although a third study reported a lifetime prevalence of 41% in children aged 10 years.w3
Despite the frequency of consultations for eczema in community care (dermatological conditions account for 15% of such consultations, of which 22% involve eczema2
), general practitioners lack dermatological knowledge and training.4 w4
The aim of the new guidance is to provide a framework for healthcare professionals to empower children with atopic eczema and their parents or carers to manage the condition effectively, thus alleviating the negative impact on their quality of life. The guidance encompasses education and information about topical treatments, including topical corticosteroids, which are currently a source of confusion and anxiety for many parents and limit adherence to treatment.3 5 w5
Recent studies have linked ichthyosis vulgaris, the commonest inherited type of dry skin, to a high risk of developing atopic eczema, which may be severe and persistent.3 4
This supports the belief that inheritance of genetic traits causing impaired skin barrier function is a major factor in the development of atopic eczema. Strategies to improve skin barrier function, such as reduction of irritants and the use of emollients, as recommended in the guidance, are vital for successful treatment.
The guidance was developed by the National Collaborating Centre for Women’s and Children’s Health in accordance with NICE guideline development methods (see www.nice.org.uk/page.aspx?o=114219
). The collaborating centre established a guideline development group consisting of healthcare professionals and patient and carer representatives, with experts in guideline methodology from the collaborating centre. The guideline development group identified and appraised clinical effectiveness evidence and evaluated cost effectiveness of interventions where possible. Stakeholder organisations were invited to comment on a draft of the guideline that was subsequently revised to take account of comments received.
NICE has produced four different versions of the guideline: a full version containing all the evidence and the recommendations; a quick reference guide; a version known as the “NICE guideline” that lists the recommendations; and a version for patients and the public. All these versions are available from the NICE website (www.nice.org.uk/CG057
). Future updates of the guidance will be produced as part of the NICE guideline development programme.w6
Key areas for future research
- Optimal feeding regimens for children aged under 1 year with established atopic eczema
- Treatment strategies for managing and preventing flares of atopic eczema in children
- The effect of controlling atopic eczema in children aged under 1 year on subsequent development and severity of other atopic diseases
- Long term effects of topical corticosteroids for atopic eczema in children
- Clinical and cost effectiveness of different models of education in the early management of atopic eczema in children
- w1 Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol 1994;30:35-9.
- w2 Harris JM. Early allergen exposure and atopic eczema. Br J Dermatol 2007;156:698-704.
- w3 Kurukulaaratchy R, Fenn M, Matthews S, Arshad H. The prevalence, characteristics of and early life risk factors for eczema in 10-year-old children. Pediatr Allergy Immunol 2003;14:178-83.
- w4 Schofield JK, Adlard TP, Heatley P, Gunn S. A study of the dermatological knowledge of general practitioner (GP) registrars: implications for GP training programmes. Br J Dermatol 2003;149(suppl 64):19-56.
- w5 Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000;142:931-6.
- w6 National Institute for Health and Clinical Excellence. Updating guidelines and correcting errors. In: The guidelines manual. (Ch 15.) www.nice.org.uk/page.aspx?o=423088.
Members of the Guideline Development Group
- Denise Carr, general practitioner with special interest in dermatology, Eden Park Surgery, Beckenham
- Christine Clark, medical writer and independent pharmaceutical consultant, Rossendale
- Michael J Cork, head of academic dermatology, Academic Unit of Biomedical Genetics-Dermatology, The University of Sheffield School of Medicine and Biomedical Sciences, and honorary consultant dermatologist, Sheffield Children’s Hospital and Sheffield Teaching Hospitals NHS Foundation Trust
- Helen Cox, consultant in paediatric allergy and immunology, Imperial College Healthcare NHS Trust, London
- Elizabeth Gilmour, consultant dermatologist, Tameside General Hospital, Ashton-under-Lyne, and Booth Hall Children’s Hospital, Manchester
- Wendy Lancaster, health visitor, North Yorkshire and York Primary Care Trust, Haxby and Wigginton Health Centre, York
- Sandra Lawton, nurse consultant dermatology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust
- Sue Lewis-Jones, consultant dermatologist, Ninewells Hospital, and honorary senior lecturer, Ninewells Hospital and Medical School, Dundee, and University of Dundee
- Sarah Purdy, consultant senior lecturer in primary health care, University of Bristol, and general practitioner, Bristol
- Amanda Roberts, patient/carer representative, Nottingham
- Jean Robinson, clinical nurse specialist (paediatric dermatology), Barts and The London NHS Trust, Royal London Hospital
- Sue Ward, information and education manager, National Eczema Society, London
National Collaborating Centre for Women’s and Children’s Health staff
- Paula Broughton-Palmer, senior work programme coordinator, National Collaborating Centre for Women’s and Children’s Health, London
- Hannah-Rose Douglas, senior health economist, National Collaborating Centre for Women’s and Children’s Health
- Alyson Huntley, freelance systematic reviewer, Exeter
- Moira A Mugglestone, deputy director, National Collaborating Centre for Women’s and Children’s Health
- Anne Marie O’Connell, information specialist, National Collaborating Centre for Women’s and Children’s Health
- Julia Saperia, research fellow, National Collaborating Centre for Women’s and Children’s Health