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Review Date: January 2014

Eczema Care Plan Information for Patients and Carers

This care plan is designed to help you manage your child's skin condition (eczema) and give you information.

Eczema is an inflammatory skin condition with symptoms that include dryness, itching and reddened skin patches. There is no cure, but the condition can be managed. Treatment options include emollients (moisturisers), topical steroids (anti-inflammatory ointments) and oral antihistamines (medicines to reduce itch). Occasionally some children may require wet wraps (bandages applied over creams) and calcineurin inhibitors (anti-inflammatory medicines).

Name________________________________Date of birth___________________________ Doctor_______________________________ Date_________________________________

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As you can see by the diagram above, having eczema means your child's skin is lacking the particular body substances that usually keep skin supple and intact. When damaged, moisture evaporates from the skin, cells shrink and cause cracks. Allergens (substances that trigger allergic reactions) and irritants can get in, triggering your skin to release certain chemicals that make your child's skin feel itchy. When he/she scratches the skin, more chemicals are released and the itchier the skin feels. This ‘itch-scratch' cycle is most distressing.

How can this plan help us? While there is no cure for eczema, it is possible to moisturise and create a barrier on the surface to keep the added moisture in and the irritants and triggers out. This plan aims to provide strategies to keep your child’s skin in the best condition possible.

How do we avoid running out of creams? See your GP regularly to get all prescribed creams and treatments in appropriate quantities; do not wait until you run out! Give your GP 48 hours notice to get the prescription ready.

Contact your GP (or if you have been referred to one, your community paediatric nurse) if you have any concerns regarding your child's eczema.

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General Information Bathing & Showering

• Any product that bubbles is trouble (J. Carr 2006). Anything that smells nice is

double trouble, so please avoid using these products.

• Avoid using soap or soap based products that can thin and dry the skin. Use non-soap based products (bath oils, body washes) that cleanse the skin by helping dirt stick to the product, which is then rinsed off.

• Cosmetic body washes are NOT recommended.

• Skin does not have to feel dry and tight to be ‘clean’.

Soap Substitutes/Bath Oils • Use a soap substitute for washing and cleaning skin. Apply generously prior to

getting into the bath and use hands to rinse off with water.

• Beware bath oils can make the bath slippery and wet. We advise caution and the use of a bath mat.

Moisturising • By including effective moisturising into part of your daily routine, you will usually find

the skin flares less often, the flares may be less severe and your child is less prone to infection.

• It is up to you to maintain this. It is like a car - if you let servicing and maintenance slip the car will falter. It is the same with your skin.

Emollients • Emollient is a term given to a range of skin treatments that moisturise, lubricate and

soften dry skin.

• Unlike most other eczema treatments, there are no 'chemically active' ingredients in emollients, so they can be used liberally in all age groups. Use plenty when skin looks dry and not shiny, at least twice a day. You may need to change emollient type if one does not work.

• The emollients help to keep moisture in the skin and form a protective barrier to outside irritants. These are best used few minutes after a warm bath, while the skin is still slightly damp.

• They can be used instead of soap and may be added to the bath as an emollient bath oil.

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Review Date: January 2014

• Apply in direction of hair growth, not against, as this can cause infection of hair follicle.

Topical Steroids • Topical steroid creams and ointments reduce the inflammation of the eczema and

help to heal the skin. They should only be used under the supervision of your doctor.

Infection • Infection is a common trigger for eczema flares. As damaged skin has a greater

chance of becoming infected, it is important to watch for signs of infection such as pain, redness, weeping sores and/or yellowish crusted sores on the skin. If infected seek antibiotic treatment, as soon as possible.

• Extra care is needed if a person with eczema is around someone with cold sores, caused by the herpes simpex virus (HSV), which can infect damaged skin, cause blistering and make you very unwell. Seek advice from your GP if you get any cold sores or blisters.

• Molluscum contagiosum is a warty looking virus commonly occurring in children including those with eczema. Scratching will spread the infection. Although it can be distressing, it will disappear over time without treatment.

• As immunisation tries to fool the body into thinking it has an infection, eczema may flare up. However it is very important to have immunisations on the correct schedules. You should always tell your doctor that you have eczema before any immunisations.

• Avoid wet wraps, calcineurin inhibitors and medicated creams when infection is suspected.

More information is available from the National Eczema Society Hill house, Highgate Hill, London N19 5NA. Phone: 0870 241 3604 Email: www.eczema.org The British Association of Dermatologists also have more information at www.bad.org.uk

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ACTION PLAN: STEP 1 ECZEMA UNDER CONTROL - SKIN SOFT AND SUPPLE (NOT RED OR ITCHY) • Moisturise whole of skin area at least two times daily with emollient cream. • Watch for signs of skin becoming red, frequently itchy and dry. • Moisturise/Emollient:……………………………………………………………….......... (500g should last 1-2 weeks) Apply...........................................times a day • Non-soap based wash product…..............................................................................

ACTION PLAN: STEP 2 ECZEMA FLARE (MODERATE) - SKIN ITCHY, SOME REDNESS, DRYNESS, FLAKING • Apply thick cream to all of skin (contains paraffin or equivalent) during day • Apply greasy cream at night • Watch for red flares - use prescribed topical corticosteroid ointment on red areas • Watch for signs of infection (weeping, oozing, crusting, pustules, unresponsive eczema, fever or malaise) - may need antibiotic prescribed by doctor • APPLY CORTICOSTEROID CREAM/OINTMENT FIRST Face...............................................................frequency.................................times a day Scalp..............................................................frequency.................................times a day Body...............................................................frequency.................................times a day WAIT 15-30 MINUTES BEFORE APPLYING MOISTURISER Moisturiser: day .………..................................frequency................................times a day night …………………………..…........................................................................................ • Bath oil or body wash: ............………………………………………………....................... • Other prescribed medication: .............………........……………………………..................

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Review Date: January 2014

ACTION PLAN: STEP 3 ECZEMA FLARE (MODERATE TO SEVERE) - WHEN ECZEMA IS NOT RESPONDING TO THE ABOVE TREATMENT • Watch for infection (see above), if concerned, seek medical advice as soon as possible • Use corticosteroid ointment prescribed by your doctor • Corticostoid ointment: Face...............................................................frequency.................................times a day Scalp..............................................................frequency.................................times a day Body...............................................................frequency.................................times a day Moisturiser: day .………..............................frequency ……………...………times a day night …………………………..………………………………………………...... • Bath oil or body wash: ............……………………………………………………………….. • Other prescribed medication:............………........…………………………………………..

Completed by……………………………………………………Date…………………………….

Step by Step Application Use soap

substitute/bath oil in bath ↓

Rinse off with water ↓

Pat dry with clean towel ↓

Apply steroid cream according to FTU

( diagram) ↓

Wait 15 minutes ↓

Apply moisturiser liberally and top up about 4 – 6 times

during the day

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Review Date: January 2014

Languages/ Alternative Formats Please call PALS (Patient Advice and Liaison Service) if you require this information in other languages, large print or audio format on 01895 279973. Fadlan waydii haddii aad warbixintan ku rabto luqad ama hab kale. Fadlan la xidhiidh 01895 279 973

Jezeli chcialbys uzyskac te informacje w innym języku lub w duzej czcionce popros pracownika oddzialu o kontakt pod numerem telefonu: 01895 279973

各國語言/模式選擇 若你需要以下資料改為其他語言，大寫，或其他模式例如收音式或 盲人字體的話，請電 01895 279973。