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All emollients should be applied even when the skin looks good and applied in
the direction of the hair growth. The most effective emollient is the one the
child and family will use.
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STEROIDS TUBIFAST GARMENTS AND TUBIFAST LENGTHS
Medical opinion favours adequate use of steroids to get condition under control. Dry or wet wrapping helps seal in the moisturisers, aids healing and can prevent
Once under control if possible step down the steroid ladder. Ointment or cream the child scratching the skin.
preparations are available, but ointments are the first choice as they work more
effectively on dry skin and soak into creases more effectively. Also be aware that Use appropriate sized Tubifast garments or lengths ordered on
steroids under occlusion increase the potency prescription.
Can be used either dry or wet over copious amounts of emollients.
Step 1: Hydrocortisone – 0.5%, 1% and 2.5% strengths for BD use, Wet wrap after bathing where emollients and steroids have been applied.
very mild and very safe. Can be used on faces. One layer of the tubifast garment is dampened in water prior to
Step 1-2: 10% Propaderm in white soft paraffin – BD use. Potent in application then a dry garment on top.
its neat strength, but weak when in this 1 in 10 dilution. Side effects of There are leaflets, videos and other teaching aids available from Seton
hydrocortisone, excellent for widespread eczema and use under wet Healthcare (0161 621 2100).
wraps. Caution as confusion possible with Epaderm; both come in 500g Wrapping should not be carried out when the skin is infected.
pots. Liberal amounts can be used for moderately severe eczema i.e. Not recommended over potent steroids as this increases potency.
5year old 500g in 1st week, 250g in 2nd week, 125 in 3rd week and then Takes commitment from the family so it is worth asking them to comply
stop. However expensive to produce (about £100 per pot). for at least a week to see some benefit.
Step 2: Eumovate – moderately potent Good for Children over 2 years
old, if Hydrocortisone is not controlling eczema. ZIPZOC
Betnovate RD 1:4 – moderately potent. Can be used for short periods.
If needing a moderately potent steroid may be better to us Elocon, as Zipzoc is a zinc paste stocking available on prescription, but only comes
there are less side effects. in one width and length.
Step 3: Elocon – Once daily only. Potent in strength, but better Evidence has shown that Zipzoc applied to excoriated areas, particularly
metabolised in the liver than other potent steroids. Excellent for around ankles and wrists aids healing and is soothing under tubifast
eczema flare ups – can be used for 2-3 days in a row to get control then garments or the appropriate sized tubifast length.
1-2 times a week. Caution and monitoring when used under 3years. It can be worn for up to 48 hours. It is applied over copious amounts of
Known to sting. emollients and should be temporarily rolled back during the day to re-
Step 4: Dermovate – Very potent, not usually used on children and only apply more emollient.
under the guidance of a dermatologist. Not to be used on infected skin.
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INFECTIONS ALLERGY TESTING
Both topical and oral antibiotics to be used with caution due to increased Often parents wish to find a cure for their child’s eczema. They
incidence of resistance to antibiotic therapy. experiment with their child’s diet and often request allergy testing.
Fucidin H used on most cases of infected eczema. If the child has been Unfortunately, allergy testing such as skin prick testing and the RAST
using moderate/potent steroids then for infection add Fucidin without the blood test can not diagnose the causes of eczema as the child will not
Hydrocortisone. To use 2-3 x 30g tubes of Fucidin H/ Fucidin twice produce antibodies. The private tests in the community looking at a wide
daily, over a week. If this is ineffective consider for referral for range of things often give insignificant and confusing results.
antibiotics. The general advice is if the eczema is manageable with standard
Flucloxacillin is the appropriate oral antibiotic but is often unacceptable treatment, then diet should not be tampered with. If the eczema is poorly
to children, due to the taste. Only use if eczema is widespread. controlled and causing considerable problems, then diet can be looked at
Also consider whether it is fungal- infections in sweaty or wet areas such as a possible trigger. Foods such as cow’s milk should only be omitted
as under arms or nappy areas are often fungal and require anti-fungal with advice from a dietician.
topical treatment. Allergy testing is appropriate for children who have Type I
If unclear consult a dermatologist or swab the area and speak to a hypersensitivity food reactions such as immediate hives, lips or facial
microbiologist. Added to this consider swabbing the nostrils of all the swelling (angio-oedema), vomiting or the more severe reactions such as
family if infection not clearing as they may need treating with Naseptin breathing difficulties or hypotension leading to collapse. These children
or what is currently recommended by the microbiologist. should be given advice on how to manage these reactions and referred to
Introduce Dermol products to reduce risk of infection. the allergy clinic.
If the eczema is very inflamed, not obviously infected, but is not
responding to topical steroid, it is generally infected and requires topical TOPICAL IMMUNOSUPPRESSANTS
antibiotics.
Once infection has gone wetwrapping can be commenced with the Tacrolimus 0.03% (patients aged 2-16yrs) and Tacrolimus 0.1 % (patients aged
appropriate steroid or Zipzoc. 16 and over). For severe eczema and only under dermatology supervision.
Also consider if the eczema is infected by the herpes virus, known as Pimecrolimus 1% (patients over 2yrs). For mild to moderate eczema. G.P.can
herpeticum. Some children can become unwell very quickly with this prescribe. To use twice daily until clearance occurs. Then discontinued and
and need immediate dermatology treatment. restarted at first signs of symptoms.
Both drugs are immunosuppressants and useful when steroids have failed or when
there has been long term use for steroids. Often most useful on face and neck
areas. Some cautions (in addition see data sheets)
Neither drug should be used as first line management.
Not used when infection present or with live attenuated vaccines.
Skin irritation can occur which usually resolves as treatment continues.
Sun protection needed due to immunosuppressant properties.
Not to use topical steroids on same site.
Not to use under occlusion.
********************** Revised by Elaine Cleaver/Judith Ward - July 2005.
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