INFANT ECZEMA
advised to monitor the eczema closely. NICE does not recommend the use of goat’s milk or sheep’s milk as they are “nutritionally inadequate for human growth”. Goat’s milk is very similar to cow’s milk in that it has 95% of the same allergens9
. Soya based products
are not appropriate for infants under six months of age, and should only be used under specialist advice as children are more likely to go on to develop an allergy to peanuts9
.
MANAGING ECZEMA In order to effectively manage eczema, it is important to establish whether the condition is mild, moderate or severe. In any case, the parents of infants should be reassured that the condition often improves over time. It is not appropriate to assume that the severity of the eczema is directly related to the impact on quality of life; even mild eczema can have significant effects on an infant’s amount of sleep, for example. A holistic approach is necessary when establishing disease severity. Validated tools such as the Patient Orientated Eczema Measure (POEM) are useful in establishing the quality of life of the infant. POEM is a questionnaire to be completed by the parents or careers of infants, with
48 - SCOTTISH PHARMACIST
a score given for each answer. The higher the score, the more severe the eczema.
The mainstay of treatment is emollient use. Emollients cannot be overused and should always be applied, even when the skin is clear. A step down approach to treatment is encouraged, whereby treatment of flare ups is with a corticosteroid of the lowest potency to keep the skin under control. SIGN guidance supports a twice weekly application of a corticosteroid treatment between flare –ups in order to reduce exacerbations.
Pharmacists can provide self-care advice to parents and carers of affected infants, regardless of the severity of the eczema. Infants tend to scratch their skin which can damage it further, implementing a vicious cycle of scratching and skin worsening. Mittens or cotton gloves are recommended to help prevent or limit scratching. Parents or carers could be advised to rub the skin gently; this may help to alleviate the itch. Keeping nails short is also important. Avoiding any trigger factors such as synthetic- fibred clothing, soaps and detergents, animals and heat exposure is a simple measure to help reduce flare ups8
.
Although some reports suggest that reducing exposure to house dust mites can help to reduce the risk of eczema, NICE does not recommend this as it is a time consuming task and benefits are limited.
Complementary therapies are not recommended by NICE guidance either, as there is limited evidence to support their use and they can induce side effects. •
REFERENCES
Atopic Eczema, 2012. Available at:
http://www.allergyuk.org/skin-allergy/ atopic-eczema [Accesssed 08/03/15] Eczema –Atopic-Summary, 2013. Available at:
http://cks.nice.org.uk/eczema- atopic#!topicsummary [Accessed 08/03/15] NICE guidance: Atopic eczema in children, 2007. Available at: https://www.
nice.org.uk/guidance/cg57/evidence/cg57-atopic-eczema-in-children-full- guideline2 [Accessed 09/03/15] NICE CKS. Eczema –Atopic. 2013. Available at:
http://cks.nice.org.uk/eczema- atopic#!backgroundsub:1 [Accesssed 10/03/15] NICE CKS. Eczema- Atopic. 2013. Available at:
http://cks.nice.org.uk/eczema- atopic#!diagnosissub [Accessed 10/01/15] NICE CKS. Dermatitis – Contact. 2013. Available at:
http://cks.nice.org.uk/ dermatitis-contact#!diagnosissub:1 [Accessed 10/03/15] NICE CKS. Scabies. 2011. Available at:
http://cks.nice.org.uk/ scabies#!diagnosissub [Accessed 10/03/15] NICE CKS. Eczema-Atopic. Available at:
http://cks.nice.org.uk/eczema- atopic#!diagnosissub:5 [Accessed 10/03.15] NICE CKS. Eczema- Atopic. Available at:
http://cks.nice.org.uk/eczema- atopic#!scenarioclarification [Accessed 10/03/15]
IN ORDER TO EFFECTIVELY MANAGE ECZEMA, IT IS IMPORTANT TO ESTABLISH WHETHER THE CONDITION IS MILD, MODERATE OR SEVERE. IN ANY CASE, THE PARENTS OF INFANTS SHOULD BE
REASSURED THAT THE CONDITION OFTEN IMPROVES OVER TIME.
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