Children Eczema – North East London

What is eczema:

Eczema is a chronic dry skin condition also known as Atopic dermatitis. Dermatitis is a group of conditions that cause skin inflammation. Eczema is accompanied by a ferocious itch. Eczema causes the skin to be dry, itchy and scaly the colour can be red, brown, grey or purple depending on your skin tone. When not well managed the skin can be thickened, hypopigmented, hyperpigmented, and sometimes weeps fluid.

Eczema is caused by a combination of genetic, immunological and environmental factors. When someone has eczema, their skin does not provide the same level of protection as normal skin since the skin barrier is defective. Moisture is lost causing the skin to become very dry and external irritants can penetrate the body more easily and cause inflammation. However it is important to remember that eczema is a chronic dry skin condition patients and families should be reminded that is long lasting (chronic) and tends to flare sometimes. Eczema is not contagious and it is vital that everyone who comes into contact with the children who suffer with eczema understands that. There’s no cure for eczema, but treatments can ease the symptoms.

Eczema leaflet – How to manage and treat your child’s eczema

Personalised Eczema Management Plan

School Care Plan

Children’s Eczema Guidelines

https://primarycare.northeastlondon.icb.nhs.uk/wp-content/uploads/2023/11/Tower-Hamlets-Eczema-Pathway-v9-17.11.23.pdf

eczema in children | Search results | NICE

Tower Hamlets Community Children Eczema service referral criteria

Role of Community Eczema specialist nurse:

One off teaching and education on how to manage eczema for CYP and families

Support with underusage of treatment – showing how to apply treatments appropriately (videos in place for GPs to share)

Concerns/issues with topical steroid therapy

To support with optimising treatment before tertiary dermatology input/whilst waiting to be seen by derm team for those with moderate-severe eczema

Specialist input regarding treatments and support

Teaching support for staffs and colleagues (GPs, health visiting team, schools and more )

Eczema service referral criteria:

All CYP must have tried soap substitute.

All CYP must be using sufficient moisturising emollients frequent and liberal.

All CYP must have had a trial of appropriate topical steroid (moderate-potent)

All CYP must have had four weeks follow up to check response to treatment before referring to community eczema service.

All CYP should be prescribed a soap substitute for daily baths such as; Zero AQS OR Aquamax OR Zeroderm Cream OR Aproderm cream for daily baths and wash.

All CYP should be prescribed sufficient emollient treatment as emollients are crucial in managing eczema – the most effective being an ointment. Please offer choice of preferred treatment to patients. Please ensure 250g-500g/week depending on size of child including one to remain at school/Nursey.

All CYP should have tried appropriate topical steroid to manage the inflamed and itchy areas of the skin such as; Elocon ointment BD for flare ups on body and limbs and Eumovate ointment for flares on face and neck for 7-14 days as per NICE Guidelines June 2023.

All CYP should then be followed up by the GP after 4 weeks. If at that point, no improvements using a moderate-potent topical steroid then please refer to Eczema CNS.

Please ensure there is also a soap substitute and moisturising emollient in place at school/nursery.

Please note the Eczema Community Service cannot accept children who have not been commenced on a trial therapy of moderate-potent topical steroid. The clinician should then assess response to this after 4 weeks and if at this point skin has not improved then refer to the community eczema service.

Please get in touch with the eczema service at bartshealth.cypeczema@nhs with any inquiries.

Community Clinic

PFSE have community clinics in Appleby Health Centre, Stratford Village Surgery, Lathom Road Medical Centre, as well as hubs in Tower Hamlets and Waltham Forest.

GP’s can refer to them directly via eRS. They accept referrals from Tower Hamlets, Newham, and Waltham Forest at present. Their current wait time is approx. 7 weeks vs our 63-week wait! Please see the referral exclusion criteria

Dermatology | pfse (patientfirstse.com)

Specialist tertiary eczema care referral

Specialist dermatological advice

The referral should be to a specialist dermatological unit dealing with paediatric patients, for example a clinician with experience or qualifications in paediatric dermatology. This could include a paediatrician, specialist nurse or a GP with a specialist interest as long as they are within a dermatological unit and trained in paediatric dermatology.

Referral for specialist dermatological advice if the atopic eczema is not well controlled (including as assessed by the child, parent or carer), has not responded to treatment, is associated with recurring infections or if contact allergic dermatitis is suspected. Specialist dermatological advice should also be sought if the physical condition is giving rise to significant social or psychological problems for the child (or their parents or carers), including sleep disturbance or poor school attendance.

There is no Advice and Guidance but there is an on-call dermatology service, GP’s can access for emergency advice via the hospital switch board.

The primary care pathway advises for secondary care referral The Royal London Hospital via ESR;

If no improvement/worsening despite 3 weeks of optimal topical treatment (application technique, amounts of steroids/emollients used should be reviewed by GP to ensure optimal treatment)

If not responding to treatment due to lack of understanding/education should be referred to the community eczema CNS first

Recurrent infections
Suspected contributing food allergy (IgE/non-IgE) – this would warrant A&G or referral to Paeds Allergy

Please provide: Full medical and drug history including a list of all topicals emollients and steroids.

Allergy referrals should not be sent to dermatology. Community provider (PFSE) have a shorter waiting time and recommends all eczema referrals have a shorter waiting times: Dermatology | pfse (patientfirstse.com)