Management of atopic eczema in children aged up to 12 years: summary of NICE guidance

doi:10.1136/bmj.39405.503773.AD

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Sue Lewis-Jones, consultant dermatologist1,
Moira A Mugglestone, deputy director2
on behalf of the Guideline Development Group

¹Ninewells Hospital and Medical School, Dundee DD1 9SY
²National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA

Correspondence to: M A Mugglestone mmugglestone{at}ncc-wch.org.uk

Why read this summary?

Atopic eczema affects one in five children in the United Kingdom1 and accounts for 1 in 30 consultations in community care.2 Recent data suggest that impaired skin barrier function is a major causative factor.3 4 There may be considerable physical and emotional morbidity for the child and the parents or carers, particularly if the disease is poorly controlled.5 Yet most healthcare professionals receive little or no relevant training in dermatology,6 and lack of knowledge, confusion, and anxiety about many of the available treatments are widespread among parents.5 7 This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to manage atopic eczema in children from birth up to the age of 12 years.8

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

Diagnosis and assessment

• Diagnose atopic eczema in children according to the criteria in box 1.
• Adopt a holistic approach to assessing a child’s atopic eczema*, taking account of the physical severity of the eczema (box 2) and its impact on quality of life (which may range from no impact to severe limitation of everyday activities and psychosocial functioning, with loss of sleep each night (box 3). This assessment should guide treatment decisions; no direct relation necessarily exists between physical severity of atopic eczema and impact on quality of life.

Box 1 Criteria for diagnosing atopic eczema in children

Itching plus three or more of:

Visible flexural dermatitis involving skin creases (or involvement of cheeks and/or extensor surfaces in children aged up to 18 months)
History of flexural dermatitis (or involvement of cheeks and/or extensor surfaces in children aged up …