Exacerbation of atopic eczema in children

doi:10.1136/bmj.b2997

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Matthew Ridd, National Institute for Health Research clinical lecturer ,
Sarah Purdy, consultant senior lecturer and Medical Research Council clinician scientist

¹Academic Unit of Primary Health Care, University of Bristol, Bristol BS8 2AA

Correspondence to: M Ridd m.ridd{at}bristol.ac.uk

Accepted 1 December 2008

A father attends with his 18 month old son Samuel because “his eczema is playing up.”

What issues you should cover

Ask how long the patient has had eczema and what does his father already know about it? Ask what is meant by “playing up.” Specifically ask about itch and how the patient’s activities and sleep have been affected. Find out what treatments (prescribed, over the counter, and alternative) have been used. Identify and deal with confusion or concerns—for example, about emollient greasiness or steroid side effects. Acknowledge practical problems such as the need to have an emollient always to hand. Ask about reasons why the patient’s eczema has worsened. Review trigger factors such as soaps, detergents, and allergens.

What you should do

Examine the patient to see how he is generally. See which areas of skin are affected. Look for dryness, redness, scratch marks, and infection. Confirm the diagnosis, remembering that the distribution differs between ages and ethnic groups. Distinguish site and severity from effects of day to day life. Exclude systemic illness—refer the …