Young children with eczema often have atopic eczema. There are other types of dermatitis, but it is atopic eczema that often proves frustrating and difficult to treat, leading to family stress, and far-reaching effects on all aspects of life and leisure.
Why is it so difficult to manage well?
Too often there is little understanding between aspects of different disciplines; immunology/allergy, dermatology, and general practitioners’ prescribing rules. There may be fear of using steroid creams because of side effects, or the skin “getting used to it”, or fear of over-prescribing antibiotics. There may be too many tubes of cream in the bathroom to know which one to use. The child may be constantly scratching, have disturbed sleep, and may be unable to play sports, or sleep over with friends. And what about environmental factors, the cat or dog, the soft toys, milk or eggs? Parents and GPs may have only a partial understanding of why atopic patients are also susceptible to asthma, allergies, hay fever, and frequent infections. The role of Staph aureus germs may be under-estimated.
Typical mainstream management consists of individual tubs or tubes of emollient moisturising creams to combat skin dryness, topical steroid creams to combat inflammation, and occasional antibiotic creams for infection.
There are more specialised creams for those wishing to avoid steroids altogether, such as tacrolimus or pimecrolimus creams. Your GP may be unwilling to prescribe these. And there are even more specialised treatments for severe eczema, known as biologics such as Dipilumab, which can be initiated by dermatologists only under very specific guidelines. So clearly it is more complicated than a simple skin condition. Explanations such as an outside-inside and an inside-outside disease don’t help most parents either. Not many want to go into the complex immunology. But I do believe that every parent would like to see the condition go into remission, and better understand how to get there.
What I believe is needed is a tailored approach to a particular child or adult’s needs, with a simple one-stop cream used at clearly defined intervals depending upon the activity of the eczema, until such time as one can be sure the disease has gone into remission.
Such an approach needs to take account of the extent and severity of the eczema, the child’s age and weight, safety considerations, and social impact.
What is not realised is that there have been very successful treatments using compounded or pre-mixed creams for quite some time, but not available on the NHS.
Such an approach will not work for everyone; there will always be those with eczema of such severity, they require a more specialised approach. My hope is that I can help prevent things getting to that stage.