Effective: January 2021

Review: October 2023

Management of Atopic Eczema in Children
Emollients are the mainstay of management
• Use multiple times daily Take a focused allergy history:
In moderate/severe eczema developing below 12 -
• Always use liberally – 250-500g/week
18 months this is highly indicative of food allergy –
• Use long term, even when the eczema is better consider referral to paediatric allergy service.
• For mild eczema an emollient can also be used as a soap In eczema developing above 12-18 months
substitute consider referral to paediatric dermatologist or
• Add a soap substitute in addition to emollient if community clinics if uncontrolled severe eczema
moderate or severe eczema
Important to assess quality of life and the affect of eczema on day to day life
Stepped approach to management of eczema
Tailor the potency of topical corticosteroids to the severity of the child's atopic eczema, which may vary according to body site.
Note: topical steroids should be used in addition to emollients.
NICE/CKS Guidelines https://cks.nice.org.uk/topics/eczema-atopic/prescribing-information/topical-corticosteroids/
They should be used as follows:
For mild atopic eczema -­­ use mild potency steroids e.g. 1% Hydrocortisone once daily
For moderate atopic eczema -­­ use moderate potency e.g. Clobetasone Butyrate 0.05% once daily
For severe atopic eczema ­­- use potent e.g. Mometasone Furoate 0.1% review after 2-4 weeks and consider stepping down if
improving.
For the face and neck -­­ use mild potency steroids or moderate potent preparations for short term periods (7-14 days) only
For flares in vulnerable sites -­­ use mild potency steroids or moderate potent preparations for short-term periods (7-14 days) only
Do not use • Potent topical corticosteroids on the face and neck.
• Very potent steroids without specialist dermatological advice

Consider secondary infection: TOP TIPS

• Particularly if not improving, rapidly
worsening or if there is weeping, crusting,
fever or malaise
• Treat with topical (useful only for small
areas only) or oral antibiotics
• If frequent infections consider antimicrobial
emollient See CKS:
https://cks.nice.org.uk/topics/eczema-atopic/
management/infected-eczema/
• Beware eczema herpeticum -­­ Requires
immediate referral to paediatrics. Important
to alert parents on how to recognise
infection.
Antihistamines should not be used routinely try
and treat the exzema but if required:
Criteria for referral to Paediatric Dermatology:
• Offer 7 to14 day trial of sedating
antihistamine for acute flares or if sleep
disturbance is significant e.g.
Chlorphenamine
• Do not use aqueous cream as an emollient
• Advise daily bathing with soap substitute unless contraindicated
• Don’t be afraid to start topical steroids
• Step up and step down steroid strenghs, use weakest that can gain
control then reduce
• 1 fingertip (little finger) unit of steroids should be used for an area of
two palms
• Ointments are preferred as more hydrating than creams.
• Do not recommend food based emollients in children not eating that
food
• Avoiding irritants, no dietary modification without confirmed allergy
• Keep nails short, highlight fire risk with emollient use
• Share patient resources e.g. https://www.itchysneezywheezy.co.uk/
• Link to National Eczema society https://eczema.org/
For advice from
paediatrician:
• uncertain diagnosis
• multiple flare ups See Further
• recurrent severe infection Assistance sheet
• contact allergic dermatitis attached
• significant social/psychosocial effects

For more information please refer to full NICE Guidance (CG57): http://guidance.nice.org.uk/CG57
 FURTHER ASSISTANCE
This pathway has been produced by the NCL CCG to help clinicians manage the healthcare
of Children and Young People. However, if you need to contact a paediatrician, please see
below for contact details:

NMUH
• Consultant Paediatric hotline: Tel: 07436 283 463 (Mon - Sun 9am–9pm)
• If unanswered call the Paediatric Registrar: Tel: 020 8887 2000 bleep 195
• Advice and Guidance is through ERS

RFH (Barnet Hospital)

• Consultant Paediatric: Tel: 020 8216 4600 bleep 2902
• Paediatric Registrar: Tel: 020 8216 4600 bleep 2900
• Advice and Guidance through ERS

RFH (Hampstead):
• Consultant Paediatric: Tel: 020 3758 2000 bleep 1000 (Available 24/7)
• Urgent Referral Clinic: Tel: 020 3758 2000 bleep 1000 to discuss & confirm time for clinic
(available Mon-Fri, 10 to 12am)
• Advice and Guidance is through ERS

UCLH:
• Consultant Paediatric hotline: Tel: 07803 853567 (Mon - Sun 24/7)
• If not answered call the Paediatric Registrar: Tel: 020 345 6789 bleep 5301
• Daily rapid referral clinic appointments are available through ERS (specifically
choose the Children & Young People Rapid Referral Clinic, Paediatric Division-UCLH-RRV )
• Advice and Guidance is through ERS

Whittington Health:
• Consultant Paediatric hotline: Tel: 0779 694 0840 (Mon-Sun 9am - 830pm)
• For urgent advice on a sick child, bleep the Paediatric SpR: Tel: 020 7272 3070 bleep 3111
• 10 - 12 clinic: children seen 24 - 72 hours from referral.
Email form (on GP Portal) to whh-tr.childrensambulatorycare@nhs.net
• Advice and Guidance Email: askpaediatrics.whitthealth@nhs.net or via ERS

Additional Community Resources

Camden Children's Community Clinic

https://gps.northcentrallondonccg.nhs.uk/service/childrens-community-atopy-asthma-eczema-
clinic

Islington Paediatric Primary Care Service

https://gps.islingtonccg.nhs.uk/service/paediatric-primary-care-team