Magazine article Drug Topics

New Eczema Guidelines Promote Use of Emollients, Then Topical Corticosteroids

Magazine article Drug Topics

New Eczema Guidelines Promote Use of Emollients, Then Topical Corticosteroids

Article excerpt

In December 2007 the National Institute for Health and Clinical Excellence (NICE) published its clinical guidelines on the diagnosis, evaluation, and management of atopic eczema in children 12 years of age, replacing the 2006 British Association of Dermatology and Primary Care Dermatology Society guidelines.

Atopic eczema is a chronic inflammatory skin condition that commonly begins in early childhood. "There are many potential triggers. These include genetics, irritants, environmental factors, food allergies, or infectious colonization," said Anita Siu, Pharm. D., clinical neonatal/pediatric pharmacotherapy specialist and assistant and clinical professor at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey.

The NICE guidelines promote a stepwise approach to management, with regular emollients and intermittent topical corticosteroids forming the basis of treatment and topical calcineurin inhibitors as second-line treatments. Some recommendations have strong evidence to support them, indicated by a Level 1+ or Level 1++, depending on the meta-analysis or randomized clinical trials used to support the recommendations. The guidelines are evidence-based and also use a modified Delphi technique to formulate recommendations when substantial research evidence is lacking.

The guidelines have been developed for the diagnosis and assessment of the impact of the condition, management during and between flares, and education of children and their parents about the condition. A stepped approach is emphasized for managing eczema in children, tailoring the treatment step to the severity of the eczema. According to the guidelines, emollients should be the basis of management and should always be used, even when the eczema is clear. Based on the severity of symptoms, management can then be stepped up or down with the addition of treatments, such as corticosteroids, topical calcineurin inhibitors, and bandages. There are some instances in which emollients and other topical products are used at the same time of the day. In these cases, the guidelines recommend that the different products be applied one at a time with several minutes between applications, with no preference as to which product should be applied first. …

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