Eczema Management

School age child, adolescent & adult

• Basic management principles apply across the ages especially when severe, exacerbated or poorly controlled eczema

• Allergy diagnosis and management becomes less significant with increasing age and ability to self manage in regards to eczema care

• If moderate to severe eczema, likely to need skilled professional support for good management

• There are always exceptions and management should be individualised

School age child, adolescent & adult

Self care essential for good control of eczema, resilience and general physical & emotional wellbeing

In the younger child help and support is required to maintain self care

For the older child and young person, this help and support is still required but more emotional than physical

School age child, adolescent & adult

Need to address physiological issues first Then if required look at other aspects to

assist in self management of eczema; what are triggers, barriers and the possible solutions

Can only do one thing at a timeManagement needs to be incorporated into

daily life

This session is

Addressed to parents in many aspects as they are so central to the child and young person

For Health Professionals this will give you a guide of the support and guidance families and /or the individual may need

School Age ChildFamily and Health Professionals often under

estimate ability to self manageEncourage and support child to recognise

symptoms, triggers and use basic management. Eg recognising the tingly feeling before an itch and applying emollient

Provide options of management, not whether to have

• Involve your child in the management plan• Provide appropriate rewards & consequences and

follow through; consistency is essential• Again your child can really help with this

School Age ChildInvolve other family members including

siblings, extended whanau in managementInvolve other adults in your child’s life in

management such as their teacher and schoolFor boys particularly important to have male

role models supporting daily managementTalk with your child about their eczema and

or other chronic health conditions but do not make it the focus of your family or relationship with your child

School Age Child• Ensure that everyone involved with management

is in agreement especially both parents • Be consistent and maintain boundaries• Especially at times of eczema flares or general un-

wellness• Your child needs and wants to know you are in

charge• Your Eczema Nurse Specialist or Health

Professional can provide that sounding board for you, your child and all involved

School Age Child

• Its OK to not be the perfect parent(s) – you are doing the best you can

• Its OK for your child(ren) to know this• Involve other adults –family, friends,

professionals: they are your support system, not your child(ren)

School Age ChildAllow your child to be a child Encourage your child to drawUnderstand that your child cannot

comprehend eczema is not part of themAs you child’s eczema improves they maybe

fearful of not having eczema. Help them to adjust

School Age ChildYour child is more resilient than you thinkYour child maybe trying to protect youRecognise / know what is a normal response

andAsk for help Involve psychological support if needed

School Age ChildBathing can be decreased as skin improvesBathing does decrease need for skin cares so you

may wish to keep goingDry / wet wraps may be a good option for your

child if they don’t want to put emollients on regularly or forget, especially at school

Only wrap a school age child when needed otherwise they get fed up!

Depending on severity, will need mild – potent topical steroid

Swimming is a big trigger

Case Study Twelve year old urgently referred by

dermatologist. Would otherwise require hospitalisation

Condition worsening despite oral steroids and Immunosuppressant drug applied for

Needing to live with grandmother as mother no longer coping

On follow up ten days later, oral steroids being decreased yet improved enough to go to school camp without parental supervision, taught dry/wet wrapping

Follow up 4 weeks later, while wrapping not effective, condition much improved. Sleeping better, coping better at school and had moved back home with mother. Also now off oral prednisone

“ CHILDREN ARE like mountains – you can only see them properly when they’re a long way away. Which is exactly where, from time to time, you would like them to be. This may sound like heresy to parents of the cute little ones who smell nice and worship you, but will make perfect sense to parents of the big ones who look half-finished, smell like an old sock and think you’re a moron.”

Michele A’ Court your weekend August 7, 2010

AdolescentsThe most vulnerable!It does matterThey often hide eczema from you – parents

and health professionalsTrust is essentialNeed time

AdolescentsThey will bath – just need to know whyShowering with emollient is an option and can

be increasingly used as skin improvesDo need some lighter emollient options

especially to use on their faceLikely to require a moderate - potent topical

steroid at times: flares and maintenance Dry and wet wraps work extremely well for

young adults and can even be a fashion statement

AdolescentsNeed to be allowed to experience what happens when their

eczema cares are not doneIf need be to hit rock bottomto decide that yes their eczema is a problem

and they will make the changes neededto make mistakes and to know its OKto implement care in their way & paceTo have adults that will support them no

matter what

AdolescentsUnless their eczema isHaving a detrimental effect on their wellbeingAffecting their school attendance and workCausing skin infections or other health issues

requiring medical treatment or hospitalisations

…….If so then short term needs to have a management plan to follow that is supervised by parents/ adults & health professionals

AdolescentsNeed support in a variety of waysFamily, friends and ongoing involvement of health

professional (s)From school age, depending on individual needs

may need regular visits arranged with health professional to provide motivation to maintain cares as well as advice regarding implementation

When seeing health professional may wish to have family or friends present or to be seen alone

Texting!

Case Study 35 year old woman Had eczema as child and teens. Fluctuated

and worsened in last 5 years, especially in last year

Primarily chronic lesions with scarring & pigmentation changes

Clearly affecting quality of life

Provided with management plan, including dry and wet wrapping

Needing advice re asthma managementSCORAD 31 (february 09)Steady improvement seen, email helped SCORAD 14 (july 09)Feedback from primary practice, she is

engaging more with practice

The adult with eczema

Often severe with profound effect on lifestylePoorly supportedUsually resigned that little can be doneOften using no topical steroids at all

Referred to me by GP or Consultant usually after all normal management has been tried

The adult with eczemaIf willing to implement basic management

works well in most instancesDifficulty is maintaining as part of lifestyleThe adult has not usually learnt to implement

into their normal day to day lifeGreater adaptation needed at least initially

In ConclusionFinding the right fit for the family, child,

young person and adultIt is worth the effortFor most, there is such an improvement that

eczema is no longer an issueThese changes can have a profound impact

on every aspect of their lifeThere is still much we don’t know….