HOW TO MANAGE TREATMENT. Lydia Snell Paediatric Liaison Nurse March 15 th 2018 HEALTHY SKIN WORKSHOP

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1 HOW TO MANAGE TREATMENT Lydia Snell Paediatric Liaison Nurse March 15 th 2018 HEALTHY SKIN WORKSHOP

2 The beauty of skin! It is all one organ Protects what is inside is a barrier Holds us all in We don t think about it when it works well

3 What is eczema An itchy skin which may appear red and dry Affects up to 25% of infants and children and < 1% of adults Onset is usually after 3 months of age. In babies the face, scalp and outer surfaces are involved; and in childhood the flexures of the knees and elbows and the inside of the wrists and ankles are more likely to be affected The most important issue is the loss of the skin barrier it is a SKIN BARRIER DYSFUNCTION

4 Cornerstone aims of treatment To keep skin from getting dry This is to maintain the skin barrier Once the skin gets dry and dehydrated the vicious cycle starts To promptly treat any signs of inflammation and redness To control the itchiness of the skin

5 The Benefits of bathing 10 minutes in the bath (or shower)hydrates the skin and prepares the skin for creams Twice weekly give bleach baths Add Budget bleach to the bath water 20ml to every 10L of bath water. Do this two times a week Have creams ready to apply straight after the bath Over the next 3 to 5 minutes the skin is up to 10 times more receptive to creams Apply steroids, then emollients or moisturisers liberally

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7 Guidelines for treatment Maintain and Repair Skin Barrier Moisturise Moisturise Moisturise!!!!! Use a moisturiser as a soap in the daily bath. Sometimes baths are required twice a day. Straight after a bath/shower is the best time to apply creams to the skin. Apply required steroid creams and then moisturisers Use moisturisers often and liberally during the day

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9 Guidelines for treatment Reduce and Suppress inflammation The use of steroid creams and ointments damp down the inflammation and allow the skin to heal. Steroids come in a wide range of strengths. It is better to decrease the use of steroids step by step rather than stopping abruptly.

10 Common Steroids

11 Guidelines for treatment Treat Infection Promptly Infections are common because the skins barrier is compromised Staphylococcus aureus and streptococcus are bacteria that live on all of our skin and can get into the dry cracked skin and create infection The symptoms of infection are: Weeping open cuts from scratching, Yellow crusts, Increased itch, Scratched and raw skin, Pustules, boils or abscesses, Unpleasant smelling skin, Fever and general unwellness. An oral antibiotic is then required to treat the secondary infection

12 Guidelines for treatment Avoid Triggers Keep child cool - do not overheat bedrooms or use too many bed coverings Avoid the use of coarse wool undergarments(fine merino wool is actually now considered helpful!) Control dust mites by regular vacuuming/cleaning If affordable >300 thread count linen does help Avoid soap and never use bubble bath Most children with eczema do not have a food allergy

13 Some effective strategies to prevent further infection Always wash hands before applying creams etc Guidelines for Treatment replace lids and caps of creams/lotions to reduce contamination with bacteria Use separate towels for child with eczema Keep fingernails short and clean Wash bed linen regularly in hot water or dry in the sun Put on a clean change of clothes after each bath

14 The MOST Important Thing Moisturising regularly even when the skin looks good is one of the key defences against flare ups of eczema. The goal is to prevent the skin from becoming dry and cracked and to support the skin barrier. When the skin begins to become itchy, immediately increase the use of emollients.

15 Additional Tools Wet Wrapping Physical barrier to scratching Cools and Hydrates the skin Increases steroid and moisturiser absorption Dry Wrapping Sedating antihistamines at night for short periods