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Atopic eczema is a common condition, affecting as many as 15–20% of school-age children, with 1–2% of children with the condition being severely affected. It commonly begins in early childhood, when it can be particularly severe. Although most children with atopic eczema are treated in primary care, backed up by dermatologists, paediatricians need a degree of competence in managing the condition and should know when to refer for a specialist dermatological opinion.
In December 2007, the National Institute for Health and Clinical Excellence (NICE) published its clinical guideline on the management of atopic eczema in children up to the age of 12 years.1 For children this supersedes the 2006 British Association of Dermatology and Primary Care Dermatology Society guideline.2 The NICE guideline covers the diagnosis, assessment and management of the condition. The guideline development group (GDG) included Dr Helen Cox, a consultant paediatrician with an interest in allergy.
The guideline does not assign grades to its recommendations; it summarises and discusses the supporting evidence and documents how this influenced the views of the guideline development group. Where substantial research evidence was lacking, a modified Delphi technique was used by the GDG to formulate recommendations. Where strong evidence is cited for recommendations, this is indicated below with the level of evidence and the page numbers in the full guideline. Level 1+ evidence refers to well-conducted meta-analyses, systematic reviews of randomised controlled trials (RCTs) or RCTs with a low risk of bias. Level 1++ evidence refers to high-quality meta-analyses, systematic reviews of RCTs or RCTs with a very low risk of bias. Where no level of evidence is indicated, the supporting evidence is weak.
These recommendations refer to atopic eczema. For the sake of brevity the term “eczema” is used throughout instead of “atopic eczema”. The term “parents” also refers …
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