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Evidence based management of atopic eczema
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  1. Carsten Flohr,
  2. Hywel C Williams
  1. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
  1. Correspondence to:
    Professor Hywel C Williams
    Queen’s Medical Centre Nottingham, Nottingham NG7 2UH, UK; hywel.williams{at}nottingham.ac.uk

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Atopic eczema (AE, synonymous with atopic dermatitis), together with asthma and hay fever, has been on the increase for at least three decades. At present, around 15–20% of children in industrialised countries suffer from AE, leading to a significant reduction in quality of life and a burden on health care resources.1,2 Paediatricians encounter patients with AE both “on call” and in outpatient clinics and are therefore often directly involved in AE management and patient education. Paediatricians who run asthma clinics encounter AE frequently. In addition, a few paediatricians have a special interest in AE, and some even run dedicated paediatric dermatology outpatient clinics. This review focuses on the practical management of AE from a paediatric perspective, with an emphasis on relating treatment decisions to the currently available evidence. Sufficient evidence from clinical trials is now available to inform many areas of AE management, although some “grey areas” and some areas of relative ignorance remain. We will illustrate common AE management issues in case scenarios and use these to discuss the place of emollients, topical steroids, the new topical immunomodulators (tacrolimus and pimecrolimus), “wet wrap” bandages, as well as systemic treatment options, phototherapy, and advice on allergen avoidance and complementary therapies.

Much of the evidence in this article is based on a Health Technology Assessment report that was commissioned by the National Health Service in 2000, supplemented by other studies that have been published since.3 We also refer to our practical experience in running a multi-professional eczema clinic at the Queen’s Medical Centre, Nottingham.

EMOLLIENTS AND TOPICAL CORTICOSTEROIDS

Case history A

Marc, age 2 years, attends your asthma clinic. On his third visit, Marc’s father tells you that he has developed an itchy widespread rash (fig 1 ). Examination reveals widespread, ill defined erythematous patches, with more pronounced involvement in the skin folds. You are satisfied …

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