Talking point: Important to follow evidence-based guidelines to treat childhood eczema

A group of paediatricians at Hawke's Bay Hospital are worried, on the basis of recent articles, families may conclude topical steroid treatment is hazardous, or not important, in eczema management.

Parents who have children, toddlers and babies with eczema know it can be one of the most distressing and challenging of all chronic diseases.

Eczema affects up to 25 per cent of children, caused by an impaired barrier function in the skin that leads to sensitivity, dryness and itch. This condition can be variable from mild, in some children, right up to very severe.

Although not life threatening, reported parent experience tells us that the unremitting demands of eczema management can have a severe impact on parent and child quality of life.

There is no cure, and the daily care can be relentless and time consuming. Symptoms often include sleep disturbance, sleep deprivation and distressing scratching. The disease is very hard on parents and the child.

Hawke's Bay Today has recently reported the experience of one child and his family. This article made for distressing reading. As a group of children's doctors in Hawke's Bay we are concerned other families may believe that this is a typical case of childhood eczema. It is not. It is at the most severe end of the eczema spectrum.

All paediatricians in New Zealand treat eczema according to evidence based guidelines.

The Starship Hospital's website has established a clinical network site which includes information and resources for health professionals and parents for the Treatment of Eczema in Children and Youth, developed by the National Clinical Network of the Paediatric Society.

These guidelines cover all aspects of eczema management and emphasise the important role for topical steroids in most cases. They are easily available online or through your doctor.

The New Zealand Kids health website, which is written by paediatricians, also has very useful information for families.

Most Hawke's Bay children with eczema respond well to standard treatment. It is important to note that topical corticosteroids are very safe and effective when used as instructed.

All local paediatricians have years of experience in managing eczema. One of our team has a special interest and expertise in allergy and eczema and is currently one of the clinical leads of the New Zealand Child and Youth Eczema Clinical Network.

When children with very severe eczema are managed according to these guidelines, but do not respond as expected we then seek advice from skin specialists.

This may include Hawke's Bay dermatologists or the specialist paediatric dermatologists at Starship. In some cases topical steroids are used daily for a few weeks under specialist advice. Some children move on from topical treatment to more intensive treatments.

Topical Steroid Withdrawal Syndrome (TSWS) is a hugely controversial topic in paediatrics. Some authorities do not believe it has ever been reported in children, others believe it is rare.

It has been reported in adults, who misuse very potent topical steroids on sensitive skin for many months, but never in children using steroids for shorter courses.

In Hawke's Bay, after treating many hundreds of children with eczema over many years, we have never seen a case. Far more often we have seen skin flares as steroids are reduced or stopped, as a sign of under treatment rather than overuse.

The reported symptoms of TSWS are identical to the symptoms of under treated or treatment unresponsive eczema.

Recently the Australasian Paediatric Dermatologists has also reinforced that Topical Corticosteroids are safe and commonly underused.

As a group of paediatricians we are worried, on the basis of recent articles, other families may conclude that topical steroid treatment is hazardous, or not important, in eczema management.

If parents do stop prescribed treatments the eczema will flare in most children. Topical steroids used according to guidelines and under medical supervision are overwhelmingly safe and effective.

We urge parents to discuss their concerns, or changes in treatment, with their doctor.

*This Talking Point has been supplied by consultant dermatologist Ruud Horlings, and the paediatric and dermatology services at Hawke's Bay Hospital.