What’s in the web for family physicians – Update on eczema management

Wilbert WB Wong 王維斌，Alfred KY Tang 鄧權恩

HK Pract 2019;41:85-86

Eczema is a commonly encountered problem by family physicians. Persistent itchiness and dry skin can very much affect the well-being of patients, and lead to other co-morbidities such as anxiety and depression. The disease affects 5.6% of young children and 3.8% of school children and adolescents in Hong Kong. The disruption of school, family life and social interactions can severely impair the quality of life and sequelae extends beyond childhood. Parents often feel helpless on the condition, with varying degree of guilt feelings. It is therefore important for family physicians to keep themselves updated with the topic.

Basic framework of atopic dermatitis management for children

A set of guidelines was developed by the Hong Kong College of Paediatricians and a framework was laid down for basic management of atopic dermatitis. This paper highlights the key points in the NICE guidelines with additional recommendations relevant for local practice. The guidelines include the diagnosis, assessment of sever it y and treatment options. A Stepwise Management Approach and management according to disease severity is recommended, and the importance of a holistic approach cannot be over emphasised.

Guidelines for allergy prevention in Hong Kong

This guideline was presented in part at the Symposium on Allergy Prevention that was co-hosted by the Hong Kong Institute of Allergy and the Hong Kong Society for Paediatric Immunology, Allergy and Infectious Diseases. Induction of immune tolerance is the key to success in allergy prevention. Breastfeeding is recommended for all infants in the first six months of the life. Atopic eczema has been shown to be significantly reduced in high-risk infants fed on a hydrolysed formula compared with standard cow’s milk formula. Complementary food is also recommended for infants over 4 months if they are developmentally ready.

Summary of the above recommendations are presented under the guidelines.

Potency of topical Steroid

Topical corticosteroids are the most commonly used treatment for inflammation in eczema. This article gives a summary on the potency of different topical steroids.

In UK, topical steroid preparations are divided into four categories according to potency. The potency can be ‘mild’, ‘moderately potent’, ‘potent’ and ‘very potent’. The potency of topical steroids is determined by the amount of vasoconstriction they produce, the degree of inhibition on inf lammation, and also their potential in causing side effects. One way of understanding the strength of different steroid preparations is to note that 'moderate' is two times more potent than 1% hydrocortisone, 'potent' is ten times more, and 'very potent' is fifty times more.

HOME - Harmonising Outcome Measures for Eczema

HOME, founded in 2008, aims to develop a standard of outcome measures for all clinical trials on eczema, to document severity of symptoms (POEM) and to measure the quality of life (DLQI).

The Eczema Area and Severity Index (EASI) is a validated scoring system that grades the physical signs of atopic dermatitis / eczema. EASI is the core outcome for measuring the clinical signs of eczema in all trials. The Patient Oriented Eczema Measure (POEM) is a tool used for monitoring atopic eczema severity. It focuses on the illness as experienced by the patient.The Dermatology Life Quality Index (DLQI) covers all ages, have good face-validity and is the most widely used skin-specific quality of life instruments in trials.

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