Baby eczema treatments on the NHS: A parent’s guide

S'occuper d'un bébé qui se gratte est déjà assez stressant, sans avoir l'impression de devoir se battre contre le système de santé au nom de votre bébé atteint d'eczéma. Si nous avons eu une très bonne expérience du traitement de l'eczéma du bébé par le NHS, c'est en grande partie parce que le petit dernier de notre médecin souffrait également d'eczéma du bébé ou de dermatite atopique, et qu'il comprenait donc très bien la maladie. Mais nous savons que tout le monde n'a pas la chance de trouver un médecin généraliste qui comprend à la fois la maladie et l'impact qu'elle peut avoir sur toute la famille. Comprendre comment le NHS a l'intention de fournir des traitements pour l'eczéma du bébé peut vraiment aider à obtenir le bon traitement pour l'eczéma de votre bébé.

Les traitements de l'eczéma du nourrisson par le NHS sont décrits dans la directive du NICE sur l'eczéma atopique chez l'enfant. Ce guide définit les critères de diagnostic de l'eczéma du nourrisson, les traitements appropriés et les techniques de prise en charge, ainsi que le moment où un enfant doit être adressé à un spécialiste de l'eczéma.

Nos meilleurs conseils pour le traitement de l'eczéma du bébé par le NHS

• If you suspect your baby has eczema it is worth going directly to your GP, rather than starting with the health visitors. This is because the moisturisers which form the basis of all baby eczema treatments are available on prescription.
• In our experience, there is around a 50% chance that any given cream will work for any one baby. Even if a cream works well initially the benefits may reduce over time. So it’s useful to realise that the NHS is largely reactive. Your doctor will assume that prescribed treatments are working well unless you tell him or her otherwise.
• It’s worth knowing that not all doctors are particularly sympathetic when confronted by a case of baby eczema. This is largely because it typically clears up of its own accord before a baby’s first birthday.
• La peau est un organe complexe qui n'est pas toujours abordé en détail dans la formation ou les mises à jour de formation des médecins généralistes. Si vous êtes inscrit dans un grand cabinet, il est utile de demander si l'un des médecins s'intéresse particulièrement aux affections cutanées.

Diagnostiquer l'eczéma du bébé

The key indicator in the diagnosis of baby eczema or atopic dermatitis is itchy skin. As babies can’t tell you that they are itchy, this is usually indicated by babies scratching themselves repeatedly. For an eczema diagnosis to be given, this itching needs to be coupled with at least 3 of the following:

1. an obvious rash on the cheeks, trunk or extensor areas (the parts of the skin that touch when a joint bends are called the flexor surfaces, and the parts of the skin on the opposite side of the joint are called the extensor areas). In children over 18 months these rashes typically shift to flexure areas, usually behind the knees and inside elbows;
2. a history of rashes on cheeks or extensor areas (or flexure areas in toddlers and older children);
3. history of dry skin; and
4. a history of hayfever, eczema or asthma (known collectively as atopic diseases) in an immediate relative. For children over 4, this changes to a personal history of atopic diseases.

Adapter les traitements à la gravité de l'eczéma

The NHS aims to match the treatment to the severity of a baby’s eczema. We’ve tried to capture the spectrum of diagnosis and treatment in our ‘Baby Eczema NHS Treatment Summary’ below. Atopic Dermatitis, or Eczema, is a very changeable condition so it is common for a child’s eczema to move up (or down) the severity spectrum. Therefore condition should be monitored and their treatments changed accordingly.

Le résumé de ScratchSleeves sur les traitements de l'eczéma du NHS

En savoir plus sur les traitements de l'eczéma du nourrisson

Emollients 

These medical moisturisers and form the basis of all eczema treatments. They aim to reduce the moisture lost by the skin by covering it in a protective layer as well as replenish the skin’s moisture content. They are available as creams and bath additives and there is a plethora of different brands available on prescription. It is a case of trial and error to find one that works for your baby’s eczema. However, some children can develop a sensitivity to particular emollients over time. If your baby’s eczema seems to be getting worse it’s worth asking your GP for a different emollient. These sensitivities can settle after a break so you may end up alternating between 2 or 3 different brands. Emollients need to be used regularly and liberally, and cannot be over-used. Read more here.

Corticosteroid creams

Corticosteroid creams, also known as ‘steroid creams’ or hydrocortisone, are used to reduce skin inflammation and irritation. While they do not cure eczema, they can provide much needed relief during flare-ups. They also give you and your doctor some time to identify the triggers for your baby’s eczema. They should only be used for limited periods but are safe and should have no adverse effects if used as you GP instructs. Read more here.

Antihistamine

Antihistamines (e.g. Children’s Priton) can prescribed to reduce itching and help itchy babies sleep during eczema flare-ups. However they are not used in the day-to-day management of baby eczema.

Calcineurin inhibitor creams

These act on the immune system to reduce skin inflammation by blocking a chemical (calcineurin) which causes redness and itching of the skin. Like corticosteroid creams, they won’t cure eczema but they reduce the itching and inflammation, however these creams are only licensed for children over the age of 2.

Allergies alimentaires

The NICE guidelines indicate that a food allergy should be considered in babies and young children with moderate or severe atopic eczema that has not been controlled by optimum management, particularly if the child has (or has had) colic, persistent vomiting or failed to thrive. A trial period on a dairy-free formula milk can be prescribed.

Bandages, phototherapy and systematic therapies 

Bandages, phototherapy and systematic therapies are generally prescribed by specialist dermatology units and should only be used under medical supervision and monitoring. Improperly used, these therapies can aggravate rather than alleviate baby eczema.

Orientation vers des spécialistes de l'eczéma du NHS

La plupart des cas d'eczéma/dermatite atopique du nourrisson sont traités avec succès par les parents et les médecins généralistes à l'aide d'émollients, de corticostéroïdes et, surtout, en identifiant et en évitant les facteurs déclenchants de l'eczéma. Toutefois, certains cas sont plus graves ou plus lents à réagir et nécessitent un traitement spécialisé. Les spécialistes de l'eczéma du NHS travaillent au sein d'équipes multidisciplinaires basées à l'hôpital et généralement composées de :

Eczema nurses. Referrals to specialist eczema nurses are usually for demonstrations on how to use emollients and bandages effectively. Eczema nurses will also carry out regular treatment reviews for little ones who have previously been seen by a dermatologist. The eczema nurses are the backbone of NHS eczema services. They are senior specialist nurses, specially trained to deal with skin conditions and allergy testing. It’s worth remembering that they are part of a multi-disciplinary team and will know when something needs to be referred on to a specialist doctor (and be able to make that referral). A lot of the more experienced ‘eczema parents’ we talk to actually prefer appointments with the eczema nurses over those with dermatologists.

Dermatologists. You can expect a referral to a dermatologist for severe baby eczema that is not responding well to emollient and corticosteroid treatments. This would include a child who is having 1-2 flares a month or who is reacting to badly to a number of emollients. Referrals can also be made for babies with severe or recurrent eczema infections. They can also be made if eczema is causing significant social or psychological problems for a child or their carers. This includes regular sleep disturbance, or for older children poor school attendance.

Allergy specialists. If an allergy is suspected to be causing severe eczema, eczema babies and children can be referred to an allergy specialist for further investigation including allergy testing and dietary advice.

Notre politique éditoriale

Chez ScratchSleeves, notre objectif est de vous fournir des informations fiables et précises. Nous collaborons avec des dermatologues et des médecins qualifiés et nous nous appuyons sur des études médicales évaluées par des pairs et sur notre propre expérience en tant que parents. Tout le contenu médical est révisé par un dermatologue ou un médecin approprié avant la publication afin de garantir l'exhaustivité, l'exactitude et l'utilisation appropriée du langage médical. Les coordonnées des réviseurs se trouvent au bas de chaque article révisé et sur notre page "Rencontrer l'équipe".

Toutes les recherches scientifiques mentionnées dans notre blog se trouvent dans des publications évaluées par des pairs. Tous les articles médicaux relatifs à l'eczéma auxquels nous faisons référence sont inclus dans la base de données GREAT (Global Resource of Eczema Trials) gérée par le Centre of Evidence Based Dermatology de l'Université de Nottingham. Cette base de données rassemble des informations sur tous les essais contrôlés randomisés et les examens systématiques des traitements de l'eczéma. Les essais sont identifiés à l'aide d'une stratégie de recherche très sensible et complète, compatible avec la méthodologie standard de Cochrane. Cochrane est internationalement reconnu comme la norme la plus élevée en matière de soins de santé fondés sur des données probantes. Les liens vers les publications auxquelles nous faisons référence figurent au bas de chaque article.

Clause de non-responsabilité

The original editorial information we provide is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified healthcare practitioners regarding a medical condition. Never disregard professional medical advice or delay in seeking it in because of anything you have read on the internet.

This post has been reviewed for clinical accuracy by Dr Nikky Ellis. Nikky also has first-hand experience of navigating the NHS eczema and allergy services with her itchy son. After a number of years working in A&E, Nikky is now a GP.

Here at ScratchSleeves we don’t just share our experiences of bringing up an eczema child, we also manufacture and sell our unique stay-on scratch mitts and PJs for itchy babies, toddlers and children. We now stock sizes from 0-adult years in a range of colours. Visit our webshop for more information.