Abstract
BackgroundAtopic eczema (AE) is a chronic, highly pruritic, inflammatory skin condition with increasing prevalence worldwide. Atopic eczema mostly affects children, impairing quality of life with poor disease control leading to progression of other atopic disorders. As most patients in South Africa have no access to specialist healthcare, a practical approach is needed for the management of mild-to-moderate AE in paediatric patients for daily clinical practice.MethodsA panel of experts in AE convened to develop a practical algorithm for the management of AE for children and adolescents in South Africa.ResultsRegular moisturising with an oil-based emollient remains the mainstay of AE treatment. Severe AE flares should be managed with topical corticosteroids (TCSs). For mild-to-moderate AE flares in sensitive skin areas, a topical calcineurin inhibitor (TCI) should be applied twice daily from the first signs of AE until complete resolution. Topical corticosteroids may be used when TCIs are unavailable. In non-sensitive skin areas, TCSs should be used for mild-to-moderate AE, but TCIs twice daily may be considered. Proactive maintenance treatment with low-dose TCI or TCS 2–3 times weekly and the liberal use of emollients is recommended for patients with recurrent flares.ConclusionsThis algorithm aims to simplify treatment of paediatric AE, optimising clinical outcomes and reducing disease burden. This approach excludes treatment of patients with severe AE, who should be referred to specialist care. Emphasis has been given to the importance of general skincare, patient education and the topical anti-inflammatory medications available in South Africa (TCSs and TCIs).
Highlights
There is little available data regarding the incidence of Atopic eczema (AE) in South Africa, two phases of a global survey indicated that the majority of adolescents with AE from Cape Town have mildto-moderate rather than severe disease.[5,6]
topical corticosteroids (TCSs) are recommended as first-line treatment for most patients because of their superior efficacy, in the American Academy of Dermatology https://www.safpj.co.za guidelines topical calcineurin inhibitors (TCIs) are recommended as first-line treatment for patients with AE in sensitive body areas, patients with steroid-induced atrophy and patients who have current longterm uninterrupted topical steroid use.[20]
In the European AE guidelines, pimecrolimus is recommended for facial lesions and for children, and both pimecrolimus and tacrolimus for long-term maintenance treatment.[24]
Summary
Atopic eczema (AE) is a chronic, highly pruritic, inflammatory skin condition with increasing prevalence worldwide. As most patients in South Africa have no access to specialist healthcare, a practical approach is needed for the management of mild-to-moderate AE in paediatric patients for daily clinical practice
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