Eczema Management

School age child, adolescent & adult Basic management principles apply across the ages especially when severe, exacerbated or poorly controlled eczema Allergy diagnosis and management becomes less significant with increasing age and ability to self manage in regards to eczema care If moderate to severe eczema, likely to need skilled professional support for good management There are always exceptions and management should be individualised

School age child, adolescent & adult Self care essential for good control of eczema, resilience and general physical & emotional wellbeing In the younger child help and support is required to maintain self care For the older child and young person, this help and support is still required but more emotional than physical

School age child, adolescent & adult Need to address physiological issues first Then if required look at other aspects to assist in self management of eczema; what are triggers, barriers and the possible solutions Can only do one thing at a time Management needs to be incorporated into daily life

This session is Addressed to parents in many aspects as they are so central to the child and young person For Health Professionals this will give you a guide of the support and guidance families and /or the individual may need

School Age Child Family and Health Professionals often under estimate ability to self manage Encourage and support child to recognise symptoms, triggers and use basic management. Eg recognising the tingly feeling before an itch and applying emollient Provide options of management, not whether to have Involve your child in the management plan Provide appropriate rewards & consequences and follow through; consistency is essential Again your child can really help with this

School Age Child Involve other family members including siblings, extended whanau in management Involve other adults in your child’s life in management such as their teacher and school For boys particularly important to have male role models supporting daily management Talk with your child about their eczema and or other chronic health conditions but do not make it the focus of your family or relationship with your child

School Age Child Ensure that everyone involved with management is in agreement especially both parents Be consistent and maintain boundaries Especially at times of eczema flares or general un- wellness Your child needs and wants to know you are in charge Your Eczema Nurse Specialist or Health Professional can provide that sounding board for you, your child and all involved

School Age Child Its OK to not be the perfect parent(s) – you are doing the best you can Its OK for your child(ren) to know this Involve other adults –family, friends, professionals: they are your support system, not your child(ren)

School Age Child Allow your child to be a child Encourage your child to draw Understand that your child cannot comprehend eczema is not part of them As you child’s eczema improves they maybe fearful of not having eczema. Help them to adjust

School Age Child Your child is more resilient than you think Your child maybe trying to protect you Recognise / know what is a normal response and Ask for help Involve psychological support if needed

School Age Child Bathing can be decreased as skin improves Bathing does decrease need for skin cares so you may wish to keep going Dry / wet wraps may be a good option for your child if they don’t want to put emollients on regularly or forget, especially at school Only wrap a school age child when needed otherwise they get fed up! Depending on severity, will need mild – potent topical steroid Swimming is a big trigger

Case Study Twelve year old urgently referred by dermatologist. Would otherwise require hospitalisation Condition worsening despite oral steroids and Immunosuppressant drug applied for Needing to live with grandmother as mother no longer coping

On follow up ten days later, oral steroids being decreased yet improved enough to go to school camp without parental supervision, taught dry/wet wrapping Follow up 4 weeks later, while wrapping not effective, condition much improved. Sleeping better, coping better at school and had moved back home with mother. Also now off oral prednisone

“ CHILDREN ARE like mountains – you can only see them properly when they’re a long way away. Which is exactly where, from time to time, you would like them to be. This may sound like heresy to parents of the cute little ones who smell nice and worship you, but will make perfect sense to parents of the big ones who look half-finished, smell like an old sock and think you’re a moron.” Michele A’ Court your weekend August 7, 2010

Adolescents The most vulnerable! It does matter They often hide eczema from you – parents and health professionals Trust is essential Need time

Adolescents They will bath – just need to know why Showering with emollient is an option and can be increasingly used as skin improves Do need some lighter emollient options especially to use on their face Likely to require a moderate - potent topical steroid at times: flares and maintenance Dry and wet wraps work extremely well for young adults and can even be a fashion statement

Adolescents Need to be allowed to experience what happens when their eczema cares are not done If need be to hit rock bottom to decide that yes their eczema is a problem and they will make the changes needed to make mistakes and to know its OK to implement care in their way & pace To have adults that will support them no matter what

Adolescents Unless their eczema is Having a detrimental effect on their wellbeing Affecting their school attendance and work Causing skin infections or other health issues requiring medical treatment or hospitalisations …….If so then short term needs to have a management plan to follow that is supervised by parents/ adults & health professionals

Adolescents Need support in a variety of ways Family, friends and ongoing involvement of health professional (s) From school age, depending on individual needs may need regular visits arranged with health professional to provide motivation to maintain cares as well as advice regarding implementation When seeing health professional may wish to have family or friends present or to be seen alone Texting!

Case Study 35 year old woman Had eczema as child and teens. Fluctuated and worsened in last 5 years, especially in last year Primarily chronic lesions with scarring & pigmentation changes Clearly affecting quality of life

Provided with management plan, including dry and wet wrapping Needing advice re asthma management SCORAD 31 (february 09) Steady improvement seen, helped SCORAD 14 (july 09) Feedback from primary practice, she is engaging more with practice

The adult with eczema Often severe with profound effect on lifestyle Poorly supported Usually resigned that little can be done Often using no topical steroids at all Referred to me by GP or Consultant usually after all normal management has been tried

The adult with eczema If willing to implement basic management works well in most instances Difficulty is maintaining as part of lifestyle The adult has not usually learnt to implement into their normal day to day life Greater adaptation needed at least initially

In Conclusion Finding the right fit for the family, child, young person and adult It is worth the effort For most, there is such an improvement that eczema is no longer an issue These changes can have a profound impact on every aspect of their life There is still much we don’t know….

To these very special children, young adults, adults and families……Thank You …..You are our greatest teachers