So far this week Jean Robinson has reported on eczema and some of the options for treating the itchy skin condition. In the final episode, find out our emollient top tips, information on topical corticosteroids and the dangers of complementary therapies.
Emollients: top tips
When advising parents how to use emollients, some key points are:
- Apply in the direction of hair growth
- Apply 2-4 times daily depending on severity of eczema
- Apply enough – children should use at least 250g per week
- If using tubs of emollient ointment rather than creams or lotions from pump dispensers there is increased risk of infection from contamination – advise decanting from the pot with a spatula or clean spoon for each application. However, remember if the child’s skin is very dry then the use of an ointment-based emollient will be optimal.
Points to consider when educating on use of TCS
- Amount to apply – many authors advocate the use of the fingertip unit, which is the amount of ointment or cream squeezed out of the tube on to the end of the finger that would cover an area of eczema equal to two adult hands. However, this is often not a simple concept for parents and does not contribute to an easy regime to manage. There is agreement that the instruction to ‘use sparingly’ is nonsensical and should be avoided because it sends out a message that TCS are inherently dangerous and is likely to encourage their underuse. Others suggest a more easily managed instruction would be to apply to affected areas of skin (ie red, thickened and open areas of eczema), avoiding healthy skin, in a sufficient amount to produce a shine and to leave this to soak in rather than being rubbed in, which may result in irritation.
- Education about potency (many parents believe that one per cent Hydrocortisone is a strong or very strong TCS)
- Realistic instructions eg ‘continue until affected skin is completely flat and then stop’ rather than only for short time frames eg seven days
- Possible side effects and how to recognise them – many parents are worried about possible skin thinning and often mistake thickened areas of eczema for thin skin.
There is no substantive evidence as to the order in which emollients and TCS should be applied, but NICE advised an interval of several minutes between applications. This issue has been highlighted as a key issue for future research.
Many parents are keen to use complementary therapies that cover a range of approaches and may seek reassurance from pharmacists. Herbal medicines can have powerful effects and many parents and health professionals are shocked to discover some treatments bought over the internet or from market stalls such as Wau Wa cream, Abido, OSAS and Magic cream contain potent or super potent TCS. The use of these should be strongly discouraged.