eczema management. school age child, adolescent & adult basic management principles apply across...
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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 timeManagement 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 ChildFamily and Health Professionals often under
estimate ability to self manageEncourage 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 ChildInvolve other family members including
siblings, extended whanau in managementInvolve other adults in your child’s life in
management such as their teacher and schoolFor boys particularly important to have male
role models supporting daily managementTalk 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 ChildAllow your child to be a child Encourage your child to drawUnderstand that your child cannot
comprehend eczema is not part of themAs you child’s eczema improves they maybe
fearful of not having eczema. Help them to adjust
School Age ChildYour child is more resilient than you thinkYour child maybe trying to protect youRecognise / know what is a normal response
andAsk for help Involve psychological support if needed
School Age ChildBathing can be decreased as skin improvesBathing does decrease need for skin cares so you
may wish to keep goingDry / 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
AdolescentsThe most vulnerable!It does matterThey often hide eczema from you – parents
and health professionalsTrust is essentialNeed time
AdolescentsThey will bath – just need to know whyShowering with emollient is an option and can
be increasingly used as skin improvesDo need some lighter emollient options
especially to use on their faceLikely 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
AdolescentsNeed to be allowed to experience what happens when their
eczema cares are not doneIf need be to hit rock bottomto decide that yes their eczema is a problem
and they will make the changes neededto make mistakes and to know its OKto implement care in their way & paceTo have adults that will support them no
matter what
AdolescentsUnless their eczema isHaving a detrimental effect on their wellbeingAffecting their school attendance and workCausing 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
AdolescentsNeed support in a variety of waysFamily, 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 managementSCORAD 31 (february 09)Steady improvement seen, email 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 lifestylePoorly supportedUsually resigned that little can be doneOften using no topical steroids at all
Referred to me by GP or Consultant usually after all normal management has been tried
The adult with eczemaIf willing to implement basic management
works well in most instancesDifficulty is maintaining as part of lifestyleThe adult has not usually learnt to implement
into their normal day to day lifeGreater adaptation needed at least initially
In ConclusionFinding the right fit for the family, child,
young person and adultIt is worth the effortFor most, there is such an improvement that
eczema is no longer an issueThese changes can have a profound impact
on every aspect of their lifeThere is still much we don’t know….