28 November 2018

Take 25: Hard to manage eczema in children

Clinical Paediatrics

Dr Ritu Gupta explains what GPs can do when nothing is working for atopic dermatitis.

“Nothing is working. You’ve seen them for the third time, the fourth time or they are ringing you all the time. Why isn’t anything working?” says Dr Gupta, a medical, surgical and cosmetic dermatologist based in Ultimo.

GPs can investigate by asking: “Could it be infected? Are they compliant? Do they understand the treatment that you’ve prescribed? Have you dispelled all the myths that are out there about eczema? What sort of strength of steroid are they using? Are they using enough and how long are they using it for?”

In rarer cases, patients may have developed superimposed allergic contact dermatitis, says Dr Gupta.

“We have to remember that because they’ve got diseased skin, they are more prone to sensitisations,” she says. “People with atopic dermatitis are much more likely to be allergic to nickle or latex.”

It’s also important to look for ongoing environmental triggers.

“You need to be a bit of a detective,” says Dr Gupta. “Or do they just have terrible disease? Always have in the back in my mind, could my diagnosis be wrong?”

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