Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice
Background: Atopic 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 Afric...
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| Format: | Article |
| Language: | English |
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AOSIS
2020-11-01
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| Series: | South African Family Practice |
| Subjects: | |
| Online Access: | https://safpj.co.za/index.php/safpj/article/view/5190 |
| _version_ | 1818353110624501760 |
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| author | Susanna M. Kannenberg Sarah Karabus Willem I. Visser Jamilabibi Aboobaker Magdalena M. Kriel Michael Levin Basil Magigaba Ahmed Manjra Rupesh Misra Pholile Mpofu Azwitamisi Tshigabe Thomas Luger |
| author_facet | Susanna M. Kannenberg Sarah Karabus Willem I. Visser Jamilabibi Aboobaker Magdalena M. Kriel Michael Levin Basil Magigaba Ahmed Manjra Rupesh Misra Pholile Mpofu Azwitamisi Tshigabe Thomas Luger |
| author_sort | Susanna M. Kannenberg |
| collection | DOAJ |
| description | Background: Atopic 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.
Methods: A panel of experts in AE convened to develop a practical algorithm for the management of AE for children and adolescents in South Africa.
Results: Regular 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.
Conclusions: This 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). |
| first_indexed | 2024-12-13T19:04:19Z |
| format | Article |
| id | doaj.art-9172b875514e4dcc8b544222ba556fc5 |
| institution | Directory Open Access Journal |
| issn | 2078-6190 2078-6204 |
| language | English |
| last_indexed | 2024-12-13T19:04:19Z |
| publishDate | 2020-11-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Family Practice |
| spelling | doaj.art-9172b875514e4dcc8b544222ba556fc52022-12-21T23:34:36ZengAOSISSouth African Family Practice2078-61902078-62042020-11-01621e1e910.4102/safp.v62i1.51904093Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practiceSusanna M. Kannenberg0Sarah Karabus1Willem I. Visser2Jamilabibi Aboobaker3Magdalena M. Kriel4Michael Levin5Basil Magigaba6Ahmed Manjra7Rupesh Misra8Pholile Mpofu9Azwitamisi Tshigabe10Thomas Luger11Division of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape TownDivision of Paediatric Allergology, University of Cape Town, Cape TownDivision of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape TownPrivate Practice, DurbanPrivate Practice, JohannesburgDivision of Paediatric Allergology, University of Cape Town, Cape TownPrivate Practice, Port ElizabethPrivate Practice, DurbanPrivate Practice, East LondonPrivate Practice, JohannesburgPrivate Practice, JohannesburgDepartment of Dermatology, Faculty of Dermatology, University of Münster, MünsterBackground: Atopic 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. Methods: A panel of experts in AE convened to develop a practical algorithm for the management of AE for children and adolescents in South Africa. Results: Regular 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. Conclusions: This 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).https://safpj.co.za/index.php/safpj/article/view/5190atopic dermatitisatopic eczematreatment algorithmpimecrolimustacrolimus |
| spellingShingle | Susanna M. Kannenberg Sarah Karabus Willem I. Visser Jamilabibi Aboobaker Magdalena M. Kriel Michael Levin Basil Magigaba Ahmed Manjra Rupesh Misra Pholile Mpofu Azwitamisi Tshigabe Thomas Luger Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice South African Family Practice atopic dermatitis atopic eczema treatment algorithm pimecrolimus tacrolimus |
| title | Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice |
| title_full | Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice |
| title_fullStr | Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice |
| title_full_unstemmed | Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice |
| title_short | Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice |
| title_sort | paediatric atopic eczema atopic dermatitis in south africa a practical algorithm for the management of mild to moderate disease in daily clinical practice |
| topic | atopic dermatitis atopic eczema treatment algorithm pimecrolimus tacrolimus |
| url | https://safpj.co.za/index.php/safpj/article/view/5190 |
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