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. 2020 Nov 23;62(1):e1-e9.
doi: 10.4102/safp.v62i1.5190.

Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice

Susanna M Kannenberg  1 , Sarah Karabus, Willem I Visser, Jamilabibi Aboobaker, Magdalena M Kriel, Michael Levin, Basil Magigaba, Ahmed Manjra, Rupesh Misra, Pholile Mpofu, Azwitamisi Tshigabe, Thomas Luger
Affiliations

Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice

Susanna M Kannenberg et al. S Afr Fam Pract (2004). .

Abstract

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).

Keywords: atopic dermatitis; atopic eczema; pimecrolimus; tacrolimus; treatment algorithm.

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Conflict of interest statement

S.M. Kannenberg: Received honorarium from Mylan. S. Karabus: Received honorarium from Mylan. W.V.: Received honorarium from Mylan. M.L.: Funding received from Mylan, MRC, ThermoFisher, Aspen, AstraZeneca, Cipla, Astellas, PharmaDynamics, Beiersdorf, Discovery. Organisations: NAEP, ALLSA, WAO, AAAAI, ACAAI, EAACI, Allergy Foundation of SA. T.L.: Conducted clinical trials or received honoraria for serving as a member of the Scientific Advisory Board for Abbvie, Argx, Biogen, Celgene, CERIES, Galderma, Incyte, Jansen-Cilag, La Roche Posay, Leo, Lilly, Menlo, Mylan, Novartis, Pierre Fabre, PiqurI, Pfizer, Sandoz, Sanofi-Genzyme, Symrise, Wolff. J.A., M.K., B.M., A.M., R.M., P.M., A.T. have declared that no competing interests exist.

Figures

FIGURE 1
FIGURE 1
Treatment algorithm for paediatric patients with atopic eczema (AE; atopic dermatitis) in South Africa.
FIGURE 2
FIGURE 2
‘The fingertip method’. The amount of fingertip units (the amount of ointment or cream covering the area on the finger from skin-crease to the tip of an adult’s index finger) required for steroid application depends on the age of the child and the specific body area that needs to be treated.
See this image and copyright information in PMC

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