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Original Research
Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice
Submitted: 13 July 2020 | Published: 23 November 2020
About the author(s)
Susanna M. Kannenberg, Division of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South AfricaSarah Karabus, Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
Willem I. Visser, Division of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
Jamilabibi Aboobaker, Private Practice, Durban, South Africa
Magdalena M. Kriel, Private Practice, Johannesburg, South Africa
Michael Levin, Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
Basil Magigaba, Private Practice, Port Elizabeth, South Africa
Ahmed Manjra, Private Practice, Durban, South Africa
Rupesh Misra, Private Practice, East London, South Africa
Pholile Mpofu, Private Practice, Johannesburg, South Africa
Azwitamisi Tshigabe, Private Practice, Johannesburg, South Africa
Thomas Luger, Department of Dermatology, Faculty of Dermatology, University of Münster, Münster, Germany
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).
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