From the Guidelines
Infection assessment in pediatric eczema should prioritize clinical evaluation, including signs such as increased redness, warmth, swelling, crusting, weeping, pustules, and sudden worsening of the eczema, as outlined in the guidelines of care for the management of atopic dermatitis 1. When assessing a child with eczema for infection, clinicians should first look for these classic signs. The SCORAD (SCORing Atopic Dermatitis) index is particularly useful as it includes assessment of crusting and oozing as potential infection markers. For suspected Staphylococcus aureus infection, which is common in eczema, skin swabs can be taken from affected areas for culture and sensitivity testing, as recommended by the management of atopic eczema joint workshop of the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1. In cases of suspected herpes simplex virus infection (eczema herpeticum), viral PCR testing from vesicular fluid is recommended. Blood tests including white cell count and C-reactive protein may be helpful in severe or systemic infections. Treatment should not be delayed while awaiting test results if infection signs are clear. Some key points to consider in the assessment and management of infections in pediatric eczema include:
- Clinical evaluation for signs of infection
- Use of severity scoring systems like the SCORAD index
- Microbiological testing for suspected bacterial or viral infections
- Prompt treatment with appropriate antibiotics or antivirals based on the suspected or confirmed cause of infection. For mild localized bacterial infections, topical antibiotics like fusidic acid or mupirocin applied 2-3 times daily for 7-10 days are appropriate, while more extensive infections may require oral antibiotics such as flucloxacillin or cephalexin for 7-14 days, as suggested by the guidelines 1. Eczema herpeticum requires prompt treatment with oral acyclovir or intravenous acyclovir for severe cases. Regular assessment of infection status is important as recurrent infections may indicate poor eczema control, requiring optimization of maintenance therapy including emollients and topical anti-inflammatory treatments.
From the Research
Infection Assessment Tools in Paediatric Eczema
- The assessment and management of paediatric atopic dermatitis (AD) involve evaluating the severity of the condition and identifying potential complications, including infections 2, 3, 4.
- Infections in paediatric eczema can be caused by various pathogens, including bacteria, viruses, and fungi, and require appropriate treatment to prevent serious complications 5, 6.
- The use of antiviral agents, such as acyclovir, has been shown to be effective in treating eczema herpeticum, a serious herpes simplex virus infection that can occur in children with atopic dermatitis 6.
- A comprehensive approach to managing paediatric AD includes counselling, assessment, comorbidity management, and therapy, as outlined in consensus statements and clinical practice guidelines 2, 3, 4.
- The assessment of infection in paediatric eczema involves evaluating the child's symptoms, medical history, and physical examination, as well as laboratory tests and imaging studies as needed 5, 3, 4.
- The management of infections in paediatric eczema depends on the type and severity of the infection, as well as the child's overall health and medical history, and may involve topical or systemic antibiotics, antivirals, or antifungals 5, 6, 4.