The National Institute for Health and Care Excellence (NICE) wants to stop doctors prescribing bath emollients for children with eczema. NICE is consulting on proposals to change its guidelines for treating children with atopic eczema and the deadline for responses is Tuesday 4 April.
National Eczema Society believes children with atopic eczema and their families will be disadvantaged and suffer as a result of these proposals. We are asking NICE to reconsider and continue recommending bath emollients in clinical circumstances where it is appropriate to prescribe them. Bath emollients are used by many children and their parents as part of a skincare regimen to help manage eczema.
Emollients and soap substitutes are vital in helping manage the dry skin associated with eczema. National Eczema Society is concerned that only children whose families can afford to buy bath emollients will have access to these products under the new proposals. The poorest families will be hit hardest and it seems especially unjust as many are grappling with the cost of living crisis. We believe doctors should be able to continue prescribing bath emollients when it’s in the child’s best interests, to achieve the best eczema care. Hard-pressed parents can’t always find the time to use leave-on emollients with their children and they may rely on bath emollients to help manage their child’s eczema.
For some parents, using bath emollient is more practical and more effective than applying leave-on emollient to their children in the bath. Adding a capful of bath emollient to the bath while the water is running is quicker and easier than trying to emulsify a leave-on emollient to serve the function of a bath emollient. This can be important when busy parents have a number of children to care for and limited time. Caring for children with eczema can be exhausting and relentless for parents, as evidenced by the extensive literature on carer burden.
Bath emollients are formulated to disperse evenly and well in bath water. This is not the case for leave-on emollients. As anyone knows who has tried to disperse leave-on emollient in water, it usually ends up as blobs of emollient in the bath water, rather than a uniform film that covers the child’s skin more evenly and comfortably. This point is particularly relevant to children with sensory perception disorders, who can find it difficult to be touched or dislike the texture of leave-on emollients on their skin. Bath emollients can help restore the skin barrier without physical touch. The notion that using leave-on emollient as a soap substitute for washing children in the bath is equally or more effective than bath emollients for all children is not supported by the literature.
These NICE proposals are based largely on the results of the BATHE (Bath Additives in the Treatment of cHildhood Eczema) research study. National Eczema Society has expressed concerns about the design of this study and how much this reflects real-world use of emollients, soap substitutes and bath emollients.
The BATHE study did not address the questions that would have been most insightful, such as ‘what is the best soap substitute?’ and ‘are bath emollients more effective than leave-on emollients as soap substitutes?’ Rather, the BATHE study focused on a nuanced research question that looked at the efficacy of bath emollients in a very specific set of theoretical circumstances. It looked at outcomes when children used leave-on emollient during the day and leave-on emollient in the bath as a soap substitute, and bath emollient in the bath, compared to children who used only leave-on emollient and leave-on emollient in the bath as a soap substitute. Parents would typically use a bath emollient OR a leave-on emollient as a soap substitute when bathing their children, not both. National Eczema Society argues that the BATHE study design does not sufficiently reflect real world patient experience or prescribing practice.
The BATHE study addresses likely population level impacts only and was not adequately powered to identify subgroup differences. As such, the BATHE study does not take into account sufficiently the heterogeneous nature of atopic dermatitis. It is a complex immune mediated disease and affects children differently. Treatments and treatment approaches that work for one child may not be effective for another. In particular, different or more intense treatments are often appropriate for children with more severe eczema.
For these reasons and others, National Eczema Society is asking NICE to reconsider and continue recommending bath emollients in clinical circumstances where it is appropriate for healthcare professionals to prescribe them.
Wednesday 3 May, 6:00-7:00pm
This event has now taken place – you can see a recording of the webinar on National Eczema Society’s Facebook page.
This free webinar features two informative talks from dermatology experts at the forefront of eczema research and practice. We will explore the new systemic treatments for people with more severe eczema and how they work, including biologic and JAK-inhibitor medicines. We will also look at how research is helping us understand more about how systemic eczema treatments work, and highlight a new research study called BEACON. This study is looking to compare the effectiveness of different eczema treatments. National Eczema Society and St John’s Derm Academy are pleased to collaborate to bring you this free webinar. There will be time after the talks for you to ask questions of the speakers and panel.
The webinar will be livestreamed via Facebook and the recording will remain available to watch afterwards – see here. To able to participate in the webinar, you would need to register in advance.
6:00pm Welcome and overview of the evening
Professor Catherine Smith
6:05pm What are the new systemic treatments for severe eczema and how do we know how good they really are?
Dr Andrew Pink
6:25pm Understanding how systemic eczema treatments work
Dr Satveer Mahil
6:45pm Question and answer session with a panel including webinar speakers, plus Professor Catherine Smith and Andrew Proctor, Chief Executive of National Eczema Society. Participants are encouraged to ask questions on the topics being presented, as well as other areas of eczema care.
Webinar speakers and panel
Professor Catherine Smith
Consultant Dermatologist, St John’s Institute of Dermatology
Guy’s and St Thomas’ NHS Foundation Trust, London
Professor Smith is Consultant Dermatologist and Professor of Dermatology and Therapeutics at St John’s Institute of Dermatology, Kings College London and Guys and St Thomas’ Hospital. She is lead clinician in national specialised services for adults with severe eczema. Her clinical and research interests focus on inflammatory skin disease and translational medicine, extending from biomarker discovery through to interventional studies (phase II-IV), and involve major national and international collaboration. These include BIOMAP, a European-wide consortium focussed on identifying clinically relevant biomarkers in atopic eczema and psoriasis https://biomap-imi.eu/ and BEACON – a UK wide platform trial of systemic interventions in adult eczema https://www.beacontrial.org/.
Dr Andrew Pink
Consultant Dermatologist and Director of Adult Clinical Trials Unit
St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust
Honorary Senior Clinical Lecturer, King’s College London
Dr Pink is a consultant dermatologist and the Director of the adult Clinical Trials Unit at St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospitals, London. He is an Honorary Senior Clinical Lecturer at King’s College London, ex-Honorary Secretary of the St John’s Dermatological Society, a member of the International Psoriasis Council, Chair of the Annual UK Dermatology Course for Consultants and regularly acts as a NICE clinical expert. His clinical and academic interests focus on inflammatory skin disease and translational medicine, primarily in eczema and psoriasis. Andrew has helped to develop a national multi-disciplinary eczema service and a very active trials unit (phase II-IV) at St. John’s. He has acted as CI on multiple trials examining novel therapies emerging in psoriasis and eczema and is the Chief Investigator for the BEACON trial, a large UK platform trial designed to assess the comparative effectiveness of systemic therapies for moderate to severe eczema in adults.
Dr Satveer Mahil
St John’s Institute of Dermatology
Guy’s and St Thomas’ NHS Foundation Trust
Dr Mahil is a Consultant Dermatologist at Guy’s and St Thomas’ Hospital. She qualified from Cambridge University and completed integrated academic training (NIHR Academic Clinical Fellowship and NIHR Clinical Lectureship) in dermatology at St John’s. She completed a MRC-funded PhD in 2017, during which she used genetic information to gain novel insights into the mechanistic basis of different forms of psoriasis, and define new therapeutic targets.
Alongside her clinical and education work at St John’s, she continues to conduct translational research, which is focused on optimising outcomes for individuals with inflammatory skin diseases.
Chief Executive of National Eczema Society
Andrew joined National Eczema Society as Chief Executive in March 2018. He has worked in the voluntary sector for over 15 years, including spells with Asthma UK, Alzheimer’s Society and Action Medical Research. He believes passionately in people having the right information and advice to make informed choices about their health, and in supporting people to self-manage their health conditions effectively. Andrew has a particular interest in digital, which he sees as playing an increasingly important role in healthcare and in helping National Eczema Society reach more people affected by eczema. He is inspired by the Society’s many members, donors, partners and other stakeholders who work so hard to improve the quality of life for people with eczema.
The skin of many people with eczema improves in the spring and summer months. This is often due to the effects of natural sunlight – although it’s still important to protect the skin from harmful rays!
Where sunscreens are concerned, we recommend trying an unfragranced, broad-spectrum (UVA and UVB protector), mineral-based sunscreen. Sunscreens can be divided into organic (chemical) UV absorbers or inorganic (mineral-based, i.e. containing titanium dioxide or zinc oxide) UV reflectors. Many people with eczema find that mineral-based sunscreens are less irritating to their skin than chemical absorbers. For more sunscreen information, please see our Sun and eczema page.
Different types of pollen can cause problems for people at different times of the year. Tree pollen season tends to be from March to May. Common symptoms of pollen allergy are a runny nose, sneezing and swollen eyes – known as allergic rhinitis or hay fever. Most people with atopic eczema find that their skin is not really affected by the pollen season. If your skin is affected, here are some tips:
- Limit exposure on days where the pollen count is high by staying indoors and steering clear of known allergens when you can.
- Always have your eczema treatments readily available (take them with you when you go out) as tackling a flare-up quickly is imperative.
- You may also need to take an oral antihistamine (medication that helps suppress the body’s release of histamine in response to an allergen). The ‘non-drowsy’ kind can be helpful in relieving the symptoms of allergy throughout the body, including the eyes, nose and skin. The sedating antihistamine can also be useful in helping to prevent night-time scratching.
- If you’ve been doing something outdoors that might have brought you into contact with pollen, then a shower and change of clothes will remove any pollen particles you’ve inadvertently attracted.
- If you have pets, pollen is easily transmitted into the home and onto your skin via their fur. Cleaning and brushing their coats – or better still, asking someone who does not suffer from allergy to do this! – and banishing your furry friends from certain rooms, is therefore a good idea.
You’re invited to a talk organised by the West Surrey and North East Hants Support Group of National Eczema Society at 2pm on Saturday 4 March.
This event has now taken place, and you can view the recording on Facebook.
Join the West Surrey and North East Hants Support Group of National Eczema Society for an Information Afternoon, where Professor Sinéad Langan, Professor of Clinical Epidemiology and Wellcome Senior Clinical Fellow at the London School of Hygiene and Tropical Medicine, will be delivering a talk and answering questions. In a study examining the health records of more than 3 million adults, there is evidence of a strong link between atopic eczema and the risk of bone fractures and cardiovascular disease.
Attend in person at The Pavilion, Woodbridge Road, Guildford GU1 4RP
Or join via our Facebook livestream, here. You don’t need a Facebook account to watch the livestream.
Eczema is a common skin condition, affecting 1 in 5 children and up to 1 in 10 adults in the UK, and is becoming more common globally. Symptoms include intense itch, pain, sleeplessness and low self-esteem.
Entry is free but donations are very welcome. National Eczema Society literature will be available.
If you’ve got eczema, the festive season brings its challenges, but we’ve got some tips to help you have a relaxing time while looking after your skin. This article was published in Exchange 186, Winter 2022.
Trees, lights and decorations provide lovely Christmas cheer, but the dust they harbour can play havoc with eczema. Try to go for options that are smooth and easy to damp dust. If tree sap is a trigger for you, you might need an artificial tree.
2. Pace yourself
Christmas is a time when everything we learn about looking after ourselves during the rest of the year seems to go out of the window. Back-to-back nights out, long shopping trips, travel and family get-togethers can all take their toll. Have fun – but remember, sometimes less is more.
3. Be honest
Living well with eczema means making some adjustments in life. If something isn’t going to work for you – whether a get-together or an event – just explain clearly, but kindly. If someone gets it wrong, that’s not their fault, but don’t put your needs second.
4. Stay cool
Central heating and crowded rooms aren’t great for eczema. Plan ahead, dress accordingly, and step out for fresh air if you need to.
After a late night it’s easy to skip the emollient ‘just this once’. But hard-won routines can quickly unravel – especially as other daily routines melt away over the festive period. Staying on top of things is the best way to prevent a flare.
6. Overnight stays
It’s lovely visiting others at this special time of year, although this presents a host of challenges. You might need to bring your own bedding, damp dust the room and turn the temperature down. Plan ahead and have a chat with them about what you’ll need.
7. Having guests
Hosting is great fun, but can be a lot of pressure. If the thought of pulling off a large party sends your heart racing, try something smaller. When it comes to catering, find some shortcuts if you need to. If anyone judges, maybe they don’t deserve an invite!
For many, the party season is all about looking glam. But it’s not always easy to find make-up that works for you. Look for products with as few additives as possible and test them in advance. Remember, products labelled ‘natural’ may contain all sorts of nasties.
9. Food and drink
It’s hard to avoid eating and drinking differently at this time of year – even if you wanted to. But if you have eczema, what you put into your body will have some effect on your skin. Try to earmark some days for staying healthy. Your skin will thank you.
10. Dressing up
Skin prone to eczema likes natural fabrics that let your skin breathe, layered for comfort. So when it comes to getting out the glad rags, you might need to compromise. But there are plenty of options. For example, can you invest in one silk dress or shirt for special occasions?
11. Stock up on meds
The only thing worse than a last-minute scramble to a 24-hour chemist is running out of medicines altogether. Find out about closing times well in advance. If you need to order your prescriptions earlier than usual, leave time for your prescriber to sign this off.
12. A word about presents
If you have eczema, over the years you may have received a sizeable haul of useless toiletries. If someone always gives you these, why not explain your doctor has told you to avoid them. If they’re really stuck, you could always suggest a donation to NES! Point them to eczema.org/donate.
Mpox (previously known as Monkeypox) is a rare infection that appears on the skin as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs, which later fall off. The skin symptoms of mpox have the potential to be confused with infected eczema, particularly eczema herpeticum, which is a serious viral herpes infection. For more information on the other symptoms of mpox, which appear before the skin symptoms, please see the NHS website. For more information on eczema herpeticum, please see this page.
Children and adolescents with a history or presence of atopic eczema are at risk of more severe mpox. If you suspect that you or your child has mpox – or eczema herpeticum – please seek immediate same day medical advice.
Mpox vaccine (MVA-BN) and cautions for people with eczema
The vaccine recommended to protect against mpox is a third generation Modified Vaccinia Ankara (MVA) vaccine, which was first developed in the 1950s for the prevention of smallpox. See the UK Health Security Agency (UKHSA) website for more information. For most people, the mpox vaccine has a favourable safety profile.
People with atopic eczema, though, may be more likely to experience certain side effects from the vaccine. These include more intense local skin reactions (such as the skin becoming red or darker than usual, depending on skin tone, swelling and itching) and other general symptoms (such as headache, muscle pain, feeling sick or tired), as well as a flare-up or worsening of their eczema. In rare cases, people with atopic eczema have experienced serious reactions to the vaccine with widespread infection of the skin.
National Eczema Society and the UKHSA recommend that people with atopic eczema seek a risk assessment before taking the vaccine in order to balance the risk from exposure to mpox and the risk of possible side effects from vaccination.
The MVA vaccine is currently being offered to people in the UK at high risk of exposure to mpox. Note there have been challenges reported in obtaining sufficient supplies of the vaccine (as of August 2022). The UKHSA recommends MVA is offered to:
- healthcare workers caring for patients with confirmed or suspected mpox
- men who are gay, bisexual or have sex with other men, and who have multiple partners, participate in group sex or attend sex on premises venues. Staff who work in these premises may also be eligible
- people who have been in close contact with someone who has mpox – ideally they should have the vaccine within 4 days of contact, but it can be given up to 14 days after.
- NHS webpage on mpox: https://www.nhs.uk/conditions/monkeypox/
- National Eczema Society webpage describing eczema herpeticum: https://eczema.org/information-and-advice/living-with-eczema/skin-infections-and-eczema/
- UKHSA vaccination information: https://www.gov.uk/government/publications/monkeypox-vaccination-resources/monkeypox-waiting-for-your-vaccination
- UKHSA information on the smallpox (MVA) vaccination: https://www.gov.uk/government/publications/monkeypox-vaccination-resources/protecting-you-from-monkeypox-information-on-the-smallpox-vaccination
- UKHSA recommendations for the use of pre and post exposure vaccination during a mpox incident: https://www.gov.uk/government/publications/monkeypox-vaccination