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Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Atopic eczema (Paediatric)

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

Atopic eczema may present as cradle cap in babies, before spreading to face, skin creases and extensor limb surfaces  then  flexural sites .  Rapid and early control is beneficial to long term outlook. May improve with advancing age. 

 

Atopic eczema

 

Atopic eczema

 

Atopic eczema

  

Eczema Herpeticum 

consider if any acute vesicular and painful flare. 

 

Topical Steroids: 

  • Prescribe a mild (face) and moderate (body) steroid in ointment form. 
  • Consider potent topical steroid to body in over 2’s 
  • Advise on fingertip units . 
  • Simultaneous application of emollients and topical steroid may reduce potency of steroid , advise a delay before steroid 
  • Reduce topical steroid to twice weekly maintenance when improved. 

Emollients: 

Consider Prescribing  an ointment  to use in the evening (if steroid used, apply after a suitable interval ) and a cream  to use in the morning. Ointments may cause less ‘stinging’ in inflamed skin. Discuss with  patient/parent  which  he/she prefers and will use regularly. 

Prescribe adequate quantities of emollients for daily use 

Soap substitutes and bath emollients: 

Soaps, shower gels and bubble baths are very irritant and should ALWAYS be avoided. 

Prescribe a bath additive or shower emollient instead which can also be used to wash hair. 

  

Eczema Herpeticum 

  • Stop topical steroids/tacrolimus and urgent referral 
  • Urgent viral PCR swab if available. 
  • consider if any acute vesicular and painful flare. 

Referral Management

  • Eczema not controlled (2+flares per month) despite maintenance and flare treatment with hydrocortisone to face and moderately potent steroid (up to 1 year) or potent steroid (in 1 year+) to trunk/limbs. 
  • Eczema causing severe psychological or social difficulties 
  • Diagnosis uncertain 
  • History of GI symptoms with severe widespread eczema not responding to topical steroids start on extensively hydrolysed formula and refer. 
  • Eczema Herpeticum: 
  • Contact Dermatology department immediately for advice. 

Clinical tips

  • Systemic antibiotics are only indicated if patient is systemically unwell 
  • Reassure patients that topical steroids are safe and effective if used as described. 
  • Ointments are preferable to creams. 
  • The vast majority of children with mild-moderate eczema that respond to treatment do not have food allergy. 
  • Light cotton or silk garments are available on prescription and can prevent scratching, help treatments to soak in and avoid staining of bedding and clothing. 
  • consider eczema herpeticum where there is an acute blistering flare of eczema, pain, fever and patient is unwell. 

Patient information resources

1.NHS Inform: www.nhsinform.scot 

2. NHS24 Tel: 08454 242424 

3. Text Phone: 18001 08454 24 24 24 

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways .

Co-Author(s): NHS Scotland, Scottish Dermatology Society.