Eczema in Paediatric Patients: A Protocol to Inform Clinical Practice
Week 7 Paper Instructions
1. Select a topic from the approved list (I have selected Eczema).
2. Explain the selected disorder, including its pathophysiology and epidemiology.
You will:
A. Tell me what the disorder is.
B. Discuss the pathophysiology as it relates to your selected disorder. Pathophysiology is defined as: The study of the biologic and physical manifestations of a disease as they correlate with the underlying abnormalities and physiologic disturbances. Pathophysiology does not deal directly with the treatment of disease. Rather, it explains the processes within the body that result in the signs and symptoms of a disease.
C. Discuss the epidemiology of your selected disorder. Epidemiology includes:
1. The incidence, distribution, and control of disease in a population. AND
2. The sum of the factors controlling the presence or absence of a disease or pathogen.
3. Explain a protocol for the diagnosis, management, and follow-up care of this disorder.
A. Protocol is defined as a detailed plan. In this paper, just as in the last, you are expected to develop an evidence-based protocol that can be used to inform the diagnosis, management, and follow-up related to your selected topic.
B. You must include, SPECIFICS, directing and informing the clinician on how your selected topic should, in the primary care setting, be:
1) Diagnosed (this includes what to look for, symptoms, diagnostic testing, etc.);
2) Managed, which includes SPECIFIC treatment options to include medication therapy, other therapies, referrals, etc;
3) Followed, including the frequency, purpose, and plan for follow-up visits.
4. Explain how culture might impact the care of patients who present with the disorder you selected. This means you will discuss:
A. How CULTURE and cultural barriers may impact your selected topic specifically (not random groups of people, certain minority groups, or families in general, but CULTURE). Please remember, America is a cultural melting pot! AND
B. Specific strategies the clinician should utilize to overcome these barriers to ensure the patient is properly cared for. Remember, we are focused on PROPER CARE of the patient. For example, if you tell me that certain cultural practices are considered child abuse in this country, it is not appropriate for you to tell me in your protocol that you should over look this because it is a cultural thing. That would be the incorrect response.
Solution.
Eczema in Paediatric Patients: A Protocol to Inform Clinical Practice
Introduction
Eczema is a form Atopic Dermatitis (AD), conventionally caused by AD. Eczema is a disease characterized by a chronic inflammation associated with dry, itchy and red skin in children (Ruzicka, Ring, & Przybilla, 2013). This paper transcends a review of a protocol of clinical practice; pathophysiology, epidemiology, management, and treatment as well as a cultural perspective of the disorder in children. Clinical presentation of eczema suggests a mild to severe levels. Eczema disorder is rare in adults and frequent in children, at age 4.
Epidemiology
According to Hanifin, Reed, and Group (2007), the prevalence of eczema has a substantial proportion of US’ populace. The survey suggested that 31.6 million of the US population have symptoms of eczema and at least 17. 8 depict moderate to severe levels of the disorder. In childhood, approximately 10.7% of children in the US have eczema symptoms. As such it depicts that, one of every three children develop atopic dermatitis or eczema symptoms at the age of four years (Shaw, Currie, Koudelka, & Simpson, 2011). Also, eczema occurs in both male and females, and it is suggested that 90% of patients with eczema developed the disorder before the age of five years (Ruzicka, Ring, & Przybilla, 2013).
Pathophysiology
As a chronic skin disorder, the pathophysiological features of the disease are not permanent on the skin. Its symptoms can be worse, conventionally referred to as ‘exacerbations or flares’ then they are followed with skin betterment, ‘remissions.’ The standard features of eczema include rashes and ‘dry, red itchy skins’ (Ruzicka, Ring, & Przybilla, 2013). Eczema in children can occur in different parts of the body As such, babies experience rashes on the face and scalp (see appendix one), young children experience the rashes at the folds and elbows (see appendix two) as well as knees, and teens and young adults experience rashes on hands and feet. Most occur at the Pathophysiology suggests that the skin of patients with eczema has increased numbers of the T-helper type 2 (Th2) cells compared to those without eczema. At acute stages, patients with eczema have increased levels of Th2 cytokines (inerleukin-4 and interleukin-13). The interleukin- 4 enhance the differentiation of T-helper cells in the Th2 conduit as ineterleukin-13 plays a role of chemo-attractant for the T-helper -2 cells that infiltrate eczema lesions.
The etiological perspectives of eczema are linked to both environmental factors and genetic agents. Research suggests that children with parents with eczema are more likely to develop eczema by the age of three years. Additionally, concordance rates for eczema are noticeable in monozygotic twins than in dizygotic twins. Environmental allergens such as contact irritants, sweating, microbial agents, stress as well as aeroallergens can trigger the development of eczema to severe levels, exacerbations.
Protocol for Clinical Management: Eczema
Diagnosis (DDx)
Eczema is one of the diseases that entail differential diagnoses as no lab test is required to examine the presence of eczema. As such, the physician will make a diagnosis through skin examinations and review the medical history of a given patient. The differential diagnoses for eczema include Scabies, Staphylococcus Aureus Infection, Phenylketonuria, Paediatric Contact Dermatitis, Paediatric Herpes Simples Virus infection, and so on.
Treatment
After an intensive diagnosis of eczema, the physician can utilize some medical care plans for the kid. Rehydrating the stratum corneum is the most vital step in the treatment of eczemas it preserves the stratum corneum barrier, consequently minimizing the direct effects of environmental allergens and irritants on the skin as well as it reduces the need for topical steroids. Also, a child should have a bath before an application of occlusive emollients on the skin to retain moisture. The recommended emollients by the FDA include Moisturel, Curel, Dermasil, and Eucerin. Additionally, tropical phosphodiesterase-4 inhibitors can be used for children of 2 years of age and older. Other treatment options include allergen immunotherapy and use of ultraviolet light.
Prevention
As the saying goes ‘prevention is better than cure,’ eczema can be prevented through adequate maintenance of hydration of the stratum corneum, avoiding known allergens and irritants, self-treatment with proper topical steroids, and use of complementary treatment such as antipruritics, stress relievers, and antibiotics.
Cultural Considerations
To better the invention and treatment plans, physicians must be able to consider the psychosocial and cultural considerations of eczema within their practices. The vital component that culturally affects treatment and diagnosis of eczema is the hypo/hyper-pigmentation as people are scared of the diseases and find it irritating. Most people in the US always apply Vaseline to infants for the treatment of eczema in infants; this scenario is exhibited by the African-American population. As such Dr. Herbert suggests that Vaseline can create a barrier in the treatment process and this cultural perspective needs to be addressed, and parents need r-education (Chamlin, et al., 2002).
Conclusion
Eczema
mostly occurs in children and as such it parents should practice the correct
procedure when seeking advice from physicians. As one of the common disease in
the US, the population needs to be re-educated on the need to actively follow
the right procedures of eliminating the disease from their children. Analysis
of the pathophysiology, treatment, epidemiology and cultural context of the
disease in this paper will initiate a better understanding of eczema disorder
in children and their parents.
References
Chamlin, S. L., Kao, J., Frieden, I. J., Sheu, M. Y., Fowler, A. J., Fluhr, J. W., & Elias, P. M. (2002). Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. Journal of the American Academy of Dermatology, 47(2),., 47(2), 198-208. doi:10.1067/mjd.2002.124617
Hanifin, J. M., Reed, M. L., & Group, I. W. (2007, June). A population-based survey of eczema prevalence in the United States. Dermatitis, 18(2), 82-91. Retrieved January 15, 2017, from https://nationaleczema.org/research/eczema-prevalence/
Kim, H.-B., Zhou, H., Kim, J. H., Habre, R., Bastain, T. M., & Gilliland, F. D. (2016). Lifetime prevalence of childhood eczema and the effect of indoor environmental factors: Analysis in Hispanic and non-Hispanic white children. Allergy and Asthma Proceedings, 37(1), 64–71. doi:10.2500/aap.2016.37.3913
Ruzicka, T., Ring, J., & Przybilla, B. (Eds.). (2013). Handbook of atopic eczema. New York City, New York, United States of America: Springer Science & Business Media.
Shaw, T. E., Currie, G. P., Koudelka, C. W., & Simpson, E. L. (2011). Eczema prevalence in the United States: Data from the 2003 National Survey of Children’s Health. The Journal of Investigative Dermatology, 131(1), 67–73. doi:10.1038/jid.2010.251
Appendix 1: Facial rashes on a baby
Appendix 2: Fold rashes on a young kids arm
