Quality statement 4: Provision of emollients

Quality statement

Children with atopic eczema are prescribed sufficient quantities (250–500 g weekly) from a choice of unperfumed emollients for daily use.

Rationale

Emollients should form the basis of atopic eczema management and should always be used, even when the atopic eczema is clear. Children with atopic eczema should have sufficient quantities of emollients for everyday use. These should be suited to the child's needs and preferences, with alternatives offered if a particular emollient causes irritation or is not acceptable to a child.

Quality measures

Structure

Evidence of local arrangements to prescribe children with atopic eczema sufficient quantities (250–500 g weekly) from a choice of unperfumed emollients for daily use.

Data source: Local data collection.

Process

The proportion of children with atopic eczema who are prescribed sufficient quantities (250–500 g weekly) of unperfumed emollients for daily use.

Numerator – the number of children in the denominator who are prescribed sufficient quantities (250–500 g weekly) of unperfumed emollients for daily use.

Denominator – the number of children with atopic eczema.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that local arrangements are in place to prescribe children with atopic eczema sufficient quantities (250–500 g weekly) from a choice of unperfumed emollients for daily use.

Healthcare practitioners prescribe children with atopic eczema sufficient quantities (250–500 g weekly) from a choice of unperfumed emollients for daily use.

Commissioners ensure that they commission services with local arrangements for children with atopic eczema to be prescribed sufficient quantities (250–500 g weekly) from a choice of unperfumed emollients for daily use.

What the quality statement means for patients and carers

Children with atopic eczema receive a prescription for enough (between 250 g and 500 g weekly) unperfumed emollient (a special type of skin moisturiser) chosen to best suit their needs and preferences for daily use.

Source guidance

Definitions of terms used in this quality statement

Unperfumed emollients

NICE clinical guideline 57 recommends that a choice of unperfumed emollients should be offered to children with atopic eczema that is suited to the child's needs and preferences for everyday moisturising, washing and bathing. This may include a combination of products or 1 product for all purposes.

The guideline adds that healthcare practitioners should offer an alternative emollient if a particular emollient causes irritation or is not acceptable to a child with atopic eczema.

Leave-on emollients should not be of a type that can cause harm to a child's skin. The full NICE guideline states that aqueous cream is associated with stinging when used as a leave-on emollient but it can be used as a wash product. Since the publication of the guideline there has been increasing concern about the use of sodium lauryl sulfate as an emulsifier (a substance used to mix oil with water to make creams) and an MHRA drug safety update in March 2013 advises that if a patient reports or shows signs of skin irritation with the use of aqueous cream, treatment should be discontinued and an alternative emollient that does not contain sodium lauryl sulfate should be tried.

Equality and diversity considerations

In recommending skin treatments, healthcare practitioners should be sensitive to the cultural practices of families or carers of children with atopic eczema. For example, if families or carers use olive oil as a skin treatment (which is likely to be harmful to a child's skin) or if they rinse children after bathing (rinsing off emollients), the reasons for using the recommended treatment and applying it correctly should be explained sensitively.