General education and diet

It is essential to fully inform the patient and the child about the disease course and the effects of treatment. No therapy can completely prevent relapse. Atopic eczema is not a contra-indication to immunisation but these should not be given when the eczema is in an acute phase.

The concept of trigger factors should be explained. These are multiple but significant improvement may be obtained by simple measures such as wearing cotton underclothes instead of wool, the avoidance of heat, reducing exposure to house mites, and lightly bandaging limbs at night. Household pets such as cats and dogs should be discouraged.

Food allergy may be a trigger in 10% of cases. A milk free diet is advised by some but care must be taken to ensure that malnutrition does not result. Soya milk based products can be substituted for a trial period to explore possible dietary allergy. Breast feeding is advised because of it's general benefits but there is little support to the claim that it modifies or prevents dermatitis. There are no tests to predict food allergy.

• a systematic review concluded that
  • there may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs
    • however there is little to evidence support the use of various exclusion diets in unselected people with atopic eczema, but that may be because they were not allergic to those substances in the first place

Reference:

• (1) Bath-Hextall F et al. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005203.