Infant with Infected Eczema

Infant with Infected Eczema

Gilli Lewis and Debbie Rickard


Question 1. What is eczema?

Eczema is a common inflammatory skin condition, affecting up to 20% of children in the UK with around 1 in 20 having severe disease (Cork et al. 2019, de Lusignan et al. 2021). Eczema has a higher incidence in infancy and childhood, but can affect individuals throughout life and is typically an episodic disease of exacerbation and remissions. Effective therapy improves quality of life for children with eczema and their parents and carers. Lack of evidence based information and support about therapy leads to poor adherence, and consequently to treatment failure (Axon et al. 2021; Cork et al. 2020; Santer et al. 2012).

Environmental and genetic influences can lead to the breakdown of the skin barrier. This makes the skin susceptible to trigger factors, including irritants and allergens, which can make eczema worse. Many cases of eczema resolve or improve during childhood, but some persist into adulthood. Some children who have eczema will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the ‘atopic march’ (Yang et al. 2020). However while evidence does exist to support the existence of the atopic march, its prevalence may be overstated (Aw et al. 2020). There can be an association with personal or family history of atopy (atopic eczema, allergic rhinitis and/or asthma).

Eczema is usually characterised by epidermal changes, pruritus (itch), and lesions with indistinct borders. These lesions can appear as erythema, papules, or scales; they can present in an acute, subacute or chronic phase. Oedema, serous discharge and crusting occur with continued irritation and scratching. In chronic cases, the skin may become thickened and leathery and hyperpigmented from recurrent irritation and scratching. This is called lichenification. Chronic eczema is more likely to have distinct borders.

Affected sites vary with age (see

Infantile eczema commonly affects the face, sparing around the mouth, and later the hands, feet, and elsewhere (Halkjaer et al. 2006; Thomsen 2014).

While the underlying cause of eczema is not yet fully known it is thought to involve complex pathways including skin barrier dysfunction, altered innate or adaptive immune responses. There is increasing evidence disruption of the skin barrier function and atopy affect one another reciprocally. Eczema is a product of interplay between environmental factors and genetic susceptibility (Cork et al. 2020). As described by Leung et al. (2004), ‘the skin represents the interface between the body and the surrounding environment’ (p. 654).

When the skin barrier is impaired from dryness (xerosis) by genetic or environmental means and/or excoriated (in response to the pruritis from the skin xerosis) this allows bacteria, viruses, and allergens to penetrate the skin.

Historically eczema has been poorly understood and frequently under treated and there continues to be significant unmet need (Cork et al. 2020). There is no cure for eczema however effective management includes minimizing exacerbations (often referred to as flares) with a prevention focus supporting the patient and family to have control (Cork et al. 2020; Thomsen 2014). With the increasing prevalence of eczema, it is no longer dismissed as a trivial disorder; indeed, the impact of this chronic condition on the individual, families, and the community are increasingly being recognised (National Eczema Society 2021; Santer et al. 2012; Wan et al. 2020).

Question 2. On Henry’s admission to the ward, the children’s nurse will need to complete a nursing assessment, from which a nursing plan of care may be developed. Describe how the nurse would carry out this assessment.


The initial assessment will be carried out during a family interview, in which the nurse may ask questions relevant to the care of the child. It is important to be aware that caregivers of children with eczema are often frustrated and exhausted. If possible, hospitalisation of the child should be avoided as these children are highly susceptible to infections. However, admission may sometimes be the only answer to provide intensive therapy or to relieve an exhausted caregiver.

In this interview it is important to cover the history of Henry’s condition, including treatments that have been recently tried and any known allergens or triggers. It is useful to include a review of the home environment and daily routine. The nurse should evaluate Henry’s mother’s knowledge of eczema.

To aid management of eczema in children, the children’s nurse should take detailed clinical and drug histories that include:

  • Age of onset, pattern, and severity of the eczema
  • Response to previous and current treatments
  • Understanding of treatments and how these are used/implemented
  • Possible trigger factors (irritant and allergic)
  • The impact of the eczema on Henry his parents and siblings
  • Dietary history including any dietary manipulation or restrictions
  • Growth and development
  • Personal and family history of atopic conditions (such as asthma and hay fever)

In addition to the interview, data collection about Henry must include vital signs, and height and weight to assess growth. Observing general nutritional state and a complete examination of all body parts, with careful documentation of the eruptions and their location and size. It is helpful to touch the skin to assess skin integrity; rough skin is an indicator of skin dryness. Unaffected areas, as well as those that are weeping and crusted, should be documented to assist review of progress.

It may be necessary to reassess when Henry is physically better, and Sharon is not so exhausted (physically and/or emotionally).

Question 3. Identify the key healthcare issues/problems Henry and his mother, Kate, present with and using an appropriate model of nursing plan goals of nursing care in relation to these.

Identified problems

  • Impaired skin integrity related to lesions and inflammatory process
  • Risk of serious infection related to broken skin and lesions
  • Acute pain related to intense itching, irritation, and broken skin
  • Disturbed sleep pattern related to itching and discomfort
  • Incomplete knowledge of caregivers related to disease condition and treatment

Model of nursing

Anne Casey’s model of nursing (Casey 1993) guides nurses to work in partnership with children and their families. The philosophy behind the model is that the best people to care for the child are the family, with help from various professional staff. After all, following discharge from hospital, it is the family who will provide the ongoing care at home.

However, forming a partnership of care is not simple, and requires skill and sensitivity. Negotiating care is discussed by Anne Casey in her model. The ability to negotiate care is an underestimated skill, which is essential if nurses are to come alongside families/caregivers in true partnership when planning care for children.

The nurse, in this case, will need to discuss the identified problems and possible goals of nursing care with Sharon.

Goals for Henry:

  1. Improving and maintaining skin integrity; minimising flares
  2. Preventing infection of skin lesions
  3. Maintaining comfort, relief of itch
  4. Improving sleep patterns
  5. Enabling normal growth and development

Goals for Kate/other caregivers:

  1. Increasing knowledge about the condition
  2. Increasing evidence-based knowledge about management of the condition
  3. Improving confidence and competence in providing skin care

Question 4. Henry has been admitted with infected eczema. Describe the nursing care plan which the children’s nurse should follow to ensure Henry receives appropriate evidence-based skin care.

The nursing care plan will be based on the problems identified during assessment, and the goals as discussed with Kate and stated above.

Improving and maintaining Henry’s skin integrity, minimising flares

  1. The ultimate aim of treatment is to maintain skin integrity and minimise flares by replacing moisture and reducing inflammation. The key to helping maintain skin integrity is to moisturise.
  2. Henry needs a daily skin care routine which should be incorporated into his usual daily routine. Discuss Henry’s current skin care routine with Kate.

Using emollient

  • Emollients should form the basis of eczema management (Cork et al. 2003; Lindh & Bradley 2015), and generally should always be used. However, this is dependent on the severity of eczema and the flares.
  • Emollients are moisturisers, which have emulsifiers and/or humectants, which affect the permeability barrier function of skin (Hon et al. 2018; van Zuuren et al. 2017).
  • Clinical experience has shown that the amount of emollient used is important in bringing about an improvement in eczema (Cork et al. 2003; Salvati et al. 2021). Emollients should be used in larger amounts and more often than other treatments. Other treatments such as topical steroids do not replace emollients; they must always be used in conjunction with emollients unless condition is mild. (Applying emollient on top of topical steroid works well). Emollients improve efficacy of steroids and reduce flares. Emollients should be used in response to symptoms and prophylactically in response to known triggers.
  • The nurse needs to ascertain that Kate understands the use of emollients, as part of Henry’s skin care routine. Any misunderstandings and gaps in knowledge can then be discussed and offer online resources such as videos (

    Only gold members can continue reading. Log In or Register to continue

    Stay updated, free articles. Join our Telegram channel

Mar 23, 2024 | Posted by in Uncategorized | Comments Off on Infant with Infected Eczema

Full access? Get Clinical Tree

Get Clinical Tree app for offline access