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Written Eczema Action Plan

John Montgomery4 min read

Written Eczema Action Plan

A written eczema action plan (EAP, or WAP) is a personalised, usually one-page plan, modelled on asthma action plans and often colour-coded by severity. It tells parents which emollient to use every day (Emollient Therapy). It also says which Topical Corticosteroids or Topical Calcineurin Inhibitors to use on which body sites during a flare and for how long, and how to step back down (e.g. to Weekend Therapy). Finally, it lists the warning signs, such as Infected Eczema and Eczema Herpeticum, that need urgent care. NICE CG57 requires written as well as verbal information on when and how to step treatment up or down. For a toddler, whose care depends entirely on parents, nursery staff and grandparents, a shared written plan reduces the “which cream goes where?” confusion that fuels under-treatment and Steroid Phobia.

NICE CG57 [supports] Written Eczema Action Plan Written Eczema Action Plan [part-of] Stepped Care Approach Written Eczema Action Plan [treats] Steroid Phobia

Evidence. Trial evidence is sparse and mostly small and short. Shi et al. (JAMA Dermatol 2013) randomised patients and caregivers to an EAP or to standard written information. The EAP group had significantly better recognition, management and prevention of flares, and reported more comfort with self-management (unverified). Gilliam et al. (JAAD 2016) ran a pilot RCT in parents of 88 children aged 1 month to 12 years. Both groups improved over 3 months and the difference was not significant overall. Only “I feel certain about what to do when my child’s skin is getting worse” improved in the EAP group alone. Brown et al. (Clin Pediatr 2018) found that parents in EAP-using clinics understood treatment better. The systematic review by Thandi, Constantinou, Vincent and Ridd (Skin Health Dis 2023) found 20 plans from 9 countries, 18 of them for children. Only three had been tested in trials: Shi (positive), Rea 2018 (non-significant improvement) and Duhovic (no benefit over verbal instruction). The reviewers concluded that existing plans need evaluation before new ones are made. Evidence level: weak. Plans reliably improve parent confidence and understanding, but no trial shows a clear effect on eczema severity.

Written Eczema Action Plan [part-of] Eczema Education Programmes

Conflict: [Shi et al., JAMA Dermatol 2013] found significant improvement in eczema knowledge and self-management with an action plan. [Duhovic et al., cited in Thandi 2023] found no benefit over verbal instruction, and [Gilliam et al., JAAD 2016] found no significant overall difference versus standard care. Unresolved — add to open_questions.

Templates. The American Academy of Dermatology offers a one-page Eczema Action Plan for a child’s dermatologist to complete, citing Chisolm 2008 and Rork 2012. In the UK, Eczema Care Online links an action plan to fill in with a doctor or nurse (unverified). Scotland’s Eczema Outreach Support publishes downloadable care plans, and the University of Bristol hosts the EWAP (Eczema Written Action Plan) project. In South Africa, the South African Eczema Guidance recommends the Allergy Foundation of South Africa’s Child’s Eczema Action Plan. KidsHealth NZ publishes both an eczema action plan and an infected-eczema action plan (Thandi 2023). A 2022 National Eczema Association survey (547 respondents) found only 39.3% had heard of action plans, and caregivers of children were more aware than adult patients (52.3% vs 36.1%).

American Academy of Dermatology [supports] Written Eczema Action Plan South African Eczema Guidance [supports] Written Eczema Action Plan National Eczema Association [relates] Written Eczema Action Plan

What parents report. The NEA survey authors call for more personalised plans and more instruction from clinicians, and say there is room to improve how plans are used. A Canadian clinic study of an illustrated plan reported high carer ratings for usability; only a search summary of it was reviewed (evidence: anecdotal). Plans need updating whenever treatment changes.

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