Eczema

Data gathering

  • Red flags
    • Blistering of the skin
    • Painful areas of skin
    • Fever
  • Others
    • Growth and development
    • Joint problems, job
    • Triggers (washing powders, soap, stress)
    • CMPA – GI symptoms, Wheeze
  • Examine
    • Distribution
    • Crusting
    • Weeping
    • Excoriation
    • Scarring

 

Clinical management

  • Explanation
    • Irritation of the skin leading to dry itchy skin with flare ups – the cause is not fully known but known to run in families and may be linked to immune system – can sometimes become weepy and infected
  • Treatment
    • Lifestyle
      • Avoid triggers – perfumes, soaps, synthetic materials
      • Avoid scratching, wear cotton, non biological detergents
    • Medications
      • Emollients
      • Topical steroids for flare ups
    • Infection
      • Presentation: crusting, weeping, pustules, cellulitis
      • Small area: topical fucidic acid
      • Larger area: oral flucloxacillin or clarithromycin
  • Follow-up / Safety net
    • Refer
      • Poor response to treatment
      • Recurrent infections
      • Suspected dietary factors (consider CMPA for moderate eczema with onset < 6months of age)
    • Admit
      • Eczema herpeticum
      • Erythroderma

 

Emollients

  • use 3-8 times per day
  • ointments are more effective than creams (but less well tolerated)
  • remove emollients with clean spoon to avoid contamination
  • avoid emollients with preservatives e.g. E45
  • avoid aqueous cream due to skin reactions
  • bath additives are not recommended as increased risk of falls and no evidence of efficacy

Topical steroids

  • Use early in flares (redness, inflammation, itching)
  • Step up potency if required after 7 days
  • Care in flexures as potency of cream increased
  • 30 minute gap between application of steroid and emollient
  • Ointments preferable to creams (avoids preservatives) unless skin weeping
  • Allow a four week gap between courses of potent steroid treatments

Topical steroid potencies

  • Topical steroids
    • Hydrocortisone 0.5% – Mild
    • Hydrocortisone 1% – Mild
    • Eumovate (Clobetasone butyrate 0.05%) – Moderate
    • Elocon (Mometasone furoate 0.1%) – Potent
    • Dermovate (Clobetasol propionate 0.05%) – Very Potent
  • Topical steroids with antimicrobials
    • Daktacort – mild steroid + antifungal
    • Fucidin H – mild steroid + antibacterial
    • Trimovate – moderate steroid + antibacterial + antifungal
    • Fucibet – potent steroid + antibacterial
    • Lotriderm – potent steroid + antifungal