Management of Eczema / Dermatitis

Introduction

Eczema / dermatitis is a chronic inflammatory skin condition that occurs in both children and adults. It presents as ill-defined areas of erythema with scaling and associated significant itch, often on flexural sites.

See figure 1 for images of eczema / dermatitis. 

Investigations

  • Investigations are not usually required to confirm eczema / dermatitis.
  • Send off bacterial standard swab and viral PCR swabs if infected eczema is suspected.
  • WCC and/or CRP might be raised in widespread inflammatory / infected eczema.
  • Eosinophilia often seen.

Treatment options

Below is a stepped approach for newly diagnosed eczema / dermatitis. Patients with pre-existing eczema / dermatitis should be treated according to their symptoms.

Important points for prescribing topical treatments:

  • In general, ointments are preferred for dry skin but are poorly tolerated.
  • Creams are used on less dry skin and better tolerated.

Prescribe regular emollients four times a day. See West of Scotland Formulary for preferred choice.

Prescribe a course of topical corticosteroids once or twice a day for 7 days (use the lowest effective dose).

  • Face: hydrocortisone 1% or if severe, clobetasone butyrate 0.05% (Eumovate®).
  • Trunk and limbs: betamethasone valerate 0.1% (Betnovate®), mometasone furoate 0.1% (Elocon®).
  • Palms and soles: clobetasol proprionate 0.05% (Dermovate®).

Treatment for pruritis

  • Non-sedating antihistamines: cetirizine oral 10mg once a day or loratadine oral 10mg once a day.

Treatment for infected eczema

  • Bacterial infection: hydrocortisone acetate 1% with fusidic acid 2% cream twice daily for mild cases. For severe cases requiring systemic antimicrobials, see here.
  • Eczema herpeticum: aciclovir oral 400mg five times a day for seven days. Increase dose or switch to intravenous route in severe cases. N.B. Give one or two doses of aciclovir before applying topical steroid to active area.

Refer to Dermatology team

  • Severe eczema not responding to treatment
  • Concerns regarding amount of topical steroid use
  • Diagnostic uncertainty
  • Consider input from Dermatology Specialist Nurse to help with topical application.

 

Guideline reviewed September 2026
Page updated October 2026



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