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.
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 up to four times a day. Examples include: Hydromol® ointment, Zerobase® cream, QV® cream, white soft paraffin 50% / liquid paraffin 50% ointment (avoid aqueous cream).
Prescribe a course of topical corticosteroids once a day / twice a day for 7 days.
- 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
- Sedating antihistamines (first-line): chlorphenamine 4mg oral as required (maximum of 24mg in 24 hours) or hydroxyzine* oral 25mg at night.
- Non-sedating antihistamines: loratadine oral 10mg once a day or fexofenadine oral 180mg once a day.
*Note risk of QT prolongation with hydroxyzine. For further information see BNF and the Drug-Induced QT Prolongation guideline.
Treatment for infected eczema
- Bacterial infection: betamethasone valerate 0.1% with clioquinol 3% once to twice daily for mild cases (note - high rates of resistance to Fucibet®). 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.
