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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 image of eczema / dermatitis. 

Investigation

  • 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.

Prescribe regular emollients four times a day. Examples include: Zerobase® and liquid and white soft paraffin. See GGC Adult Medicines Formulary for preferred choice. Important points for prescribing:

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

Prescribe a course of topical corticosteroids once a day / twice a day for 7 days.

  • Face: 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: fexofenadine oral 180mg once a day or loratadine oral 10mg once a day.

*Note risk of QT prolongation with hydroxyzine. For further information see BNF and Medicines Update Extra (MUE08: Drug Induced QT Prolongation) at www.ggcmedicines.org.uk.

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 see the NHSGGC Infection Management Poster.
  • Eczema herpeticum: aciclovir oral 400mg five times a day for seven days. Increase dose or switch to intravenous route in severe cases.

Refer to local 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: August 2023

Page last updated: November 2023