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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. 

Investigations

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

1. Prescribe regular emollients four times a day. See West of Scotland Formulary for preferred choice. Important points for prescribing:

  • In general, ointments are preferred for dry skin but are poorly tolerated.
  • Creams and lotions are better tolerated but may sting inflamed skin.
  • Epimax® products should not be used on the face nor near the eyes.

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

  • Face: clobetasone butyrate 0.05%
  • Trunk and limbs: betamethasone valerate 0.1%, mometasone furoate 0.1%
  • Palms and soles: clobetasol propionate 0.05%

3. Consider prescribing a soap substitute if necessary. In most cases, regular emollient preparations are suitable for use as bath additives and soap substitutes; bath and shower preparations should be reserved for situations where the use of regular emollient preparations is not sufficient.

4. Prescribe a non-sedating antihistamine as an adjunct for pruritus management: 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 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 or in the immunocompromised. Urgent ophthalmology review required if skin around eyes affected. 

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: February 2026

Page last updated: September 2026