ECZEMA

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Eczema is an inflammatory skin condition recognised by vesicles, weeping and crusting in the acute phase; and thickened, scaly skin with increased skin markings known as lichenification in the chronic phase. Eczema can be allergic or non-allergic.

GENERAL MEASURES

Avoid exposure to trigger or precipitating factors, where applicable. Avoid irritants such as strong detergents, antiseptics, foam baths, perfumed soaps and rough occlusive clothing.

Good personal hygiene with regular washing to remove crusts and accretions and avoid secondary infection.

Keep fingernails short to prevent scratching.

Respect patient preference for cream or ointment topical treatment. Wet wraps may help control eczema and pruritus but should not be used for infected eczema.

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Diet modification has no role in atopic eczema treatment unless double blind challenge testing proves food sensitivity.

MEDICINE TREATMENT

To relieve skin dryness:

  • Emulsifying ointment (UE), topical, to wash or bath.
  • Aqueous cream, topical, applied daily to dry areas as a moisturiser.

Mild eczema

Topical corticosteroids, e.g.:

  • Hydrocortisone 1%, topical, applied 12 hourly until control is achieved.
    • Apply sparingly to the face.
    • Use with caution around the eyes.

Severe eczema

Potent topical corticosteroids, e.g.:

  • Betamethasone 0.1%, topical, applied 12 hourly for 7 days to the body.
    • Apply sparingly to face, neck and flexures.
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If non-responsive

Refer for dermatologist opinion.

  • Prednisone, oral. Specialist initiated

Maintenance therapy

Once eczema is controlled, wean to the lowest potency topical corticosteroid that maintains remission.  Apply moisturiser as needed.

  • Aqueous cream (UEA) or emulsifying ointment (UE), topical, applied daily.

Infected eczema 

This is usually due to staphylococcal infection.

Antibiotic therapy

  • Flucloxacillin, oral, 500 mg 6 hourly for 5 days.

Penicillin allergy:

  • Clindamycin, oral, 300 mg 8 hourly for 5 days

For sedation and relief of itch:

  • Chlorpheniramine, oral, 4 mg at night as needed.

REFERRAL

»              Severe, non-responsive or complicated cases (e.g. severe infection including disseminated herpes simplex).

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