L20.0/L20.8-9
DESCRIPTION
An allergic disorder with an itchy red rash or dry rough skin.
In babies it appears at approximately 3 months.
Family history of asthma, hay fever or atopic dermatitis is common.
Clinical features:
- occurs on the inner (flexural) surfaces of elbows and knees, the face and neck
- can become chronic with thickened scaly skin (lichenification)
- secondary bacterial infection may occur with impetigo or pustules
- can be extensive in infants
- very itchy at night
Eczema is usually a chronic condition and requires long-term care.
Sufferers of atopic eczema are particularly susceptible to herpes simplex and may present with large areas of involvement with numerous vesicles and crusting surrounded by erythema (eczema herpeticum). See Herpes simplex
GENERAL MEASURES
- Avoid direct skin contact with woollen or rough clothes.
- Avoid overheating by blankets at night.
- Trim fingernails to prevent scratching.
- Good personal hygiene with regular washing to remove crusts and accretions and to avoid secondary infection.
- Diet modification may have no role in atopic eczema treatment.
- Avoid soap on affected areas.
MEDICINE TREATMENT
(For management of severe eczema, start at step 3).
STEP 1
- Avoid soap, use soap substitutes such as aqueous cream (UEA).
- Rub on skin, before rinsing off completely.
- Aqueous cream should not be used as an emollient.
- Emollient, e.g. :
- Emulsifying ointment (UE).
STEP 2
If no response within seven days or more severe eczema:
- Hydrocortisone 1% topical, applied twice daily for 7 days.
- Apply sparingly to the face.
- Do not apply around the eyes.
If there is a response:
Reduce the use of the hydrocortisone cream to once daily for a further few days, then stop and maintain treatment with:
- Aqueous cream (UEA) as a soap.
AND
- Emollient, e.g. :
- Emulsifying ointment (UE).
STEP 3
If no response within seven days or more severe eczema:
- Corticosteroid, potent, topical, e.g.: (Doctor prescribed).
- Betamethasone 0.1% ointment applied once daily for 7 days
- Do not apply to face, neck and flexures
If there is a response:
Reduce use of corticosteroid ointment to once daily for a further few days, then stop and maintain treatment with:
- Aqueous cream (UEA) as a soap
AND
- Emollient e.g.
- Emulsifying ointment (UE).
For itching
Children
- Chlorphenamine, oral, 0.1 mg/kg/dose at night for a maximum of 2 weeks. See paediatric dosing tool.
Adults
- Chlorphenamine, oral, 4 mg, at night for a maximum of 2 weeks.
- Note: Chlorphenamine is sedating.
If itch not controlled or more severe daytime itch, switch to:
Children: 2–6 years of age
- Cetirizine, oral, 5 mg once daily. See paediatric dosing tool.
Children > 6 years of age and adults
- Cetirizine, oral, 10 mg once daily.
CAUTION
Do not give an antihistamine to children < 2 years of age.
REFERRAL
- No improvement in 2 weeks.
- Infants and children requiring more than 1% hydrocortisone cream.
- Extensive involvement.
- Eczema herpeticum.