Eczema, Atopic (Adult)

Presentation

Atopic eczema is a common relapsing and remitting skin disease that often improves with advancing age. Regular treatment is required.

Acute Eczema

 

Chronic lichenified flexural eczema

 

Severe Erythrodermic Eczema

 

Eczema Herpeticum

consider if any acute vesicular and painful flare.

 

 

Management
  • Bath emollients and soap substitutes
  • Regular emollient application (minimum bd) prescribe sufficient quantities
  • Sedating antihistamine if required (non sedating less helpful for itch)
  • If secondary bacterial infection suspected take bacterial swab, treat with oral antibiotics or combined topical antibiotic/steroid preparations (Fusidic acid preparation for short term use due to high resistance rates)
  • SIGN guideline 125 Management of Atopic Eczema in Primary Care http://sign.ac.uk/pdf/sign125.pdf

Mild disease

  • Mild to moderate topical steroid eg clobetasone butyrate to trunk and limbs
  • Mild topical steroid eg hydrocortisone 1% to face

Moderate / Severe disease

  • Potent topical steroid until signs of improvement, then consider frequency reduction or potency step down
  • Mild to moderate potency topical steroid to face then reduce frequency or potency
  • Consider topical Tacrolimus for facial eczema unresponsive to mild/moderate topical steroids in those over 2yrs

Eczema Herpeticum

  • Stop topical steroids/tacrolimus and urgent referral
  • Urgent viral PCR swab if available.
Referral

Dermatology Referral Criteria

  • Failure to respond to continuing use of moderately potent steroids.
  • Sleep problems and psychosocial upset .
  • Recurrent secondary infection .
  • History suggestive of contact allergy
  • In children history suggestive of a  dietary allergy.

Erythrodermic eczema

  • >90% coverage  refer urgently
  • If systemically unwell refer urgently

Eczema Herpeticum

  • Contact Dermatology department immediately for advice.
Therpeutic Tips
  • Reassure patients that topical steroids are safe and effective during flares of eczema
  • Ointments preferable to creams in chronic eczema
  • Irritant avoidance i.e. soaps, fragrance, harsh washing powders
  • Dietary modification is usually not required
  • Light cotton tubular bandages can hold treatments in place and avoid staining
  • Light cotton clothing, or prescription silk garments may be beneficial
Patient Information