Atopic Eczema/Dermatitis

 

Description

General measures

Medicine treatment

Referral

---

L20.0/L20.8-9

DESCRIPTION

Eczema is a pruritic, inflammatory skin condition characterised by vesicles, weeping, and crusting in the acute phase; and thickened, scaly skin with increased skin markings known as lichenification in the chronic phase.

Assessing severity

1% of body surface is equal to the size of one hand (including the fingers) of the patient.

Mild

• Less than 5% body surface involved.
• No acute changes.
• No significant impact on quality of life.

Moderate

• 5-30% body surface involved.
• Mild dermatitis with acute changes.
• Mild dermatitis with significant impact on quality of life.

Severe

• More than 30% body surface involved.
• Moderate dermatitis with acute changes.
• Moderate dermatitis with significant impact on quality of life.

GENERAL MEASURES

• Avoid exposure to trigger or precipitating factors, where applicable.
• Avoid irritants such as strong detergents, antiseptics, foam (especially hot) baths, soaps and rough occlusive clothing (silk is better than cotton, which is better than nylon, which is better than wool).
• Good personal hygiene with once daily washing to remove crusts and accretions and avoid secondary infection.
• Keep fingernails short to minimise trauma from 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.
• Diet modification has no role in atopic eczema treatment unless double blind challenge testing proves food sensitivity.
• Avoid smoking.

LoE:IIIb^vi

MEDICINE TREATMENT

To relieve skin dryness:

• Aqueous cream topical, to wash or bath

AND

• Emulsifying ointment (UE), topical, applied daily to dry areas as a moisturiser

LoE:IIIb^vii

---

Note

Maintenance treatment with moisturising soap, creams, and ointments as described above should be continued, even if the dermatitis is controlled.

---

To control wet or weepy dermatitis:

Creams are preferred to ointments on open or oozing lesions and in intertriginous folds.

Mild eczema

• Hydrocortisone 1%, topical, applied 12 hourly to body and face until control is achieved
  • Can be used on face and in skin folds.
  • Apply sparingly to the face.
  • Use with caution around the eyes.

Moderate and severe eczema

• Potent topical corticosteroids, e.g.:
• Betamethasone 0.1%, topical, applied daily for 7 days to the affected areas
  • Apply sparingly to face, neck and flexures.

---

Note

There is no clear benefit for more than once daily application.

---

LoE:Ia^viii

If non-responsive:

• Refer for dermatologist opinion, and whilst awaiting referral, initiate:
  • Prednisone, oral, 0.5 mg/kg daily, for ≤ 2 weeks (Specialist initiated)

Maintenance therapy

• Once eczema is controlled, wean to the lowest potency topical corticosteroid that maintains remission, and continue applying twice a week
• Emulsifying ointment (UE), topical, applied daily
  • Apply moisturiser as needed

Infected eczema

• This is usually due to staphylococcal infection

Antibiotic therapy

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

Severe penicillin allergy: (Z88.0)

• Clindamycin, oral, 450 mg 8 hourly for 5 days

For sedation and relief of itch: 

• Chlorphenamine, oral, 4 mg at night as needed

Eczema herpeticum (B00.0)

Therapy should be initiated without delay:

• Aciclovir, oral, 400 mg 8 hourly for 7 days

LoE:IIIb^ix

If patient is unable to swallow due to odynophagia:

• Aciclovir, IV, 5 mg/kg/dose, 8 hourly for 7 days
  • Infuse over 1 hour

LoE:IIIb^x

REFERRAL

• Severe, non-responsive or complicated cases.
• Cases with uncertain diagnosis (e.g. severe infection including disseminated herpes simplex).

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_07 November 2024

Chapter 4 Dermatology_4.5 Atopic Eczema/Dermatitis