Eczema

Description

Diagnostic criteria 

General and supportive measures

Medicine treatment

Referral 

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ICD-10 code: L20.9

 DESCRIPTION

An inflammatory itchy skin condition characterised by:

• Vesicles, weeping and crusting during the acute stage.
• Scaling and lichenification during the chronic stage.

 DIAGNOSTIC CRITERIA

• Intractable itch.
• Family history of allergies.
• Onset under the age of 2 years
• Dry skin.
• Typical distribution: face, flexures of knees and elbows, and creases of neck.

 GENERAL AND SUPPORTIVE MEASURES

• Avoidance measures: use neutral soaps and rinse clothes properly after washing.
• Keep fingernails short to prevent scratching.
• Wrap with dressings soaked in sodium chloride 0.9%.
• Avoid sunlight and recommend the use of sunscreen.

MEDICINE TREATMENT 

Antihistamine:
For children 2 years and older:

• Cetirizine, oral, as a single dose.
  • Children 2–6 years: 5 mg.
  • Children 6–12 years: 10 mg.

LoE: III²

For children less than 2 years:

• Chlorphenamine, oral, 0.1 mg/kg/dose as a single dose at night. (Maximum 4 mg).

To relieve skin dryness:

• Emulsifying ointment.

For baths, as a soap substitute:

• Aqueous cream.

For the face and skin folds:

• Hydrocortisone 1%, topical, 12 hourly.

For the body:

• Betamethasone 0.1%, topical, undiluted applied once daily for 7 days.
  • Moisturise with emulsifying ointment during therapy and in subsequent weeks

Secondary infection

Bacterial

• Cephalexin, oral, 25 mg/kg/dose, 6 hourly.

Viral
If HSV suspected:

• Aciclovir, oral, 250 mg/m2/dose 8 hourly for 7 days

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Note:
•    Short-term use of topical steroids is recommended (as outlined above)  
•    Oral corticosteroids do not have a role in the management of this condition

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 REFERRAL

• Recalcitrant cases.
• Concomitant food allergy (allergy clinic).

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Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 5: Dermatology,   5.3 Macules And Papules,  5.3.4 Eczema