Eczema, Acute, Moist or Weeping

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Click here to access the Primary-Healthcare-Chapter-5-Skin-Conditions-with-Supporting-NEMLC-Report-2020-4-Review-Version-2.0-November-2025

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Description

General Measures

Medicine Treatment

Referral

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ICD 10 code: L20.0/L20.8-9

DESCRIPTION

• A form of eczema with small or large vesicles, associated with oozing and eventual crusting and scaling
• Yellow pustules which crust indicate sepsis

GENERAL MEASURES

• Sodium chloride 0.9% dressings, applied daily or twice daily
• Avoid use of soap on affected areas

MEDICINE TREATMENT

Topical steroids, e.g.:

• Hydrocortisone 1%, topical, applied 12 hourly, until improved
  • Topical steroids should be applied to both moist and dry inflamed areas

Antibiotic treatment if secondary infection is present:

Children ≤ 7 years of age

• Cefalexin, oral, 25 mg/kg/dose 12 hourly for 5 days. See: dosing table

OR

• Flucloxacillin, oral, 12–25mg/kg/dose 6 hourly for 5 days. See: dosing table

Children > 7 years of age and adults

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

OR

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

Severe penicillin allergy: 

ICD 10 code: Z88.0

Children

• Macrolide, e.g.:
  • Azithromycin, oral, 10 mg/kg/dose daily for 3 days. See: dosing table

Adults

• Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days.

If the patient is itching:

Children

• Chlorphenamine, oral, 0.1 mg/kg/dose at night. See: dosing table

Adults

• Chlorphenamine, oral, 4 mg at night

LoE: IVb²²

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Note:
Chlorphenamine is sedating.

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If itch is not controlled or is more severe during the day, switch to:

Children: 2–6 years of age

• Cetirizine, oral, 5 mg once daily. See: dosing table

Children > 6 years of age and adults

• Cetirizine, oral, 10 mg once daily

LoE: IVb

For itching in children < 2 years of age:

• Calamine lotion, applied on the skin

REFERRAL

• No improvement after a week
• Severe acute moist or weeping eczema

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024

Chapter 5: Skin Conditions_5.8.2 Eczema, Acute, Moist or Weeping