Eczema, Atopic
Eczema and Dermatitis
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ICD 10 code: L20.0/L20.8-9
DESCRIPTION
- An inflammatory 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
- Counsel on 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
- Do not use aqueous cream as an emollient
- Emollient, e.g.:
- Emulsifying ointment (UE)
If no response within seven days; or more severe eczema:
STEP 2
- 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 wash-off soap
AND
- Emollient, e.g.:
- Emulsifying ointment (UE)
If no response within seven days or more severe eczema:
STEP 3
Corticosteroid, potent, topical, e.g.: (Doctor prescribed)
- Betamethasone 0.1%, topical, apply ointment once daily for 7 days
- Do not apply to face, neck and flexures
LoE: IIb20
If there is a response:
Reduce use of corticosteroid ointment for a further few days, then stop and maintain treatment with:
- Aqueous cream (UEA) as a soap
AND
- Emollient, e.g.:
- Emulsifying ointment (UE)
If the patient is itching:
Children
- Chlorphenamine, oral, 0.1 mg/kg/dose at night for a maximum of 2 weeks. See: dosing table
LoE:IVb21
Adults
- Chlorphenamine, oral, 4 mg, at night for a maximum of 2 weeks
Note:
Chlorphenamine is sedating.
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
REFERRAL
- No improvement in 2 weeks
- Infants and children requiring more than 1% hydrocortisone cream
- Extensive involvement
- Eczema herpeticum
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.8.1 Eczema, Atopic