Eczema/dermatitis

• Eczema/Dermatitis


  Eczema and dermatitis mean the same thing. Eczema is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, sore and scaly. The condition is also referred to as acute, a single exposure to an irritant, or chronic, repeated exposure. In primary care, the two most common forms of dermatitis are irritant and allergic dermatitis.
• Trigger factors


  • Excessive washing
  • Exposure to heat/cold
  • Tight fitted clothes
  • Contact with cosmetics
  • Using electric blankets
  • Emotional stress
  • Recurrent skin infections
  • Food allergies (cow's milk, eggs, food colourings)
  • Materials (e.g. wool (lanolin), synthetic fabrics)
  • Hormones, teething, sleep deprivation
  • House dust mites
  • Moulds
  • Pollen
  • Animal dander
• Self Help


  • Correct use of emollients
  • NHS pre-payment certificate
  • Recognise symptoms of infection
  • Recognise early symptoms of a flare up
  • Avoid triggers
  • Complementary therapies = no adequate evidence
  • Don't scratch (pat skin dry not rub)
  • Keep nails short
  • Eczema support signposting, e.g. BAD British Association of Dermatologists, NES National Eczema Society
• Emollients


  • First line: available OTC or NHS but some are ABCS (advisory committee on borderline substances)
  • Purpose: hydrate and soothe skin
  • Apply frequently and liberally
  • Several times per day 2-3° for very dry kin)
  • Can keep separate packs at work/school to help with frequent application
  • Use daily (even if no flare up)
  • Apply to damp skin (during or after washing)
  • Replace soap with emollient (ointment, lotion or bath additive)
  • Smooth emollient gently into skin along line of hair growth
  • Don't use aqueous cream
  • Paraffin-containing products are highly flammable (self/clothing and bedding)
  • Bath emollients can pose a slip hazard
  • If a skin reaction occurs or ineffective, switch product (trial and error)
  • Wait 15-30 mins after emollient, before applying corticosteroid
  • Most emollients contain no active ingredients while some do: Urea (keratin softener, hydrating agent), Lauromacrogols (local anaesthetic properties), Lanolin or derivatives, Antiseptic
  • May increase risk of skin reactions in some patients
  • No evidence supporting one emollient over another
• Emollient Formulation


  • Options: ointments, creams, gels, sprays, lotions, bath/shower additives
  • Creams/lotions for red, inflamed skin as evaporation of water-based products cools skin
  • Ointments for dry skin are more effective but may be poorly tolerated
  • Could use better tolerated forms during day and ointment at night
• Emollient Device/container


  • Pump dispensers preferred, reduces contamination
  • Use clean spoon/spatula if using pots
• Topical Corticosteroids


  • Second line
  • Purpose: reduce inflammation, itching and redness
  • Variety of strengths and potencies: mild, moderate, potent, very potent
  • Potency prescribed/supplied dependent on severity of flare up and affected area
  • Some lower strengths available OTC
  • All available on NHS prescription
  • Some patients may require chronic corticosteroid treatment — use lowest potency required
  • Ointments preferred to creams but creams better tolerated
  • Apply thinly once or twice daily to affected areas only
  • See BNF for quantities required to treat various body parts
  • See BNF for info on FTU (fingertip units)
  • May help to apply at night (less likely to wash off and improve compliance with ointment)
  • If used inappropriately — thinning of skin, systemic ADRS
• Topical Corticosteroid Products


  • Hydrocortisone 1% cream 15g P over 10 years old
  • Clobetasone 0.05% cream 15g P over 12 years old (eczema and dermatitis only)
  • Max treatment 7 days
  • Restricted areas of body
• OTC Hydrocortisone Restrictions


  • Can be sold to public for treatment of: Allergic contact dermatitis, Irritant dermatitis, Insect bite reactions, Mild to moderate eczema in 10 years or older
  • Refer: Under 10 years, Pregnant, Application to face, anogenital region, Broken skin, Infected skin (inc. cold sores, acne, athlete's foot unless specific dual product), Severe flare up
• Severe Eczema


  • Refer either to GP or specialist
  • Potent or very potent topical corticosteroids
  • Occlusive dressings or dry bandages option
  • Severe itch = trial of antihistamine
  • If causing psychological distress = short course of oral corticosteroid
  • Signs of infection = depends on severity and systemic signs: Localised — consider topical fusidic acid, Flucloxacillin first-line (clarithromycin if allergy/resistance)