Management of atopic eczema
The management of this often distressing condition involves the following steps:
- Identify and remove or avoid triggers if possible. There may not always be an obvious trigger
- Follow the stepped care plan – matching intensity of treatment to severity of disease and stepping up or down as needed, using emollients all the time. Topical corticosteroids (TCS) or a topical calcineurin inhibitor (TCI) should be used to control flare-ups. Alternatively, if flares are very frequent, regular intermittent (‘weekend’) treatment with a potent TCS should be used to prevent them
- Severe atopic eczema calls for treatment with immunosuppressant drugs, such as azathioprine, or monoclonal antibodies such as dupilumab.
Infected eczema
Infected eczema can be associated with a rapidly worsening condition (more than a normal flare-up), and sometimes with fever and malaise. Weeping, pustules and crusts suggest bacterial infection (relatively common), clustered blisters like early cold sores suggest herpes virus infection (rare).
In either case, prompt referral to a GP is required for antibiotic or antiviral treatment.
A scabies infestation can look like eczema and the severe itching that accompanies an established infestation adds to the confusion. Scabies (and head lice) can also precipitate local flare-ups of eczema.