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Management of Eczema/Dermatitis

The mainstay of eczema/dermatitis management should comprise: 

1.    Irritant avoidance

2.    Regular emollient

3.   Careful topical steroid 

Eczema/dermatitis (the terms are synonymous) is no more a diagnosis than, say, anaemia.  It simply describes the clinical morphology of an ill-defined erythematous rash, which is weepy and blistered in the acute stage, becoming scaly and subsequently thickened if repeatedly scratched or rubbed. 

Sometimes there is only one cause for eczema, eg contact allergy to nickel in earrings. Often, however, there is more than one, and sometimes several, eg a hairdresser with an atopic background who has developed an irritant hand eczema from shampoos, which subsequently becomes secondarily infected and the patient becomes allergic to protective rubber gloves.  It is important to identify all contributory factors.

• Diagnosis should be checked to exclude psoriasis, fungal infection or scabies.

• Determine whether there is an atopic background ie dry easily irritated skin.

• Determine the role of irritants.  This is inevitable and must be tackled. 

• An allergic component must be considered especially in varicose, ear, genital, hand or facial eczema involvement.

• Consider the presence of infection.  Differentiate, if possible between bacterial (golden crust, pustules caused by Staph. aureus or Strep. pyogenes), or herpetic (vesicles or pustules).

• If a single secondary infection diagnosis cannot be established, swab for both and treat for both.  If severe infection, may require parenteral therapy.  Contact on-call Dermatologist for urgent assessment.

• In seborrhoeic eczema reduce yeast numbers with ketoconazole cream.
• Weepy or blistered skin can be soaked for 10 minutes twice a day in potassium permanganate solution (due to its antiseptic and astringent properties) made up to a light pink colour. Staining of skin can occur and should disappear within 48 hours.  to prevent staining of nails, petroleum jelly e.g. Vaseline can be applied.
• Wet wrap or paste bandages can be useful in children and adult limb eczema.
• Sedative antihistamines chlorphenamine maleate or alimemazine (previously called trimeprazine) (for further information see section 3.4) can be helpful at night.
• Phototherapy (narrow-band UVB, occasionally PUVA or UVA1) should be considered for more extensive disease to reduce steroid use. 

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