Medicated creams and ointments

• Apply topical steroids at the first stages of a flare (acute deterioration, redness, inflammation and increased itch) and cease when clear.
• Instruct the parents to recommence topical steroids as soon as the eczema flares again.
• Instruct parents to apply topical steroids in adequate amounts for optimal effect
• A weaker steroid should be applied to the face
• An authority prescription will need to be written for advantan and elocon for greater than 1 tube (15 gms)

Medicated creams and ointments for the face

• These ointment / creams may be applied up to twice a day
• Pimecromlimus should be prescribed for moderate or persistent facial eczema unresponsive to topical hydrocortisone 1%. An authority prescription can be given every 6 months

Medicated creams and ointments for other parts of the body

• Hydrocortisone 1%, apply only to mild eczema
• Elocon: apply nocte for moderate to severe eczema on limbs and trunk
• Advantan cream/ointment/fatty ointment: apply nocte
• Hamiltons Eczema Cream: apply up to twice a day to thickened eczematous lesions or discoid eczema on the limbs and trunk. It should not be applied to acute lesions or to the face or nappy area.

Wet dressings

• Good for moderate and severe eczema to gain control of the eczema and promote sleep
• Apply a wet dressing to the limbs nocte when the topical treatments have not improved the eczema within 24 to 48 hours
• Apply cool compresses to itchy areas on the face and body for immediate relief and preventative management. Apply a moisturiser afterwards
• Wet bandannas and scarves should only be applied when the parent is supervising
• Wet T-shirts may be applied for immediate relief of the itch and also as a preventative measure for example on hot days
• For moderate eczema apply: nocte until cleared. Restart wet dressings nocte if the eczema flares again
• For severe eczema apply: QID for 2 - 3 days, bd for 1 week and then nocte until clear. Restart wet dressings nocte if the eczema flares again.
• If the wet dressing equipment cannot be obtained or the parent is unable to apply or has not had education, recommend a layer of wet clothes followed by a dry layer of clothes

Infected eczema

• Secondary bacterial infection is a common complication in eczema. It should be suspected if there is crusting, weeping, erythema, cracks, frank pus or multiple excoriations and an increased itch. The usual organism is Staphylococcus aureus.
• Secondary herpes simplex virus infection is a less common complication in eczema. This is characterised by a sudden onset of grouped, small white or clear fluid filled vesicles, satellite or "punched out" lesions, pustules or erosions. It is often tender, painful and itchy.
• Management for bacterial infected eczema includes;
  • Remove crusts asap. Do this by soaking the child in a cool bath for 15-30 minutes, and gently wipe away crusts before getting out of bath. Once the crusts have been removed start the topical treatments.
  • Cephalexin or flucloxacillin, 6.25- 12.5mg/kg, orally, qid for 10 days for S.aureus infections.
  • For severe infections, threatened eye involvement, or unwell and febrile patients use flucloxacillin, IV, 25- 50 mg/kg/dose. Duration is patient dependent and based upon clinical assessment of disease severity. Then use flucloxacillin orally, qid for a combined 10 day course.
  • Antiseptic bath oils may be considered as prophylactic therapy for patients who become recurrently infected.
• Management for herpes simplex virus includes;
  • For moderate infections; Acyclovir, orally, < 2years, 100 mg per dose/5 times/day for 10 days. > 2years old, 200mg/dose/5 times/day for 10 days.
  • For severe infections or unwell and febrile patients; Acyclovir IV, 3 months to 12 years, 250mg per meter squared, per dose 8 hourly. > 12 years, 5 mg/kg/dose 8 hourly. Duration is patient dependant based upon clinical assessment of disease severity. Then acyclovir, orally, for 10 days.
  • Most patients with viral infected eczema invariably also have a bacterial skin infection. Assess for this and start antibiotics as instructed.

Everyday care

• These treatments are ongoing regardless of the presence or absence of eczema
• Bathing
  • It is good to bath the child twice a day in a cool bath no hotter than 29 degrees.
  • Pat dry the child and apply moisturiser within 3 minutes post bath.

Moisturisers

• Moisturisers should be applied from top to toe 2-4 times a day. The drier the skin the more frequent the applications.
• Ointments are best for babies faces and under wet dressings; QV Kids balm and Dermeze.
• Creams are better for daily use and older children as they are less greasy and more user friendly.
• If a child develops miliaria (blocked pores) cease ointments and prescribe a cream instead.
• If the cream stings on application use an ointment instead.

For children with infected eczema or prone to secondary skin infections

For children with infected eczema or prone to secondary skin infections add the following to a FULL ADULT bath

• 1kg of pool salt
• 125 mls of White King Bleach
• 2 capfuls of bath oil