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.

Note for when recomending the 10% olive oil, 10% liquid paraffin, 10% soft white paraffin in aqueous cream:
For health care card holders; 1kg plus and 5 repeats ($5.40), for non health care card holders; 1 kg plus and 5 repeats ($33.30)

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 (100 litres)

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