The initial management of atopic eczema in children involves the use of emollients as the foundation of treatment, which should be used regularly even when eczema is clear NICE CG57.
Children and their parents or carers should be offered a choice of unperfumed emollients for daily moisturising, with large quantities prescribed for use at nursery, pre-school, or school NICE CG57.
Emollients should be applied in larger amounts and more often than other treatments, covering the whole body both when eczema is active and when it is not NICE CG57.
Application should involve smoothing emollients onto the skin rather than rubbing them in, and if irritation occurs, an alternative emollient or application method should be offered NICE CG57.
In addition to emollients, topical treatments such as mild or moderate-potency topical corticosteroids are used to manage flares, with treatment started as soon as signs and symptoms appear and continued for about 48 hours after symptoms subside NICE CG57.
The potency of topical corticosteroids should be tailored to the severity and location of eczema: mild for mild eczema, moderate for moderate eczema, and potent for severe eczema, with special caution around vulnerable areas like the face and neck NICE CG57.
Topical corticosteroids should be prescribed for once or twice daily application, and only to areas of active eczema NICE CG57.
Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, are considered second-line treatments and should only be initiated by specialists, mainly for areas of active eczema that are difficult to control with corticosteroids, especially on the face and neck NICE CG57.