What first-line treatments are recommended for eczema in children and adults according to current UK guidelines?

For children: The first-line treatment is emollients, which should be used regularly to manage dry skin and prevent flares, and should be applied in larger amounts and more often than other treatments on the whole body, even when the skin is clear ².

During flares, treatment should be started as soon as signs and symptoms appear, with emollients and topical corticosteroids, with the choice of potency depending on severity: mild potency for mild eczema, moderate potency for moderate eczema, and potent corticosteroids for severe eczema, used for short periods (7-14 days) and only on active areas ².

Topical calcineurin inhibitors (pimecrolimus or tacrolimus) are recommended as second-line treatments for children with moderate to severe eczema that is not controlled by topical corticosteroids, particularly on the face and neck, and should only be initiated by experienced physicians after discussion of risks and benefits ².

Oral antihistamines are not routinely recommended, but may be trialed for severe itching or urticaria, with sedating antihistamines used during acute flares if sleep disturbance is significant ².

For adults:

The first-line treatment is also emollients, which should be used regularly to maintain skin hydration and reduce flares ¹.

In addition, topical corticosteroids are recommended for managing flares, with potency tailored to severity: mild potency for mild eczema, moderate for moderate, and potent for severe cases, applied once or twice daily for short periods (7-14 days) ¹.

Topical calcineurin inhibitors are second-line options for adults with moderate to severe eczema not controlled by corticosteroids, used with caution and under specialist advice ¹.