management of chronic eczema

Appropriate management of chronic eczema involves a stepped approach based on severity, with emollients as the foundation of treatment. Emollients should be used daily and in large amounts on the whole body, both when eczema is clear and during flares, to maintain skin hydration and barrier function.

For mild eczema, use emollients plus mild-potency topical corticosteroids.

For moderate eczema, add moderate-potency topical corticosteroids, topical calcineurin inhibitors, and consider bandages.

For severe eczema, use potent topical corticosteroids, topical calcineurin inhibitors, bandages, and consider phototherapy or systemic therapy under specialist supervision.

Topical calcineurin inhibitors should be applied only to active eczema areas and not under occlusion without specialist advice.

Occlusive dressings and wet wrap therapy are not first-line treatments and should be initiated by trained healthcare professionals.

Oral antihistamines are not routinely recommended but may be trialed in cases of severe itching or urticaria, or to manage sleep disturbance during acute flares.

Management also includes educating patients and carers on recognising flares and how to adjust treatment accordingly, starting treatment promptly at flare onset, and continuing treatment for about 48 hours after symptoms subside.

Referral to specialist dermatology is advised if eczema is uncontrolled, diagnosis is uncertain, there are significant psychosocial impacts, suspected contact allergy, or severe/recurrent infections.