The mainstay of eczema/dermatitis management should comprise:
- irritant avoidance
- regular emollients
- careful use of topical steroid.
Eczema/dermatitis (the terms are synonymous) is no more a diagnosis than, say, ‘anaemia’. It simply describes the clinico-pathological characteristics of an inflammatory erythematosquamous rash, which may weep and blister in the acute stage, becoming scaly and subsequently thickened if repeatedly scratched or rubbed.
Sometimes there is only one cause for eczema, eg allergic contact dermatitis to nickel in earrings. Often, however, there are more than one and sometimes several contributory causes, eg a hairdresser with an atopic background who develops irritant hand eczema from shampoo, which can be secondarily infected, or further complicated by allergic contact dermatitis to protective rubber gloves. It is important to identify all contributory factors.
- Check diagnosis to exclude psoriasis, fungal infection or scabies.
- Determine whether there is an atopic background.
- Determine the potential role of irritants, which is almost inevitable. Zerobase® cream or Zeroderm® ointment are good soap substitutes (refer to section 13.2).
- Consider an allergic component, particularly in varicose, ear, genital, hand, foot or facial eczema.
- Consider the presence of infection. Differentiate, if possible, between bacterial (golden crust, pustules usually caused by Staph. aureus or Strep. pyogenes), herpetic (vesicles or pustules) or mycological causes. Send appropriate swabs or scrapings for mycological assessment when necessary. Severe infections may require parenteral therapy.
- In seborrhoeic dermatitis consider yeast infection and treat with Canesten HC® or Daktacort® ointment.
- Weeping or blistered skin can be washed once or twice daily in a bath containing Emulsiderm® emollient, which can also be applied directly to lesions before drying. Lukewarm olive oil applied after washing and drying can be soothing and helpful, especially to remove crust and scale.
- Wet wrap or paste bandages can be useful in children and adults with limb eczema.
- Sedative antihistamines can be helpful at night. For further information see section 3.4. Phototherapy may be considered for more chronic, stubborn extensive disease.