Eczema

Differential diagnoses include miliaria, scabies, psoriasis or occasionally zinc deficiency or

histiocytosis.
Bacterial infection
Herpes infection
Consider immunodeficiency if there is associated failure to thrive, persistent diarrhoea or repeated
infection.
Eczema flowchart
 Return to Eczema Guideline

Steroids (to involved areas)

 Face/ nappy areas: Hydrocortisone ointment 1% bd

 Body:Betamethasone Valerate 0.02%(Celestone M) bd, or mometasone furoate 0.1%
(Elocon) daily
Ointments are preferred because they have emolient effects and are less irritating. They should be
applied thinly and not rubbed in vigorously. Families should be reassured about the safety and
efficacy of topical steroids.

Moisturisers
4-6 times per day eg. 50% soft, 50% liquid paraffin (Dermeze). It should be stored in the fridge and
applied over steroid creams. Sorbolene may cause irritation. Care should be taken to avoid
contaminating cream remaining in the jar.

Avoid Irritants

 overheating: wear light loose clothing to bed; luke warm baths

 soap: do not use soap
 excessive soaking: limit baths to 5 minutes maximum; add 1 capful of bath oil; apply
moisturisers after baths
 scratchy clothing and sheets: wear cotton, cotton/polyester, care with labels etc,
 scratching: keep fingernails short; mittens; if severe consider splints at night for facial eczema
 consider other irritants such as sand, chlorinated water

Cold compresses and wet dressings:

These rehydrate, reduce heat and itch, and protect from trauma and friction. They should always be
used if the child is not sleeping well because of itch.

Antihistamines
A short period of antihistamine treatment is sometimes useful to prevent itch.

Diet

 Infants with eczema should be breast fed as long as possible.

 Parents may notice that certain foods are associated with a flare up of eczema. Common
associations are artificial colours/preservatives, shellfish, oranges, tomatoes, eggs and nuts.
In such circumstances it is sensible to avoid these foods but more extensive elimination diets
should be avoided without discussion with dietician, immunologist.

Topical antibacterial treatment

If there is recurrent infection, consider nasal swabs and elimination of nasal carriage with mupirocin
ointment (Bactroban). Skin carriage can be reduced with antiseptic preparations such as
benzalkonium chloride/triclosan/paraffin (Oilatum bath oil) or triclosan cream (Microshield-T)

Disposition
Refer children with troublesome eczema to medical outpatients for follow-up.referal to dermatologist
atopic dermatitis (history of hay fever or asthma), contact dermatitis (no silvery scale), lichen planus (involves the
wrist and ankles with less scale), seborrheic dermatitis (greasy scale), onychomycosis, tinea corporis (thinner
scale with positive potassium hydroxide preparation), pityriasis rosea, and mycosis fungoide (less distinct lesion
borders).2,7 For guttate psoriasis, the differential diagnosis should include sec- ondary syphilis, which presents
with red-brown lesions on the palms of the patient’s hands and the soles of the patient’s feet. 2 For erythrodermic
psoriasis, the differential diagnosis should include drug rash with eosinophilia and systemic symptoms and
Stevens-Johnson syndrome.2,7 Finally, with pregnant women, evaluate for impetigo herpetiformis, also called
pustular psoriasis of pregnancy.