Eczema and dry skin conditions
NICE Guidelines CG57 recommend a stepped approach to managing atopic eczema, tailoring the treatment step to the severity of the eczema:1
From NICE Clinical Guidelines CG57: Atopic eczema in children. December 2007.
Emollients should form the basis of atopic eczema management and should always be used, even when the atopic eczema is clear.1,8
Complete Emollient Therapy is the most important treatment for dry skin conditions. This involves substituting all wash products for emollient-based versions, and only applying emollient-based topical treatments to the skin.3
Read more in the Complete Emollient Therapy section.
Topical corticosteroids are available in four potencies: mildly potent, moderately potent, potent, and very potent.
Regimen for flares
For normal skin on the body (not the face, genitals, or axillae), prescribe a strength of topical corticosteroid to match the severity of the eczema. For flares on the face, genitals, or axillae, consider prescribing a mild potency topical corticosteroid and increase to a moderate potency corticosteroid only if necessary.
Regimen for maintenance
For the maintenance treatment of chronic eczema on the body (that is, skin other than the face, genitals, or axillae), consider one of the following two treatment options.
Step down treatment: prescribe the lowest potency topical corticosteroid that controls the eczema.
Weekend therapy: prescribe the usual topical corticosteroid, to be used on two consecutive days, once a week.
Twice weekly therapy: prescribe the usual topical corticosteroid, to be used twice a week.
Further information on the use of topical corticosteroids in children can be found in NICE Guideline CG57 (2007).
Topical calcineurin inhibitors
Topical tacrolimus and pimecrolimus are calcineurin inhibitors, and are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.8
NICE recommends that "treatment with tacrolimus or pimecrolimus be initiated only by physicians (including GPs) with a special interest and experience in dermatology."8
These drugs do not cause skin atrophy9, but may cause stinging on application, and increase the risk of skin infections.8,9
Further information on the use of calcineurin inhibitors can be found in NICE Technology Appraisal TA82 (2004).
Adverse reactions and treatment-resistant eczema may warrant referral to a dermatologist.4