How is it treated and managed?

Bandages or wraps

Treatments used in mild eczema

Treatments used in moderate eczema

Treatments used in severe eczema

The main treatment of eczema is emollient cream. These are non-irritant moisturising creams that hydrate and soothe dry, itchy skin. Use of emollients alone will often be enough to control eczema most of the time. Emollients may be used once a day – typically after washing or bathing to retain moisture in the skin, or they may be used four times a day in severe eczema. Stepping up emollients to several times a day will be the main step up treatment in eczema. Emollients are applied thickly and smoothed onto the skin rather than rubbed in. Use of soap is avoided in eczema and either emollient cream is used for washing and cleaning the skin or emollient bath additives are used. These can be bought over the counter or prescribed. This is a list of commonly used emollients but there are many others:

Bandages or wraps

These are applied after emollients usually at night to improve hydration of the skin and reduce itching. Bandages may be dry or wet or medicated. Bandages are a time consuming treatment. Eczema needs to be kept very clean to prevent secondary infection so a bath is needed every day. A typical routine for a child with eczema having bandage treatment would include washing in a bath using an emollient cream or emollient bath additive. Patting the skin dry followed by the application of emollient cream to retain hydration of the skin. Waiting half an hour and then applying treatment creams. Only then can the bandage or wrap be applied. The bandage may be wet or dry or medicated or may be an elasticated stockinette. The whole process from bathing to bandaging and being ready for bed may take around 90 minutes to complete. The following morning the bandages are removed. This may take time and patience particularly if the eczema is weepy and the bandages have become stuck to areas of the skin, another bath may be required to soak some bits of the bandage off. Once the bandages are removed further emollient and treatment creams need to be applied before the child can be dressed for the day. Typically the morning routine will take around 30 minutes. Children having bandage treatment on a daily basis rather than just during flares are likely to require repeated application of emollient cream during the day every day; the child will have to be undressed on each occasion that this is applied.

Treatments used in mild eczema

• Emollients – usually up to twice daily
• Mild potency topical corticosteroids up to twice daily

During flare ups treatment may be stepped up -:

• Emollients more than twice daily
• Moderate potency topical corticosteroids up to twice daily
• Tacrolimus or Pimecrolimus ointment
• Bandages

Treatments used in moderate eczema

• Emollients up to 4 times daily
• Moderate potency topical corticosteroids
• Tacrolimus or Pimecrolimus ointment
• Bandages

During flare ups treatment may be stepped up:

• Potent topical corticosteroids
• Systemic therapy (the use of oral drug treatments to control a condition)

Treatments used in severe eczema

• Emollients up to 4 times daily
• Potent topical corticosteroids
• Tacrolimus or Pimecrolimus ointment
• Bandages
• Phototherapy (treatment involving exposure of the skin to light)
• Systemic therapy

• Corticosteroid creams

• Other therapies and treatments