treatment of eczema

Last edited 10/2020 and last reviewed 06/2023

Can be considered in terms of:

• general education
• first-line therapy
• second-line therapy

In children, NICE suggest a treatment schema based on the severity of the atopic eczema:

• mild atopic eczema
  • emollients
  • mild potency topical corticosteroids
• moderate atopic eczema
  • emollients
  • moderate potency topical corticosteroids
  • topical calcineurin inhibitors e.g. pimecrolimus
  • bandages
• severe atopic eczema
  • emollients
  • potent topical corticosteroids
  • topical calcineurin inhibitors
  • bandages
  • phototherapy
  • systemic therapy -
  systemic immunosuppressive treatments are reserved for the treatment of more severe cases of eczema that have been inadequately controlled with topical treatments (such as topical corticosteroids and topical calcineurin inhibitors)

Notes:

• use topical corticosteroids of appropriate potency to treat affected sites
  
• topical calcineurin inhibitors (including tacrolimus and pimecrolimus) are licensed for use in adults and children two years of age and older as second-line treatments for moderate to severe eczema that has not been controlled by topical corticosteroids, when there is serious risk of important adverse eIects from further topical corticosteroid use (particularly irreversible skin atrophy)
  

Reference:

• NICE (December 2007).Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.
• Sawangjit R et al. Systemic treatments for eczema: a network meta-analysis. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013206. DOI:10.1002/14651858.CD013206.pub2