C. Topical corticosteroids – Explanation
Atopic eczema usually begins between ages 3 and 12 months and usually starts on the
scalpe and face. As they get older, it may localize in the flexures.
If flare-ups of atopic eczema occur, then corticosteroids are effective in controlling and
supressing symptoms in most cases. Topical corticosteroids for atopic eczema should
be prescribed for application only once or twice daily as long term use of topical steroids
may result in skin atrophy, striae and telangiectasia. During the course of topical
steroids, he should continue to use emollients regularly.
Any physiological or emotional stressor can cause a flare up of eczema as well as a
variety of environmental factors, temperature and diet.
COMPARISON OF PSORIASIS, ECZEMA AND SEBORRHEIC DERMATITIS
| Psoriasis | Eczema | Seborrheic Dermatitis |
|---|---|---|
Management
|
Management
|
Management
|
MANAGING FLARE-UPS of ATOPIC ECZEMA
- Emollients routinely for moisturizing, bathing and washing (first line)
- Topical corticosteroids for eczema itself (second line)
o Mild strength – Hydrocortisone
o Moderate strength – Betamethasone 0.025%
o Potent strength – Betamethasone 0.1%
o Very potent strength – Clobetasol
- Treat bacterial infection if present with oral antibiotics
o Oral antibiotics (Flucloxacillin as first line choice) are used for a week only
o Topical antibiotics or steroid-antibiotic mixtures may be considered (In the exam,
topical antibiotics for eczema is rarely the correct choice as we are moving away
from this because of regular use which can promote antibiotic resistance)
- Change the emollient to one with a higher lipid content and advise on applying more
emollient each time as well as applying it more often
o Remember to use emollients at least twice a day
- If awake at night, consider sedative antihistamine
- Avoid environmental irritants and stresses where possible
