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13.5.1 Preparations for eczema

Topical preparations for eczema

First-line management in primary care

Emollients +/- antimicrobials (see section 13.2.1 )

Topical corticosteroid (see section 13.4 )

Prescribing Notes

  • Refer to COMPASS therapeutic notes-‘Primary Care Pharmacological Management of Atopic Eczema.’
  • All patients with eczema should use emollients along with soap substitutes (and/or bath oil if appropriate).
  • Exacerbation of eczema may represent secondary bacterial or viral infection. Refer to NICE NG190 for management of secondary bacterial infection of eczema and other common skin conditions. Appropriate swabs should be taken, and topical anti-bacterials applied. Systemic antibiotics may be required in widespread infected eczema. However, in people who are not systemically unwell, do not routinely offer either a topical or oral antibiotic for secondary bacterial infection of eczema
  • Emollients with antimicrobials may be considered in patients with infected eczema only.
  • Bandages (including those containing zinc and ichthammol) are sometimes applied over topical corticosteroids or emollients to treat eczema of the limbs. Zinc and ichthammol cream is available as a “special” on a named patient basis.
  • Lichenification, which results from repeated scratching, is treated initially with a potent corticosteroid. Bandages containing ichthammol paste (to reduce pruritis) and other substances such as zinc oxide can be applied over the corticosteroid or emollient.