Atopic eczema may present as cradle cap in babies, before spreading to face, skin creases and extensor limb surfaces  then  flexural sites .  Rapid and early control is beneficial to long term outlook. May improve with advancing age. 

Eczema Herpeticum 

consider if any acute vesicular and painful flare. 

Topical Steroids: 

• Prescribe a mild (face) and moderate (body) steroid in ointment form. 
• Consider potent topical steroid to body in over 2’s 
• Advise on fingertip units . 
• Simultaneous application of emollients and topical steroid may reduce potency of steroid , advise a delay before steroid 
• Reduce topical steroid to twice weekly maintenance when improved. 

Emollients: 

Consider Prescribing  an ointment  to use in the evening (if steroid used, apply after a suitable interval ) and a cream  to use in the morning. Ointments may cause less ‘stinging’ in inflamed skin. Discuss with  patient/parent  which  he/she prefers and will use regularly. 

Prescribe adequate quantities of emollients for daily use 

Soap substitutes and bath emollients: 

Soaps, shower gels and bubble baths are very irritant and should ALWAYS be avoided. 

Prescribe a bath additive or shower emollient instead which can also be used to wash hair. 

Eczema Herpeticum 

• Stop topical steroids/tacrolimus and urgent referral 
• Urgent viral PCR swab if available. 
• consider if any acute vesicular and painful flare. 

• Eczema not controlled (2+flares per month) despite maintenance and flare treatment with hydrocortisone to face and moderately potent steroid (up to 1 year) or potent steroid (in 1 year+) to trunk/limbs. 
• Eczema causing severe psychological or social difficulties 
• Diagnosis uncertain 
• History of GI symptoms with severe widespread eczema not responding to topical steroids start on extensively hydrolysed formula and refer. 
• Eczema Herpeticum: 
• Contact Dermatology department immediately for advice. 

• Systemic antibiotics are only indicated if patient is systemically unwell 
• Reassure patients that topical steroids are safe and effective if used as described. 
• Ointments are preferable to creams. 
• The vast majority of children with mild-moderate eczema that respond to treatment do not have food allergy. 
• Light cotton or silk garments are available on prescription and can prevent scratching, help treatments to soak in and avoid staining of bedding and clothing. 
• consider eczema herpeticum where there is an acute blistering flare of eczema, pain, fever and patient is unwell. 

1.NHS Inform: www.nhsinform.scot 

2. NHS24 Tel: 08454 242424 

3. Text Phone: 18001 08454 24 24 24