Eczema (Antimicrobial)

• CKS
• Scottish National Dermatology Pathway – atopic eczema in adults

Use of antibiotics (alone or with steroids) if there are no visible signs of infection, encourages resistance and does not improve healing.

Do not routinely take a skin swab for microbiological testing in people with secondary bacterial infection of eczema at the initial presentation. 

In people who are not systemically unwell, do not routinely offer either a topical or oral antibiotic for secondary bacterial infection of eczema.

Secondary infection

Prescribe systemic antibiotics if patients are systemically unwell with suspected secondary bacterial infection.  Antibiotic choice is as per cellulitis section.

For people with secondary bacterial infection of eczema that is worsening or has not improved, consider sending a skin swab for microbiological testing.

Eczema herpeticum - Prescribe systemic aciclovir and refer patient as medical emergency if eczema herpeticum (widespread herpes simplex virus) is suspected with atopic eczema (sudden onset of painful, uniform grouped vesicles/erosions).