Eczema management strategies - clinical fact sheet & MCQ
Eczema (atopic dermatitis) is a common, chronic, relapsing, inflammatory skin condition. It typically presents before 1 year of age and can be lifelong.
Allergy testing and elimination diets
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People with eczema often have other allergic conditions, including food allergy, but food allergy does not cause eczema.
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Results from skin or blood tests for food allergies do not predict foods that trigger eczema. Allergy testing should only be undertaken if recommended and interpreted by a clinical immunology/allergy specialist.
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Common triggers for eczema flares include dry climate, overheating, irritants (fragranced products, chemicals, sand, grass or dirt), scratching, allergens (dust mites), stress, sweat and excessive saliva, hormones and infections.
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Avoid elimination diets and changes to infant formulas in those without a confirmed food allergy as this may result in malnutrition, poor growth and the development of new food allergies.
Shared decision-making and care
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To support shared decision-making:
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use the Eczema Care Plan
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follow the Eczema Management Algorithm
Moisturisers
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Improves skin hydration and maintains the skin barrier
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Daily use reduces the number of flares and need for topical corticosteroids
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Moisturisers with ceramides may repair the skin barrier more effectively than others, but patient needs and preferences should be considered
- Avoid products containing:
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Topical corticosteroids (TCS)
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Beyond the use of daily moisturiser, topical corticosteroids are first-line for management of eczema, showing proven efficacy and safety
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Treat until fully resolved: generously apply TCS before moisturiser, on all areas of inflammation (not just the worst areas) until the skin feels smooth and itch-free - without strict time limits
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Treat early using appropriate potency to avoid a chronic cycle of inflammation
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Prescribe appropriate quantities (consider PBS streamline authorities for higher quantities).
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Ointments are more effective than creams. When choosing a formulation, consider site and patient preference, see algorithm for further details
Eczema beyond the physical symptoms
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Eczema impacts the well-being and quality of life of both individuals and caregivers.
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Children with eczema are more likely to experience sleep deprivation, mood disturbances, inattention and learning difficulties at school.
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Adults with eczema have an increased risk of mental health disorders, such as anxiety and depression, when compared to adults without the disease.
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