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Eczema management strategies - clinical fact sheet & MCQ

18 March 2025 - Quality Use of Medicines Alliance

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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

  • People with eczema often have other allergic conditions, including food allergy, but food allergy does not cause eczema.

  • 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.

  • 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.

  • 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

Moisturisers

  • Improves skin hydration and maintains the skin barrier

  • Daily use reduces the number of flares and need for topical corticosteroids

  • Moisturisers with ceramides may repair the skin barrier more effectively than others, but patient needs and preferences should be considered

  • Avoid products containing:
    • animal or plant-derived proteins (e.g., nuts, coconut, milk) especially if a person has broken skin and does not readily eat the food or has an allergy to it

    • essential oils

    • aqueous cream containing sodium lauryl sulphate

    • benzalkonium chloride, methylchloroisothiazolinone (MCI) or methylisothiazolinone (MI)

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Topical corticosteroids (TCS)

  • Beyond the use of daily moisturiser, topical corticosteroids are first-line for management of eczema, showing proven efficacy and safety

  • 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

  • Treat early using appropriate potency to avoid a chronic cycle of inflammation

  • Prescribe appropriate quantities (consider PBS streamline authorities for higher quantities).

  • Ointments are more effective than creams. When choosing a formulation, consider site and patient preference, see algorithm for further details

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Eczema beyond the physical symptoms

  • Eczema impacts the well-being and quality of life of both individuals and caregivers. 

  • Children with eczema are more likely to experience sleep deprivation, mood disturbances, inattention and learning difficulties at school.

  • 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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Quality Use of Medicines Alliance
Quality Use of Medicines Alliance

The Quality Use of Medicines Alliance a consortium of eight health and consumer organisations, will align their work across the two grants, awarded under the Australian Government’s Quality Use of Diagnostics, Therapeutics and Pathology (QUDTP) Program.  

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