Improving the management of atopic eczema in primary care

Although generally considered a childhood ailment, 38% of patients in the UK with atopic eczema are adults. The diagnosis of uncomplicated atopic eczema is based on clinical history and visual assessment. Atopic eczema may be complicated by secondary infection, particularly staphylococcal and streptococcal, and herpes simplex virus may cause eczema herpeticum, which is uncomfortable and potentially dangerous. Patients or carers should receive a full explanation of how to use topical treatments and a demonstration of how to apply dressings, if applicable. Emollients are the mainstay of treatment. They should be applied liberally and frequently and their use continued during periods of treatment with corticosteroids. Topical calcineurin inhibitors should be considered, in patients two years and older, for the acute treatment of moderate and severe atopic eczema that has not been controlled by topical corticosteroids or if there is a serious risk of adverse effects from further corticosteroid use. Short-term use of oral antibiotics in infected eczema is recommended.