Treatment Options
There are a number of different solutions available for patients to treat their eczema.

NICE Guidelines CG57 recommend a stepped approach to managing atopic eczema, tailoring the treatment step to the severity of the eczema:1

Emollients

Emollients should form the basis of atopic eczema management and should always be used, even when the atopic eczema is clear.1,2


Complete Emollient Therapy is the most important treatment for dry skin conditions. This involves substituting all wash products for emollient-based versions, and only applying emollient-based topical treatments to the skin.3


Read more in the Complete Emollient Therapy section

Topical corticosteroids

The full CG57 guidelines can be found here

NICE CG57
Topical corticosteroids are available in four potencies:

  • mildly potent,
  • moderately potent,
  • potent,
  • very potent.

See below for further details.
NICE CG57

Regimen for flares

For normal skin on the body (not the face, genitals, or axillae), prescribe a strength of topical corticosteroid to match the severity of the eczema.

For flares on the face, genitals, or axillae, consider prescribing a mild potency topical corticosteroid and increase to a moderate potency corticosteroid only if necessary.

Regimen for maintenance

For the maintenance treatment of chronic eczema on the body (that is, skin other than the face, genitals, or axillae), consider one of the following two treatment options.

Step down treatment

Prescribe the lowest potency topical corticosteroid that controls the eczema.

Intermittent treatment

Weekend therapy: prescribe the usual topical corticosteroid, to be used on two consecutive days, once a week.

Twice weekly therapy: prescribe the usual topical corticosteroid, to be used twice a week.

Topical calcineurin inhibitors

Further information on the use of calcineurin inhibitors can be found in NICE Technology Appraisal TA82 (2004)

ACCESS NICE TA82

Topical tacrolimus and pimecrolimus are calcineurin inhibitors, and are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.2

NICE recommends that “treatment with tacrolimus or pimecrolimus be initiated only by physicians (including GPs) with a special interest and experience in dermatology.”2

These drugs do not cause skin atrophy4, but may cause stinging on application, and increase the risk of skin infections.2,4

ACCESS NICE TA82

When to refer?

Adverse reactions and treatment-resistant eczema may warrant referral to a dermatologist.5
FOLLOW UP AND REFERRAL
1. NICE Clinical Guidelines CG57, Atopic eczema in under 12s: diagnosis and management, last updated March 2021, https://www.nice.org.uk/guidance/cg57. Last accessed April 2023.
2. NICE Technology Appraisal TA82. Tacrolimus and pimecrolimus for atopic eczema. August 2004.https://www.nice.org.uk/guidance/ta82. Last accessed April 2023.
3. Cork MJ. Skin barrier breakdown: a renaissance in emollient therapy. BJN 2009;18(14):872-877
4. British Association of Dermatologists patient information leaflet. Atopic Eczema. February 2017.
5. British Association of Dermatologists & Primary Care Dermatology Society. Guidelines on the management of atopic eczema. 2006. Reviewed January 2010