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Emollients are an essential component in the treatment of atopic eczema and psoriasis and can reduce the need to use topical steroids. All patients with dry skin conditions should be using an effective and cosmetically acceptable emollient regimen. Soaps and detergents should also be avoided by using substitutes such as those listed in section 13.1 Dry and scaling skin conditions
Topical steroids should not be used routinely on clinically infected skin, unless the infection is being treated. A short course of a suitable oral antibiotic maybe indicated.
“To be spread thinly" is a cautionary warning that must legally be included on the label of topical steroid preparations. This can mean different things to different people and can worry some patients. Therefore, it is important to counsel patients on the correct application and ensure adequate coverage of affected areas.
The use of oral antihistamines can be effective in the treatment of itching associated with eczema. Itching is generally worse in the warmth of the bed and can often interfere with sleep. Sedating antihistamines are therefore useful in this situation.
Infection of broken skin is common making the patient feel unwell and limiting movement. Clinical signs of infected eczema include weeping, pustules, crusts, fever and malaise, or atopic eczema failing to respond to therapy or rapidly worsening atopic eczema.
Take swabs from infected lesions of atopic eczema only if you suspect microorganisms other than Staphylococcus aureus or if you think antibiotic resistance is relevant. Staphylococcus aureus infection is the commonest cause of acute flare up of atopic eczema and should be treated accordingly (see Chapter 5, skin and soft tissue infections)
Explain that topical treatments in open containers can be contaminated with microorganisms and act as a source of infection.
Use oral antibiotics plus appropriate potency topical corticosteroid (see Skin and soft tissue infections)
Fucidin® H cream (hydrocortisone 1% / fusidic acid 2%)
Fucibet® cream (fusidic acid 2% / betamethasone valerate 0.1%)
Trimovate® cream (clobetasone / oxytetracycline / nystatin)
Antimicrobial and emollient combinations
The following is for second line use when skin has not responded to alternative antiseptic/antibacterial products, when the skin is very weepy or there is persistent infection.
Potassium permanganate solution (1 in 10,000)
Ensure appropriate potency of topical corticosteroid is being used. Inadequate control of the underlying atopic eczema is the most frequent cause of repeated infections.
Consider antiseptic emollients / shower / bath preparations (e.g. Dermol® range) to reduce bacterial colonisation.