Dermatology prescribing update: eczema
Eczema is a common skin condition, which for the majority is managed in primary care. Nurse prescribers should be aware of evidence–based guidelines in eczema treatment, on which they need to base prescribing decisions and work with the patient on individual skin care plans. Education and support in managing eczema is essential for patients of all ages (and carers of children and older people). Eczema has a huge impact on quality of life but a good management plan can make a big difference to controlling eczema, which is a chronic condition. This article explains the principles of eczema treatments, in acute, sub-acute and chronic stages of eczema with emollients, topical corticosteroids, antibiotics, antimicrobials and antivirals, topical calcineurin inhibitors and antihistamines.
This article will examine the guidance and evidence for prescribing topical treatments in eczema management. Prescribers will assess patients with eczema and should manage symptoms according to national guidance. NICE provides clinical knowledge summaries and specific guidance for children with atopic eczema under 12 years of age (National Institute of Health and Care Excellence (NICE), 2007; 2018). The Primary Care Dermatology Society (PCDS) provides eczema treatment pathways with practical advice for managing adults and children with eczema in primary care (PCDS, 2019). An overview of the PCDS eczema treatment pathways are outlined in Box 1. This article will explore the benefits and risks of the five main topical treatment strategies for eczema: emollients, topical corticosteroids, topical immunomodulators, antimicrobials and antihistamines.
Box 1.Management ABC
Source: NICE, 2007
Emollients are first-line therapy in eczema, this is evidence-based UK guidance (NICE 2007; 2018; PCDS, 2019). Complete emollient therapy should always be advised, this is: ‘everything that goes on the skin should be emollient-based, and all soaps and detergents should be replaced with emollient wash, bath and shower products (NICE, 2007; Cork and Danby, 2009). Most emollients can be used as soap substitutes and eave-on emollients.
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