Synopsis
Recognise age-dependent atopic eczema patterns, assess severity and psychosocial burden, use stepped topical care safely, and detect infection or an alternative diagnosis promptly.
- Infants often have cheeks, scalp and extensor involvement; flexural eczema becomes common in older children, while adult disease often affects hands, face, neck and flexures.
- Assess clear, mild, moderate or severe disease by signs, itch, sleep and daily impact; visible redness may appear purple, brown or grey in deeply pigmented skin.
- Use leave-on emollient every day and as a soap substitute, then add a topical corticosteroid whose potency matches site, age and flare severity.
- Apply topical corticosteroid to active inflamed skin, not as whole-body moisturiser; teach fingertip units and a written body-site plan to reduce underuse and overuse.
- Do not order broad food tests or advise exclusion diets without a compatible immediate reaction, growth concern or specialist assessment.
- Widespread weeping or crust does not automatically require antibiotics in a systemically well patient; look for severity, progression and alternative causes.
- For Atopic eczema across the life course, document body sites, severity, sleep and function, recent treatment, infection features and what the patient can realistically apply each day.
- In Atopic eczema across the life course, reassess the diagnosis when a well-used, correctly potent regimen fails rather than repeatedly intensifying treatment without examining adherence, exposure and mimics.
Key red flags
Painful monomorphic erosions, eye symptoms, fever, rapidly spreading blistering, failure to thrive, erythroderma, recurrent deep infection or safeguarding concern requires urgent assessment.
Rapid painful monomorphic vesicles or circular punched-out erosions with fever are not an ordinary flare and require immediate antiviral action.
Investigation priorities
Confirm age-patterned itchy dermatitis and map severity, burden and possible alternatives.
Management branches
Eczema is mild or moderate without infection, systemic illness or diagnostic red flags.
- Agree a fragrance-free leave-on emollient and soap substitute used frequently, with separate clean containers or pumps to reduce contamination.
- Apply an age- and site-appropriate topical corticosteroid once or twice daily according to its product and written plan until the flare is controlled.
- Review technique, quantity, sleep and trigger exposures; consider proactive intermittent anti-inflammatory treatment for repeatedly relapsing sites under guidance.
Key medicines
Hydrocortisone 1% creamAdults apply a thin layer once or twice daily to affected skin for no longer than seven days under this product licence; paediatric use follows age-specific guidance.Avoid untreated infection, eyes and prolonged unsupervised use; minimise face, flexure and large-area exposure, review local atrophy, and remember formulations may contain sensitising excipients.
Betamethasone valerate 0.1% creamApply a thin film to affected skin once or twice daily for up to four weeks, reducing frequency or potency when control is achieved.Avoid face, flexures, genital skin, untreated infection and large-area or occluded use unless directed; children and pregnancy require greater caution, and rebound suggests review.