Eczema Management and Treatment

Clinical Presentation and Diagnosis

Eczema causes general dry skin (xerosis), which progresses to inflammatory skin conditions including fissures, characterized by dehydration of the stratum corneum 1
Eczema commonly affects flexural areas (folds of elbows, around neck) where chronic rubbing leads to lichenification, and general dry skin in the past year is a diagnostic criterion for atopic eczema 2, 3

Apply emollients liberally and frequently (at least twice daily) to the whole body to prevent dehydration and return moisture, as recommended by the British Medical Journal 1, 4
Avoid hot showers and excessive soap use, which remove natural lipid from the skin surface, and use dispersible cream as a soap substitute for cleansing, as suggested by the British Medical Journal 3, 1
Use topical corticosteroids as the mainstay of treatment, selecting the least potent preparation required to control the eczema, according to the British Medical Journal 3
Treat fissures with propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing, or alternatively, use antiseptic baths (potassium permanganate 1:10,000) or topical silver nitrate solutions to accelerate wound closure 1

Do not overlook secondary bacterial infection, which commonly complicates eczema and presents with crusting or weeping, and requires treatment with flucloxacillin, as warned by the British Medical Journal 2, 3, 5