Treatment Plan

Treatment Plan
Maintenance:
• Emollients: lotions, creams, gels, ointments
• Apply 4x daily
• 250-500mg weekly target
• Use the pump method to avoid contamination
• 10-15 min gap between emollients and other topicals
• Dry skin requires thicker emollients
Acute flares:
• Topical corticosteroids based on severity:
Mild: 1% Hydrocortisone
Moderate: Betamethasone 0.025% (Betnovate RD), Clobetasone 0.5% (Eumovate),
Potent: Betamethasone 0.1% (Betnovate)
Very potent: Clobetasol (Dermovate)
Steroid usage guidelines:
• Continue until 48hrs post-flare resolution
• Avoid potent/very potent steroids in:
o Axilla
o Groin
o Face
o Scalp
o Under 12 years
o Maximum 5 days for moderate potency in children/delicate areas
Additional treatments:
• Non-sedating antihistamines: cetirizine (1-month trial)
• Sedating antihistamines: chlorphenamine for sleep
• Severe cases: oral prednisolone (30mg/1wk)
• Frequent flareups: long-term topical corticosteroids (two days each week)
Referral criteria:
• Uncertain diagnosis
• Uncontrolled eczema
• Recurrent secondary infections
• For specialist treatments:
o Ciclosporin
o Phototherapy
o Bandaging
o Dry wrap dressing
o Tacrolimus
Special considerations:
• Food triggers: 4-6 week food diary
• Referral options: paediatrics/immunology/dermatology
• Psychology referral if mental health impact
• Mothers who are breastfeeding infants that have suspected atopic eczema from cow’s
milk protein may need a referral to dietary services:
o Can switch to hydrolysed or amino acid formulas (soy milk can be used if
more than six months old)
o If the mother wants to continue breastfeeding, a free cow’s milk protein diet
with supplementation is required