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13.5.1 Preparations for eczema and psoriasis

Atopic eczema usually requires regular application of an emollient with short courses of a mild to moderate topical corticosteroid. Severe atopic eczema on the limbs or body (or a flare up of mild to moderate severity) may require application of a potent or moderately potent corticosteroid for the first one to two weeks, followed by a weaker preparation as the condition improves; an emollient should always be used.

Alitretinoin capsules.
Alitretinoin is for severe chronic hand eczema refractory to potent topical steroid therapy (hospital only).
See NICE TA 177.

N.B. Alitretinoin is teratogenic. It should be prescribed by a consultant dermatologist only and managed through a pregnancy prevention programme.

Notes:

1. Chronic eczema which has become lichenified can be treated with an ichthammol preparation if mild, or a tar preparation; medicated bandages are useful if the limbs are extensively affected. Steroid ointments may also be necessary. In young children wet wrap bandages on top of steroid preparations may be useful.

2. Weeping eczema can be treated with wet dressings of potassium permanganate solution or it can be added to the bath.

3. Seborrhoeic eczema of the scalp can be treated with a tar shampoo if mild, or a steroid scalp application (section 13.4) if more severe.

4. Eczema, which becomes secondarily infected, should be treated appropriately with antibacterials or antifungals; see section 13.4 for combinations of topical steroid/anti-infectives. Bacterial infections, unless superficial, may be more effectively treated with systemic flucloxacillin.

For link to BNF section: 13.5.1 Preparations for eczema & psoriasis