Although there is currently no cure for atopic eczema, various interventions do exist to control symptoms, but the effectiveness of many treatments has not been established (Hoare
et al., 2000). Conventional treatment consists of the application of emollients and topical corticosteroids, both of which have been in use for over 30 years (Hanifin and Rajka, 1980; Leung, 2000). NICE (2007) advocates a ‘stepped approach’ to treatment for atopic eczema in children, which tailors the treatment steps to the severity of atopic eczema. Emollients should always form the basis of eczema treatment and used when there is no visible eczema (see
Emollients). The use of occlusive techniques, such as wet and dry wrapping, has been discussed in
Protecting the skin and preventing breakdown. The stepped approach is summarised in Table 9.7.
| | | | | | Table 9.7 Recommendations for the ‘stepped approach’ to atopic eczema management. | | Mild atopic eczema | Moderate atopic eczema | Severe atopic eczema | | | Emollients | Emollients | Emollients | | | Mildly potent topical corticosteroids | Moderately potent topical corticosteroids | Potent topical corticosteroids | | | | Topical calcineurin inhibitors | Topical calcineurin inhibitors | | | | Bandages | Bandages | | | | | Phototherapy | | | | | Systemic therapy | | | | |
Source: NICE (2007). | | |
Other treatments include wet wraps, bandaging (damp, occlusive body bandages either impregnated with a therapeutic substance or applied over topical preparations), behavioural management and habit reversal; these have been discussed extensively in
Protecting the skin and preventing breakdown. Complementary therapies for atopic eczema, such as medical herbs, are embraced by guidance from NICE (2007) which concludes that there is insufficient evidence to make recommendations for clinical practice. For more severe atopic eczema, secondary care referral for phototherapy and systemic therapies may be employed. The following section discusses other treatment options for acute and severe exacerbations of atopic eczema, including complementary therapies and treatment provided in secondary care settings.
