Dermatology Made Simple : General principles for Management of Eczema Part 2

In case of infected eczema,antibiotics either systemic or topical should be used.

Topical Antibiotics

Topical antibiotics include: fusidic acid,silver sulfadiazine,polymyxins,neomycin and mupirocin.

Topical antibiotics should be used for at least a maximum period of 2 weeks continuously to reduce the risk 

of developing resistance in bacteria.

Systemic antibiotics include : Flucolxacillin (amoxicillin,penicillin)

Erythromycin ,clarithromycin,azithromycin

Ciprofloxacin,levofloxacin and ofloxacin.

Antibacterial emollient washes can be useful in active cutaneous infections as well as prophylactically.

Phototherapy

This is usually done with Narrow band UVB (TL-01) or PUVA (psoralen with UVA)

This is highly effective for generalized eczema.

Each course lasts for 6 – 8 weeks and patients have to attend atleast 2 to 3 times per week.

However there is a limit to the number of courses (cumulative dose) of phototherapy that any individual 

patient can receive before an increased risk of skin cancer occurs.

Systemic Immunosuppressants:

These are used in severely wide spread disease not controlled with topical therapy.

Dermatology specialists prescribe a reducing course of oral prednisolone 30 mg for 5 days,then reducing by 5 mg every 5 days to control very sever generalized acute eczema in adults.

Long term oral steroids shouldnot be used to control eczema .

Rather azathioprine,ciclosporin,mycophenolate mofetil and methotrexate canbe used for long term management.

If possible,levels of TPMT : Thiopurine methyl transferase should be checked before starting azathiopurine.