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These are activities that use your work data to ensure quality results.
These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.
These are activities that require reflection on feedback about your work.
These are activities that use your work data to ensure quality results.
The goal of home management is threefold: restoring the skin barrier, controlling inflammation, and preventing secondary infection. To support patient compliance, management advice should be simplified into three key areas.
1. Regular moisturising
This is the best defence against skin breakdown, Ms James stresses. “If you have skin that is dry and prone to inflammation, you are going to always need a moisturiser.”
Emollients should be applied at least one to two times a day, or whenever the skin feels dry—even when it looks clear. For children, roughly 150 to 200 grams of moisturiser per week is an appropriate amount.
She recommends starting with a thick cream and switching to a paraffin-based ointment if the skin gets drier.
“The lotions can be helpful, but they don’t absorb well into the skin layer,” she explains.
It should be applied gently using downward strokes to align with the skin cells. The optimal time is immediately after a bath or shower when skin pores are open. Always choose non-soap, non food-based and non-fragranced products free from chemical irritants. Patients may need to trial a few different brands to find one they are most comfortable with.
To prevent bacterial cross-contamination and ensure an adequate amount is used, scoop moisturiser from containers with a spatula or clean teaspoon, Ms Said says.
2. Avoiding triggers
These vary widely and can change over time, but common culprits include dry weather, temperature changes, overheating, stress, bathing products, playing in sand, sitting on grass, and chlorinated swimming pools. Ms James gives patients a list of known triggers so they can look for patterns.
While it’s best to avoid triggers wherever possible, this isn’t always easy in everyday life— but you can usually find a workaround, Ms James notes.
For example, she does not advise against swimming in chlorine. “I just advise patients to wash off immediately after getting out of the pool.”
“Children who play in the sandpit, I tell the parents to tell the daycare to wash them off and apply moisturiser straight after.”
In the laundry, non-fragranced, hypoallergenic washing liquids or powders are best. Hot washing and then drying clothes or bedding in the hot sun can help kill dust mites, Ms James says.
Pollen can also be a trigger, Ms Said adds. “We’d advise drying in a hot dryer so clothes and bedding doesn’t capture pollen on windy days.”
3. Early intervention
Parents need to learn to recognise the first signs of skin breakdown—increased redness, dryness, and itching—so they can promptly step up their treatment plan before a severe flare takes hold.
Parents are often hesitant about topical steroids, which can lead to under-dosing. To allay fears, you can explain that when used correctly, with proper instruction on potency and amount, research confirms their safety and efficacy, Ms James says.
It’s also important to note that it’s safe to use steroid creams on broken skin, Ms Said says.
Steroid selection will vary between practitioners.
Ms James uses a ‘step-up, step-down approach’ according to skin condition.
“If the skin becomes reddened, dry, itchy, scaly, starting to break, it’s unhappy. So my education with patients is to recognise that when it’s unhappy and reddened, we need to do something about it.”
She starts with a low potency steroid, noting the amount should be quantified using an appropriate guide (such as the fingertip unit guide).
Steroids should be applied at least once, sometimes twice, per day until the skin looks clear and feels smooth. When the skin improves, the dosage is weaned from twice to once daily, then stopped, with the patient resuming only moisturiser, Ms James says, “but with the caveat that if the skin starts to look unhappy again then we add the steroid again.”
“I’ll also give them a plan for when we have a moderate to severe flare-up where we’ll use stronger steroids as well.”
While ointments are generally preferred for inflamed skin due to better absorption, starting a reluctant patient on a cream and transitioning later can aid compliance. In terms of application order, a practical approach is to apply the steroid first to target inflammation, followed by moisturiser as a sealing layer.
Itch is a primary symptom that drives flares, as the physical act of scratching activates a pro-inflammatory signalling cycle. Practical tips to minimise scratching include:
While there is limited evidence for oral antihistamines for eczema-specific itch, they are often prescribed to improve sleep quality—with no major side effects in children or adults with long-term use.
“Sometimes doctors prescribe a sedating antihistamine as it can help improve sleep,” Ms Said says.
Wet dressings can be helpful for intense, localised flares. Carers can use cotton clothing, bandages or even paper towels soaked in boiled water (cooled to tepid) and bath oil. The moisturiser is applied first, then the wet dressing is placed on top. Although historic advice suggested overnight use, children often tolerate them for just 20 to 30 minutes. Consistent application multiple times a day over at least three days during a flare is key to effectiveness.
This is a leading area of misconception, and you may need to explain the difference between food allergies/reactions and eczema/inflammation to carers, Ms James says.
About 30% of infants with eczema develop a food allergy, and they both often start around the same time in infancy—but there are clear differences in the symptoms, Ms James says.
“Eczema will be dry and thickened and reddened but food reactions will resemble mosquito bites or hives, and these symptoms often progress and can have associated symptoms. If a child has a food reaction it can trigger an immune inflammation that can sometimes result in eczema inflammation. That’s what I tell patients.”
Food allergy reactions occur within 30 minutes to two hours after ingestion, while eczema can be delayed, she adds.
Current ASCIA guidelines strongly advocate introducing solids, including common allergy causing foods the family generally has in their diet, at around 6 months, not before 4 months when the baby is ready to begin solids while still breastfeeding. Introducing the common allergy causing foods before 12 months and keeping these foods in the baby’s diet at least weekly decreases the risk of developing food allergy, even in high-risk babies, Ms Said explains. Furthermore, avoiding food ingredients in moisturisers can also lower the risk of sensitisation to foods through the skin.
In children with eczema, parents can apply a tried and tested barrier ointment (like QV ointment or Vaseline) around a child’s mouth when introducing common allergy causing foods or foods such as strawberries or tomatoes to help prevent transient localised irritation, otherwise known as perioral dermatitis.
Infection is a major cause of flare-ups and requires immediate intervention, so it’s important that carers can recognise the signs.
“I show pictures to patients of what clear skin, what slightly inflamed skin and then what broken infected skin looks like,” Ms James says. Infection is not always pus-like; signs include oozing, crusting, increasing redness, and worsening itch, she adds.
Preventative measures include using spatulas for cream application, practising hand hygiene, and avoiding touching the skin.
For widespread infection, bleach baths can be effective. Parents should be reassured that the recommended dose—10 mL of standard bleach added to a standard tepid bath—is comparable to the chlorine level in a swimming pool. The child soaks for 10 to 15 minutes and is then patted dry without rinsing before applying topical steroids and moisturising cream.
Bathing should be kept to 15 minutes or less, or five to 10 minutes for showering, Ms James says. “But just remember that the shower spray can sometimes be irritant. So I always tell people to start children with a bath.”
Water should be tepid. Parents can use the elbow test to make sure it’s not too hot or cold.
Use non-soap, non-fragranced cleansers and avoid oatmeal or other food-based products (as the latter can increase food allergy risk).
Adding a bath oil can help boost moisture absorption. Post-bath, the skin should be gently patted dry with a clean, soft towel before applying skin creams or ointments.
Sleep is often compromised in children with eczema. Practical strategies include applying extra moisturiser before bed, wearing gloves to prevent scratching, using antihistamines every night, having light cotton bedding, wearing loose clothing, and establishing a consistent, relaxing bedtime routine. Dust mite covers for bedding can also help reduce exposure to dust mites.
Key takeaways
More information on eczema and its management can be found at Allergy & Anaphylaxis Australia. People managing eczema are encouraged to call the National Allergy Helpline for guidance and support. Allergy educators are all trained health professionals.
Information on food allergy prevention and eczema management in infancy can be found at the National Allergy Council’s Nip allergies in the Bub website
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