Moderate to severe eczema is a miserable condition for sufferers. General Practitioners can reduce this distress by explaining to patients about the need to avoid heat, soap, dryness of the skin, over-immersion, avoidance of irritants and control of itch. Antihistamines and the appropriate use of the correct strength topical steroids are well-known treatments. Ointments are used on dry skin, creams have better penetration in moist skin areas.
In addition to these suggestions, cellulitis and topical superinfection needs to be treated with oral, not topical, antibiotics (the latter can worsen dermatitis). Reduction of the bacterial colonisation, commonly found in moist eczema, may be achieved by adding quarter of a cup of bleach to 75L of warmish bath water and soaking for ten minutes only.1
Eczema is primarily a condition of abnormally dry skin. A soap-free moisturising wash is important. In addition to this, moisturise the skin several times a day and before bedtime (avoid vitamin E, tea tree oil and other supplements as this can worsen dermatitis), apply the steroid cream and then moisturiser under clean, damp cotton tea towels or bandages. These may be kept in place overnight by bandages or thin plastic wrap (note, plastic is a choking hazard in young children) on the limbs, hand and feet. A sedating antihistamine at night will help reduce nocturnal scratching and inflammation. Consider a referral to an allergy specialist, in addition to a dermatologist, if eczema is very widespread, severe or not reasonably quickly brought under control.