Executive summary
- Emollients: The anchor of therapy. Prescribe generously (250g-500g per week). Apply frequently.
- Steroids: Match potency to severity and site. Use "Finger Tip Units" (FTU) to dose safely.
- Infection: Use oral flucloxacillin if widespread bacterial infection. Use topical antibiotic/steroid combo (e.g., Fucibet) only for localised small areas (max 2 weeks).
The Steroid Ladder (Know Your Potency)
- Mild: Hydrocortisone 1% (Face, Flexures, Children).
- Moderate: Eumovate (Clobetasone butyrate 0.05%). (Trunk, Limbs).
- Potent: Betnovate (Betamethasone 0.1%) or Elocon. (Stubborn areas, Lichenified skin, Hands/Feet).
- Very Potent: Dermovate (Clobetasol propionate). (Palms/Soles only - Specialist use usually).
- Application: 1 FTU (end of finger to first joint) covers 2 adult hand palms of area.
Flare Management
- Step Up: Increase steroid potency during flare (e.g., Mild -> Moderate). Apply od/bd for 7-14 days.
- Step Down: Once controlled, stop steroid or use "weekend therapy" (maintenance 2 days/week) for recurrent cases.
- Infected Eczema (Eczema Herpeticum):
- Red Flag: Rapidly worsening, painful, punched-out erosions/vesicles. Fever. -> Same Day Derm/Hospital Referral (needs IV Acyclovir).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.