Management

• topical corticosteroids are usually effective; weaker agents may be substituted when the rash is controlled.
• if intensely itchy, occlusive bandages will limit excoriation - for example, zinc paste or ichthymol bandage such as Viscopaste, or impregnated steroid tape containing flurandrenolone 0.0125%.
• steroid-antibiotic combination eg. betamethasone valerate + chinoform (Betnovate C), may be valuable since secondary infection is so common; suspect when response to topical steroid alone is inadequate
• stress management
• potassium permanaganate soaks if the eczema is oozing
• in resistant cases UVB or PUVA therapy may be beneficial (1)
  • typically, twice-weekly PUVA treatments are given for eczema, and the dose of UVA radiation is gradually increased over the course of treatment.
    long-term continuous treatment is not advised due to increased risk of developing skin cancers
  • can be used as a monotherapy or in combination with emollients and topical corticosteroids (2)

Reference:

• (1) Belsito DV. Dermatitis, including atopic, contact, seborrheic, and stasis. American Academy of Dermatology
• (2) Sawangjit R et al. Systemic treatments for eczema: a network meta-analysis. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013206. DOI:10.1002/14651858.CD013206.pub2