What is the recommended cream for treating eczema?

Recommended Creams for Eczema Management

For eczema treatment, fragrance-free emollients should be used as the foundation of therapy, with topical corticosteroids added during flares, with potency selected based on severity and location of eczema. 1

First-Line Treatment: Emollients

Emollient Selection and Application

• Base therapy: Liberal use of fragrance-free emollients is the cornerstone of eczema management
• Apply emollients 3-8 times daily, especially immediately after bathing while skin is still slightly damp 1
• Formulation selection:
  • Ointments: Best for very dry skin and winter months
  • Creams: Good balance between moisturization and cosmetic acceptability
  • Lotions: Preferred in hot, humid weather (less moisturizing)
  • Recommended options: 10% urea cream, white soft paraffin, emulsifying ointment 2, 1

Application Amounts (per 2 weeks)

• Face and neck: 15-30g
• Both hands: 15-30g
• Both arms: 30-60g
• Both legs: 100g
• Trunk: 100g 2

Topical Corticosteroids for Flares

Potency Selection Based on Severity

1. Mild eczema: Low-potency corticosteroids

   • Hydrocortisone 0.1-2.5% 1, 3
   • Dioderm (hydrocortisone 0.1%)

2. Moderate eczema: Medium-potency corticosteroids

   • Eumovate (clobetasone butyrate 0.05%)
   • Betnovate-RD (betamethasone valerate 0.025%) 2, 1

3. Severe eczema: High-potency corticosteroids (short-term use)

   • Betnovate (betamethasone valerate 0.1%)
   • Elocon (mometasone 0.1%) 2, 1

4. Very severe/refractory eczema: Very high-potency corticosteroids

   • Dermovate (clobetasol propionate 0.05%)
   • Nerisone Forte (diflucortolone valerate 0.3%) 2, 1

Application Frequency

• Once daily application of potent topical corticosteroids is as effective as twice daily application 4
• Use for short periods (2-4 weeks) to avoid side effects 1
• For prevention of flares, consider weekend/proactive therapy (twice weekly application) which reduces relapse risk from 58% to 25% 4

Special Considerations

Infection Management

• If signs of infection present, consider:
  • Topical antibiotics in alcohol-free formulations 2
  • Antiseptic washes with aqueous chlorhexidine 0.05% for erosive lesions 1
  • Bleach baths with 0.005% sodium hypochlorite twice weekly to help prevent infections 1

Cautions

• Monitor for skin thinning, especially with higher-potency corticosteroids 4
• Fucidin-containing combination creams may lead to antibiotic resistance with prolonged use 5
• The order of application between emollients and corticosteroids does not significantly affect treatment outcomes - allow 15 minutes between applications 6

When to Refer

• Diagnostic uncertainty
• Failure to respond to appropriate topical steroids
• Need for second-line treatments (systemic therapies) 1

Patient Education Points

• Demonstrate proper application technique to patients/caregivers
• Explain that hydrocortisone is a mild steroid (31% of patients incorrectly classify its potency) 7
• Address "steroid phobia" - 72.5% of patients worry about using topical corticosteroids, affecting compliance 7
• Emphasize that consistent emollient use, even when skin appears normal, is essential for management 1

Remember that the most effective emollient is one that the patient will actually use consistently, considering their preferences and climate conditions.