From the Research
In New Zealand, guidelines for managing eczema exacerbations recommend a stepped approach to treatment, prioritizing topical corticosteroids and emollients as first-line therapy, as supported by the most recent evidence from 1.
Key Recommendations
- For mild flares, increase the frequency of emollient use and apply topical corticosteroids (TCS) of appropriate strength once or twice daily until the flare resolves, typically for 3-7 days.
- Commonly prescribed TCS include hydrocortisone 1% for mild cases, triamcinolone 0.02% for moderate cases, and betamethasone valerate 0.1% or mometasone furoate 0.1% for severe cases.
- The use of potent and moderate topical corticosteroids is probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema, as indicated by 1.
- Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application, according to 1.
- For infected eczema, topical antiseptics like dilute bleach baths may help, while oral antibiotics such as flucloxacillin are recommended for more severe infections.
- Wet wraps can provide relief for intense flares by applying emollients and TCS, then covering with damp bandages followed by dry ones.
- For severe or widespread exacerbations unresponsive to topical treatments, oral corticosteroids like prednisone may be prescribed, though these should be used cautiously due to rebound flares upon discontinuation, as noted in 2.
Considerations
- Trigger identification and avoidance are essential components of management, as is patient education about proper application techniques and the importance of continuing maintenance therapy between flares to prevent recurrence.
- The evidence from 3 highlights the importance of considering ethnic differences in prevalence and access to effective management, particularly for young Māori and Pacific New Zealanders.
- The use of systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, as stated in 2.