Treatment of Eczema on the Lateral Elbow Region
Apply a moderate-potency topical corticosteroid twice daily to the affected lateral elbow area as first-line treatment, combined with liberal emollient use. 1
First-Line Topical Corticosteroid Strategy
Start with a moderate-potency topical corticosteroid applied twice daily to the lateral elbow eczema - this potency level is appropriate for body sites like elbows and provides superior efficacy compared to mild-potency agents 2, 1, 3
Use the least potent preparation that adequately controls symptoms, but recognize that moderate potency is typically required for elbow lesions to achieve treatment success 1, 3
Apply no more than twice daily - once daily application of potent corticosteroids shows similar effectiveness to twice daily use, so avoid excessive application frequency 1, 3
Continue treatment until signs and symptoms (itching, rash, redness) resolve, then stop 4
Implement short "steroid holidays" when possible to minimize side effects like skin atrophy 1
Essential Emollient Therapy
Apply emollients liberally and regularly as the cornerstone of maintenance therapy, even when eczema appears controlled 1
Apply emollients immediately after bathing to provide a surface lipid film that retards evaporative water loss 2, 1
Use soap-free cleansers (dispersible cream as soap substitute) since soaps and detergents remove natural lipids and worsen the already dry skin in eczema 2, 1
Regular bathing is beneficial for both cleansing and hydrating the skin 2, 1
Avoiding Aggravating Factors
Keep nails short to minimize trauma from scratching 2
Avoid extremes of temperature 2
Avoid irritant clothing like wool next to the skin; recommend cotton clothing instead 2
Managing Secondary Bacterial Infection
Watch for signs of bacterial superinfection: increased crusting, weeping, or pustules 2, 1
If infection is present, prescribe flucloxacillin as first-line oral antibiotic for Staphylococcus aureus while continuing topical corticosteroids - do not delay or withhold corticosteroids when appropriate systemic antibiotics are given concurrently 1, 5
Send bacteriological swabs if the patient fails to respond to treatment 2
Recognizing Eczema Herpeticum (Medical Emergency)
If you observe grouped vesicles, punched-out erosions, or sudden deterioration with fever, suspect eczema herpeticum - this requires immediate treatment 2, 1, 5
Send swabs for virological screening and electron microscopy if herpes simplex infection is suspected 2
Initiate oral acyclovir early; if the patient is ill and febrile, administer intravenous acyclovir immediately 1, 5
Second-Line Options for Refractory Cases
Consider pimecrolimus cream (topical calcineurin inhibitor) if corticosteroids are inadequate or for maintenance therapy - use only on areas with active eczema, for short periods with breaks between treatments 4, 6
Pimecrolimus is indicated for patients age 2 years and older after other prescription medicines have not worked 4
Pimecrolimus may better preserve skin barrier structure (lamellar bodies) compared to corticosteroids, though clinical improvement may be slower 6
For chronic severe eczema, narrowband ultraviolet B (NB-UVB) phototherapy shows good evidence of efficacy 2, 1
Common Pitfalls to Avoid
Do not use mild-potency corticosteroids on elbow eczema - moderate or potent preparations are needed for adequate control on body sites 3
Do not use topical corticosteroids continuously without breaks - implement "steroid holidays" to minimize atrophy risk 1
Patients' or parents' fears of steroids often lead to undertreatment - explain the different potencies and emphasize that appropriate use is safe 2, 1
Do not use systemic corticosteroids for maintenance treatment - reserve only for acute severe flares requiring rapid control after all other options exhausted 1, 7