New guideline on atopic eczema

In the UK, around 15–20% of school-aged children and 2–10% of adults have atopic eczema.1 A new guideline on management for such individuals from the Scottish Intercollegiate Guidelines Network aims to improve outcomes and cost-effectiveness of treatment. Its key recommendations include the following:

• Patients should have ongoing treatment with emollients (at least 2–4 times daily, even when eczema is under control), including during concurrent treatment with topical corticosteroids.

• Patients should be advised to apply topical corticosteroids once daily. For those with moderate to severe disease with frequent relapses, twice-weekly topical corticosteroid as maintenance therapy should be considered.

• Topical tacrolimus should only be considered, in those aged 2 years or more, for the short term, intermittent treatment of moderate to severe atopic eczema that has not been controlled by topical corticosteroids; or where there is a serious risk of important adverse effects from further topical corticosteroid use (particularly skin atrophy).

• Oral antibiotics are not recommended in the routine treatment of patients with non-infected atopic eczema.

• Patients should be referred to a dermatologist where there is uncertainty concerning the diagnosis; poor control of the condition or failure to respond to appropriate topical treatments; psychological upset or sleep problems; or recurrent secondary infection.

Comment: This guideline offers clinicians useful advice on treatment and referral. Its advice on topical tacrolimus is particularly helpful. Topical tacrolimus is not as effective as topical corticosteroids2 and its main advantage appears to be the avoidance of skin atrophy caused by topical corticosteroids. Concerns have been expressed over reported cases of malignancies, including lymphoma and skin cancers in patients using tacrolimus ointment.2,3 It should only be considered as a second-line option after discussing the risk-benefit balance with the patient.