Dermatitis / Eczema (Mild)
Please refer to the BNF or SPC for licenced indications, doses, contraindications and
other prescribing information.
--------------------------------------------------------------------------------------------------------------------Definition/Criteria
Atopic eczema is an inflammation of the skin that tends to flare up from time to time and
usually starts in childhood. Severity can range from mild to severe. There is no cure but
treatments can usually control or ease symptoms. Emollients, steroid creams and
ointments are the common treatments. About 2 in 3 children grow out of it by their teens.
Contact dermatitis is a dermatitis that occurs as a response to external agents
interacting with the skin. These may me irritants or allergens.
Symptoms: A dry itchy rash, which can be characterised by its appearance. Some
areas of the skin may become dry and inflamed.
Eczema - most common areas affected (but not exclusively) are in the skin creases such
as elbows, back of knees and around the neck. The face is commonly affected in
babies.
Contact dermatitis often occurs on the hands.
--------------------------------------------------------------------------------------------------------------------Criteria for INCLUSION
Treat Patients who present with characteristic symptoms of eczema or contact
dermatitis.
--------------------------------------------------------------------------------------------------------------------Criteria for EXCLUSION
 Condition presenting on the face or genital areas
 Condition severe and widespread (>20% of the body is affected)
 Children under 10 (for supply of hydrocortisone only)
 Infected eczema or contact dermatitis
 Rashes caused by prescribed medicines
 Condition is worsening with increased oozing, crusting and redness
 Nappy rash
--------------------------------------------------------------------------------------------------------------------Action for excluded patients and non-complying patients
Refer to GP*
--------------------------------------------------------------------------------------------------------------------Action for patients who are included for treatment
Advice
 Keep nails short to minimise damage to the skin through scratching
 Consider wearing cotton mittens at night
 Establish triggers/ irritants/ allergens, which may cause a flare up. (E.g. fabrics,
detergents, soaps, certain foods)
 Try to minimise or avoid contact with irritant/allergen at home and at work. If
complete avoidance is not possible, advise the patient on the use of measures aimed
at preventing or minimising contact with the affected areas. For example:
o Rinsing with water or washing with soap or a soap substitute as soon as
possible after contact. (NB overuse of skin cleaning agents can aggravate
contact dermatitis)
o Reducing the duration and frequency of contact with the irritant
o Using protective clothing such as latex/polythene gloves
o Consider use of barrier cream
 No improvement after 10 days or sooner contact GP
---------------------------------------------------------------------------------------------------------Treatment choice from the formulary
 Hydrocortisone cream 1% 15g (not for children under 10 years old, not for use on
the face, broken skin or genital areas, only licenced for 7 days use OTC)



Diprobase® cream 50g (for contact dermatitis affecting smaller areas)
Diprobase® cream 500g pump pack for larger areas
Recommend frequent, liberal use of an emollient to maintain skin hydration and
improve barrier repair as first line treatment. Advise patient that emollient may be
used as a soap substitute
 The use of antihistamines for the relief of itching associated with acute contact
dermatitis is not recommended, If itching is a major problem, emollients can be
cooled by storing them in the refrigerator
 First consultation supply sufficient quantity of an emollient cream for one month, if
treatment is effective and an on going need is established repeat supply at two
month intervals (supplying sufficient quantities for two months) for as long as
treatment is effective or as is necessary
 Supply one tube of hydrocortisone cream on one occasion only
 More than one product may be supplied at a consultation, only one consultation fee
may be claimed per consultation irrespective of the number of treatments supplied,
e.g. hydrocortisone and an emollient
--------------------------------------------------------------------------------------------------------------------Routine referral to GP*
 Condition presenting on the face or genital areas
 Severe and widespread condition (>20% of the body is affected)
 No improvement after 10 days or sooner
 If condition is worsening with increased oozing, crusting and redness
 Condition is affecting sleep or other activities
* The pharmacist should complete a referral note for the patient to hand to the
surgery detailing why the patient was unable to be treated under the MAS.
--------------------------------------------------------------------------------------------------------------------Referral to GP within 24 hours*
 Signs of infection
 Rashes possibly caused by a reaction to a prescribed medicine
 Rapid worsening of the condition with suspected systemic infection
 Severe cracked, weeping or painful skin
 Blistery rash suggestive of herpes simplex virus
----------------------------------------------------------------------------------------------Emergency referral to A&E
N/A
----------------------------------------------------------------------------------------------------------*The pharmacist should complete a referral note for the patient to hand to the surgery
detailing why the patient was unable to be treated under the MAS.
Version 1.0 29/10/14