Guidelines for the outpatient management of childhood eczema

Author: Dr Diana Purvis, Paediatric Dermatologist, Starship Hospital, Auckland, New Zealand, September 2014.

Read these guidelines in association with:

The majority of children with eczema can be managed in an outpatient setting.

Treatment should be prescribed as a package including:

Prescribers need to spend time to ensure that children and their caregivers understand all aspects of therapy and how to use them.

Prescriptions for topical treatments should be supported with verbal instructions, written information (eg eczema action plan, handouts) and demonstration (eg videos). Education from an eczema nurse has been shown to improve adherence and the effectiveness of treatment.[1]

Resources for families

  1. includes videos and handouts

Resources for prescribers include:



Topical corticosteroids

The benefits and harms of topical corticosteroids should be discussed with the family/caregivers, emphasizing that benefits outweigh possible harms when they are used correctly.

The potency of topical corticosteroids should be tailored to the child’s eczema:

Mild potency

Moderate potency


Do not use super potent topical corticosteroids in children (or potent in children under the age of 12 months) without specialist dermatological advice.[2]

Topical calcineurin inhibitors




If there is no improvement after 7–14 days of treatment then the following should be considered:

When to refer

Referral for specialist advice
Referral for inpatient care
  • Eczema herpeticum is suspected
  • Eczema is severe and not responding to treatment
  • Bacterially infected eczema is not responding to appropriate treatment
  • For education, support and respite in select cases
Referral for eczema nurse advice
  • Where the patient and caregivers would benefit from advice and support regarding correct use of treatment
Referral for specialist dermatologist advice
  • The diagnosis is uncertain
  • Eczema on the face has not responded to treatment
  • Contact dermatitis is suspected
  • Eczema is causing significant psychological or social problems
  • Eczema is associated with severe or recurrent infections
  • The family or child would benefit from specialist advice on treatment
  • Where phototherapy or systemic treatment is required
Referral for psychological advice
  • Children with ongoing psychological or social impact despite appropriate medical advice
Referral for specialist paediatric advice
  • Children with suspected immediate food hypersensitivity
  • Children with poor growth
  • Children with severely restricted diets

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