Step 1: clear skin. Use emollients only
Step 2: mild-areas of dry skin, and infrequent itching. Use emollients alone or combined with a topical steroid of mild potency
Step 3: moderate- areas of dry skin, frequent itching and redness. Use emollients with a topical steroid of moderate potency (7-14 days, face 3-5 days use), bandages, (then a topical calcineurin inhibitor such as tacrolimus-but only initiated under specialist dermatological supervision).
Step 4: severe- widespread areas of dry skin, incessant itching, and redness. Use emollients, potent topical steroids (moderate potency on the face or neck), bandages, (then tacrolimus, phototherapy or systemic treatment-but only initiated under specialist dermatological supervision).
Table 4: Treatment of atopic eczema based on a “stepped care plan”.