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Abstract Dirven-Meijer PC, De Kock CA, Nonneman MGM, Van Sleeuwen D, De Witt-de Jong AWF, Burgers JS, Opstelten W, De Vries CJH. NHG Guideline Eczema. Huisarts Wet 2014;57(5):240-52. The Dutch College of General Practitioners’ Guideline Eczema gives recommendations for the diagnosis and treatment of atopic dermatitis in children and adults. It replaces the earlier guideline on atopic dermatitis. The revised guideline also covers the diagnosis and treatment of contact dermatitis, acrovesicular eczema, nummular eczema, hypostatic eczema, and asteatotic eczema. The occurrence of the different types of eczema is age dependent. For example, the prevalence of atopic dermatitis is highest in children, whereas contact dermatitis mainly occurs in adults, as a result of daily activities or work, and hypostatic eczema typically occurs in the elderly, as a result of venous insufficiency. The diagnosis is based on the patient history and examination. Additional investigations seldom contribute to the diagnosis or treatment of eczema and are only recommended if food allergy or contact dermatitis is suspected. Patient education is an important aspect of the management of eczema. Emollients, whether or not used in combination with topical corticosteroids, are the cornerstone of treatment. To optimize compliance, patient preference is the main determinant of the choice of emollient. Patients with moderate eczema can often be treated adequately with class 1 or 2 topical corticosteroids. In contrast, patients with severe eczema should be treated with a class 3 topical corticosteroid; however, these corticosteroids should not be applied to the face or skin folds. If the response to treatment is good, the use of topical corticosteroids should be reduced while the use of emollients is continued. The guideline provides recommendations for the stepwise reduction in corticosteroid use and for follow-up. General practitioners should consider how the daily activities and work of patients are affected by eczema and provide specific advice for the different types of eczema. If appropriate topical treatment has insufficient effect or the use of corticosteroids cannot be reduced, the patient should be referred for specialist treatment. If the treatment of suspected contact dermatitis or acrovesicular eczema does not have a satisfactory effect after 6 to 8 weeks, patients should be referred for investigation of potential contact allergens.

Corticosteroiden eczeem

corticosteroiden eczeem

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