Patient education is critical for ensuring the most effective use of treatments  and supporting parents and carers to monitor their child’s skin condition, recognise flares and complications and take appropriate action when required are all important aspects of effective pharmaceutical care. 

The management of atopic eczema involves the following steps:

1. Identify and remove or avoid triggers if possible. There may not always be an obvious trigger
2. Follow the ‘stepped care’ plan – matching intensity of treatment to severity of disease and stepping up or down as needed, using emollients all the time. Topical corticosteroids or a topical calcineurin inhibitor should be used to control flare-ups. Alternatively, if flares are very frequent, regular intermittent treatment – sometimes known as weekend treatment – with potent topical corticosteroids should be used to prevent them
3. When eczema fails to respond to emollients, topical steroids and avoidance of trigger factors, patients are referred to a specialist who may recommend an immunosuppressant treatment.

Weekend treatment

Once the initial eczema episode has been controlled in children who experience frequent flares, it is appropriate for the affected areas to be treated with potent topical corticosteroids on two consecutive days per week to prevent flares, instead of treating them when they arise. Moisturising emollients should continue to be used every day in addition to this.

This type of maintenance therapy is sometimes known as ‘weekend’ or ‘pulse’ treatment. It can mean that, in the long run, less topical steroid will be needed to control the eczema than if each flare-up was treated as it occurred.