Childhood atopic dermatitis
Diagnosis, severity, infection recognition and stepped care for childhood eczema.
Updated: 2026-09-13
Written for clinicians and medical students
This section is a teaching reference for doctors, residents and medical students. It is not patient guidance and not a substitute for clinical examination, and it must not be used for self treatment.
Assessment
- Diagnosis is clinical: itch plus an age-appropriate distribution, chronic or relapsing dermatitis, xerosis and personal or family atopy. Infants often have facial and extensor disease; flexures become typical later [1].
- Record sleep loss, school impact, treatment burden and infection, not surface area alone. Skin of colour may show violaceous or grey inflammation, follicular accentuation and prominent post-inflammatory pigment change.
- Pain, rapidly worsening eczema, clustered punched-out erosions, fever or malaise suggest eczema herpeticum and require same-day specialist or emergency assessment [1].
Stepped care
- Use fragrance-free emollients liberally and continue when clear. Match topical corticosteroid potency to site, age and flare severity; explain fingertip units and a written stop or step-down plan [1,2].
- Topical calcineurin inhibitors are steroid-sparing options for sensitive sites in appropriate ages. Persistent moderate to severe disease warrants specialist review for phototherapy or systemic therapy [2].
- Do not use routine antibiotics for non-systemically unwell children with eczema flares. Treat confirmed clinical infection and address colonisation only when recurrent infection justifies it [1].