Atopic eczema/dermatitis
The terms atopic eczema and atopic
dermatitis are used interchangeably.
•
One of
the most common skin diseases affecting children, with a prevalence of 5–15% in
developed countries.
•
The
age of onset is less than 6mths in 75%.
•
Flare-ups
are commonly due to dry skin, irritants, infection, sweating/ heat, emotional
stress, and occasionally allergies.
•
Genetic
susceptibility.
•
Impaired
epidermal barrier function.
•
Immune
dysregulation.
•
Allergen
(food and airborne) sensitization and infection play a lesser role.
See Plate 1.
•
Acute
eczema may be erythematous and weeping.
•
Chronic
eczema may be lichenified and dry.
•
There
are often s changes of excoriation,
post-inflammatory hypo/ hyperpigmentation and infection.
•
Infant
eczema often affects cheeks, elbows, and knees with crawling.
•
Childhood
eczema is often flexural; also affects the wrists and ankles.
•
Adolescent
and adult eczema is also flexural, but may also affect the head and neck,
nipples, palms, and soles.
•
General measures: soap avoidance, e.g. soap free
bath oil or wash. Limit showers/baths
to 5–10min in lukewarm water. Moisturize immediately after showering. Wear
loose fitting cotton undergarments. Avoid over heating. Keep finger nails
short.
•
Specific measures: use topical corticosteroids daily
until the eczema is clear, then taper
off on alternate days for 1wk and then twice weekly before stopping. If the
eczema returns resume once daily application until clear and then recommence
taper.
•
ointments
are generally better than creams;
•
wet
dressings improve efficacy and can be done at home;
•
swab
suspected infection (viral PCR, immunofluorescence or culture and bacterial
cuture);
•
treat
promptly with antibiotics or antivirals after this;
•
sedative
antihistamines may improve sleep at night for those older than 2yrs.
•
In
those not improving, review the causes for flare-ups (see b ‘Presentation’, above). They may
need admission to hospital for intensive wet dressings or referral to a
dermatologist for consideration of phototherapy or systemic therapy.
For
mild eczema: a mild
potency topical corticosteroid ointment, e.g. 1% hydrocortisone, is appropriate daily for anywhere on the body.
•
For
mild to moderate eczema, a moderate potency topical corticosteroid
ointment: e.g. clobetasone butyrate 0.05%, is appropriate and safe for
daily use on the face and body, but not the groin.
•
For
moderate to severe eczema, a potent topical corticosteroid ointment, e.g.
mometasone furoate, is appropriate daily for the body, but not the face or
groin.
•
Sleep
disturbance.
•
Emotional
upset.
•
Family
dysfunction.
•
Eczema
herpeticum (HSV)
•
Staphylococcus aureus infection
•
Growth
delay.
•
Atopic
cataracts.
The natural history tends towards
resolution with age. Predicting this is dif-ficult, however, early onset severe
disease with associated atopy (hayfever and asthma), and elevated IgE may be
associated with a worse prognosis.
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