Atopic dermatitis and eczema

Question 1

Atopic dermatitis/eczema

How does it typically present?

Answer 1

• early childhood
• episodic itchy patches of erythema and scale

Question 2

Atopic dermatitis/eczema

What is the general management (very vague overview explanation)

Answer 2

emollient use and trigger avoidance
+
treatment of flare-ups (topical steroids)

Question 3

Atopic dermatitis/eczema

How is it diagnosed?

Answer 3

history + examination

itchy skin
- Acute lesions of erythematous, vesicular, and/or exudative skin.
* Chronic lesions of excoriated, lichenified skin.
* Flexor surface involvement, e.g. inside of elbows and behind the knees, (or cheek and extensor surface involvement in infants).
* History of eczema or dry skin.
* History or family history of atopy, i.e. asthma or allergic rhinitis.

Question 4

Atopic dermatitis/eczema

How do we assess the severity of eczema?

Answer 4

Question 5

Atopic dermatitis/eczema

Do we do allergy testing?

Answer 5

only indicated if there are reasons to think that allergens are causing eczema flares or eczema is refractory despite optimal management

Question 6

Atopic dermatitis/eczema

How do we manage it? (prescribing)

Answer 6

topical steroid according to table

Other treatments:

• Oral corticosteroids – short course if severe and extensive eczema.
• Steroid sparing agents, such as the topical immunomodulators tacrolimus or pimecrolimus.
• Antihistamines for severe itch or urticaria.
• Antibiotics and antivirals for secondary infections.

Question 7

Atopic dermatitis/eczema

How do we manage it? (prescribing)

Answer 7

General advice:
- maintain the skin barrier function
- identify and avoid exacerbating agents
- use of emollients +/- bandaging
- soap substitutes

Question 8

Atopic dermatitis/eczema

What other conditions is atopic eczema often associated with?

Answer 8

other atopic diseases:
- allergic rhinitis
- food allergy
- asthma

Question 9

Atopic dermatitis/eczema

When does eczema typically present in life?

Answer 9

6 months and 5 years for most patients

Question 10

Atopic dermatitis/eczema

Name the main symptoms:

Answer 10

• Dry scaly patches of skin
• Pruritus – itching is a predominant symptom in atopic eczema
• Lichenification – accentuation of skin lines.
• Excoriation

Secondary skin changes, such as lichenification and excoriation are due to excessive itching.

Question 11

Atopic dermatitis/eczema

What are some risk factors?

3

Answer 11

• FHx (atopic disease)
• environment (pollution, extreme weather, second hand smoke)
• high birth weight

Question 12

Atopic dermatitis/eczema

When might a skin biopsy be requested?

Answer 12

symptoms and skin examination do not confirm the diagnosis to be atopic eczema.

• help to differentiate eczema from cutaneous T-cell lymphoma

Question 13

Atopic dermatitis/eczema

Which immunoglobulin is typically raised?

Answer 13

IgE (but this doesnt change treatment)

Question 14

Atopic dermatitis/eczema

What treatment may be offered to eczema which is resistant to topical steroids

Answer 14

UV light therapy or a systemic immunosuppressive drug (ciclosporin)