Eczema

Question 1

What are the signs and symptoms of eczema?

Answer 1

• Infant – face and trunk
• Older child – extensors of limbs
• Young adult – localises to flexures

Question 2

How can you classify the severity of eczema?

Answer 2

Mild - Areas of dry skin, infrequent itching (± small areas of redness)
Moderate - Areas of dry skin, frequent itching, redness (± excoriation and localised skin thickening)
Severe - Widespread areas of dry skin, incessant itching, redness (± excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation)

Question 3

What investigations are carried out for eczema?

Answer 3

• Consider food allergies -> blood or skin prick testing

- Consider contact dermatitis -> patch testing

Question 4

What is the management for eczema?

Answer 4

Mild

• Emollients
• Mild-potency topical corticosteroids

Moderate

• Emollients
• Moderate-potency topical corticosteroids (step-down approach)
• Topical calcineurin inhibitors
• Bandages

Severe

• Emollients
• Potent topical corticosteroids
• Phototherapy
• Systemic therapy
• Topical calcineurin inhibitors
• Bandages

Infected

• Skin swab and culture
• Oral flucloxacillin (erythromycin if pen-allergic)

Eczema Herpeticum

• Oral aciclovir
• If around eyes, refer to ophthalmologist (same day)
• Health education (emergency = rapidly worsening eczema, clustered blisters, punched-out erosions)