Eczema

Question 1

What is eczema?

Answer 1

A chronic, relapsing inflammatory skin condition
Common in children, also present in adults

Question 2

Epidemiology of eczema?

Answer 2

20% prevalence in <12 year-olds in the UK

Question 3

RF for eczema?

Answer 3

Atopy - personal Hx, FHx
Skin irritants

Question 4

Clinical features/presentation of eczema?

Answer 4

Quick answer:
Itchy, erythematous rash
Young children = on extensor surfaces
Older children + adults = on flexor surfaces

Long answer:
- Acute presentation: Itchy papules and vesicles, often weepy

• Chronic lesions: dry scaly itchy patches, can be erythematous in paler skin, grey/brown in richly pigmented skin
• Common on face and extensor surface of limbs in babies, on flexor surfaces in children+adults
• darker skin = brown, grey, purple bumps (aka papular or follicular eczema)
• lichenification - due to chronic scratching/rubbing
• pigment changes = hypo pigmentation and hyperpigmentation
• nails = pitting and ridging of nails

Question 5

Complications of eczema?

Answer 5

Secondary bacterial infections (see crusty weeping lesions)

Secondary viral infection (molluscum contagiosum, viral warts, eczema herpeticum)

Question 6

Investigations for eczema?

Answer 6

Patch testing
Serum IgE levels
Skin swab

Question 7

Management for eczema?

Answer 7

Emollients
Corticosteriods
Immunomodulators - calcineurin inhibitors e.g. tacrolimus but not on infected eczema
Antihistamines e.g. chlorphenamine (piriton) ease itch at night and sedating
Biological e.g. dupilumab (MAB) mod-severe
Systemic immunosuppression e.g azathioprine widespread severe AD unresponsive to topical treatments

Question 8

What does eczema look like?

Answer 8

Dry, erythematous patches
Acute eczema is erythematous, vesicular and exudative