Eczema

Question 1

What is eczema?

Answer 1

A chronic inflammatory skin condition

Question 2

What can trigger eczema?

Answer 2

• Stress
• Allergens such as soaps
• Irritants such as clothing
• Hormonal
• Climate
• Dietary factors

Question 3

How does eczema present?

Answer 3

• Usually affects the skin creases e.g. bends of elbows or behind the knees
• Pruritus: severity of this is associated with extent of skin involvement
• Erythema: Increased cutaneous blood flow resulting from inflammatory mediators like histamine
• Acute lesions are generally papules/vesicles
• Chronic lesions are thickened skin with pigmentation changes
• Dry skin: caused by impaired barrier function

Question 4

How is eczema managed?

Answer 4

• Liberal use of emollients
• Mild topical corticosteroid for areas of red skin
• Patient education on use of emollients, avoiding scratching
• Topical corticosteroids as maintenance treatment can be considered and these should be stepped down

Question 5

Steroid Ladder

Answer 5

Mild: Hydrocortisone 0.1%, 0.5%. 1%
Moderate: Betamethasone 0.025% (Betnovate), Clobetasone 0.05% (Eumovate)
Potent: Betamethasone 0.1%
Very potent: Clobetasol (Dermovate), Diflucortolone (Nerisone)

Question 6

Where should topical corticosteroids not be applied unless absolutely necessary?

Answer 6

• Face, genitals or axillae

Question 7

How should patients be told to apply topical corticosteroids?

Answer 7

Using finger tip units (one finger tip worth of cream is enough to treat the front and back of the hand)