Eczema Flashcards
What should be asked about during a history for a patient presenting with eczema?
Presence of itching - unlikely to be eczema if it doesn’t itch.
Onset - usually starts in infancy and is episodic
Family/personal history - eczema associated with allergic rhinitis and asthma.
Possible triggers
Where does eczema tend to present?
In infants: face, scalp, limbs.
In children: localised to inside of knees/elbows
When would eczema be diagnosed?
Presence of itchy skin condition plus 3 of:
Visible flexure eczema in skin creases
Personal history of flexural eczema or eczema on cheeks.
Personal history of dry skin in the last 12 months.
Personal history of asthma or allergic rhinitis.
Onset of symptoms before age 2.
What are the characteristics of eczema severities?
Clear - normal skin with no evidence of active eczema.
Mild - areas of dry skin and infrequent itching.
Moderate - areas of dry skin, frequent itching, redness.
Severe - widespread areas of dry skin, incessant itching, redness.
Infected - weeping, crusted, or pustules with fever and malaise.
Eczema treatment pathway.
- Emollients - diprobase, hydromol, E45.
- Mild topical corticosteroids - 1% hydrocortisone cream.
- Moderately potent topical corticosteroids - betamethasone valerate 0.025%, clobetasone butyrate 0.05%
- Regular use of non-sedating antihistamine - cetirizine, loratadine, fexofenadine.
- Maintenance therapy of topical corticosteroids -see above, choose potency depending on severity.
What are some counselling points for emollients?
Creams and lotions (water-based) tend to be better for cooling/red inflamed areas while ointments are better for dry skin.
Use emollient liberally and frequently, even when symptoms improve.
Use around 350-550g every week.
Apply every 2-3 hours.
Apply during and after washing. Dry skin gently and apply while skin still moist.
Smooth emollient into skin along line of hair growth rather than rubbing them in.
What are some prescribing and counselling points for topical corticosteroids? (7)
Use mildest potency possible (systemic absorption).
Generally only use mild potency on sensitive areas such as face and flexures.
Use 15-30 minutes after emollient.
Avoid systemic absorption, more common if used long-term, on large surface areas, or on thin, inflamed skin, in elderly or children.
Systemic absorption can cause growth suppression in children, adrenal suppression, Cushing’s syndrome.
Adverse effects: burning or stinging for first 2 days, thinning of skin, allergic contact dermatitis, acne, mild depigmentation, hypertrichosis (hair growth at site).
Apply using finger tip units (FTU). See product literature for which areas require how many FTUs.
What is some lifestyle advice for eczema?
Eczema is a chronic condition which often improves with time, but not all children grow out of it.
Children with eczema often develop asthma and or allergic/rhinitis.
Encourage frequent and liberal use of emollients even if skin is clear.
Avoid triggers such as synthetic fibres, soaps and detergents, animals, and heat.
Avoid scratching skin - keep nails short and use anti-scratch mittens on babies.
Maintain a regular diet and don’t change it drastically.
How is infected eczema treated?
Usually S. aures infection/
Flucloxacillin first line or clarithromycin if penicillin allergy.
If recurs frequently, send skin swab for testing, take nasal swab, and start treatment for decolonisation.
What is eczema herpeticum?
Widespread herpes simplex virus causing widespread lesions which coalesce into large bleeding areas across the body. Also causes fever, lymphadenopathy (swollen lymph nodes), and malaise.
Medical emergency, especially in under 2s.
