Eczema

Question 1

Eczema presentation

Answer 1

• pruritus that may interfere with quality of life
• erythema (inflammatory mediator release causes increased cutaneous blood flow)
• skin lesions - erythematous papules or vesicles with serous exudate
• scratching causes scale, lichenification, crusting

Question 2

Eczema differentials

Answer 2

• other types of eczema (e.g. discoid)
• allergic contact dermatitis
• psoriasis (more defined, thicker plaques, larger scales)
• scabies (also pruritus - check for burrows)
• lichen simplex

Question 3

Complications of eczema

Answer 3

• eczema herpeticum
• infection
• viral warts

Question 4

Eczema management

Answer 4

• identify and avoid allergens
• large quantities of emollients (500g per week)
• topical corticosteroids for acute flares, moderate-to-severe eczema
• topical calcineurin inhibitors e.g. tacrolimus if steroids contraindicated
• narrow band UVB phototherapy
• systemic immunotherapy e.g. ciclosporin
• biologics e.g. Dupilumab prescribed by specialist