eczema

Question 1

diagnostic criteria

Answer 1

pruritis
eczema
- chronic or relapsing history
- facial, neck and extensor involvement
- sparing of the groin and axillary regions
- early age of onset
- atopy
- xerosis (dry skin)

Question 2

everyday management

Answer 2

avoid overheating or overdressing
keep nails cut short to avoid trauma when scratching
avoid irritants, rinse after swimming in chlorine or salt water
minimise contact with sand, grass, carpet

Question 3

bathing

Answer 3

daily bath or shower - short, less than 5 mnutes with luke warm water with bath oil or soap free wash

Question 4

moisturiser

Answer 4

reguklar application improves skin barrier and should be done immidiately after bathing and showering as this is when it is absorbed the best

Question 5

what sort of moisturiser should be used

Answer 5

use cream or ointment rather than lotion
avoid skin products containing food derived proteins

Question 6

topical steroids

Answer 6

safe and effective
apply liberally to all affected areas
post inflammatory hyperpigmentation or hypopigmentation is normal and self resolves

Question 7

topical calcineurin inhibitors

Answer 7

typically used for children requiring frequent and prolonged use of methyprednisolone aceponate on the face
pimecrolimus 1% is used for children >3 for mild/moderate eczema on the face
tacrolimus 0.03% (not available commercially, must be compounded) is used for childdren >2 for moderate/severe facial eczema
if using these agents, consider discussing with dermatology

Question 8

wet dressings

Answer 8

recommended for more sevre eczema, especially if the child is itchy or waking at night with itch
cools the skin which helps to reduce itch
assists with penetration of topical steroids for severe inflammation or when the skin is thickened or lichenified

Question 9

antihistamines

Answer 9

will not help as the itch is not histamine related
sedating antihistamines may be given to improve sleep but promt treatment of the eczema is better

Question 10

dilute bleach baths

Answer 10

anti-infective treatment shown to reduce the incidence of recurrent staph aureus cutaneous superinfection
improves the condition of the skin
usually prescribed twice a week for three months

Question 11

infected eczema

Answer 11

skin swabs for bacterial and viral infectons if required
for treatment - consult CHAMP guidelines
commence aciclovir for herpetic eczema

Question 12

treatment for very mild eczema

Answer 12

hydrocortisone 1% twice daily

Question 13

treatment for mild eczema

Answer 13

methylprednisolone aceponate 0.1% one daily