Eczema

Question 1

What is the most common type of eczema?

Answer 1

Atopic dermatitis

Question 2

What are the other types of eczema?

Answer 2

Contact dermatitis
Dyshidrotic eczema
Discoid eczema
Seborrhoeic dermatitis
Venous dermatitis (stasis dermatitis)

Question 3

What are the clinical features of atopic dermatitis?

Answer 3

Pruritis
Dry skin
Erythema
Vesicles and pustules in acute flares
Lichenification
Excoriations

Question 4

Where does atopic dermatitis typically occur on the body?

Answer 4

In infants:
- Face and extensor surfaces
In adults:
- Flexural surfaces

Question 5

How is eczema diagnosed?

Answer 5

Eczema is a clinical diagnosis

Question 6

How is the severity of eczema classified?

Answer 6

Mild
- Areas of dry skin
- Infrequent itching

Moderate
- Areas of dry skin
- Frequent itching
- Erythema

Severe
- Widespread areas of dry skin
- Incessant itching and erythema
- Extensive skin thickening
- Bleeding, oozing or cracking may be present

Question 7

What is the first line management of mild eczema?

Answer 7

Emollients - use liberally
Mild corticosteroids:
- Hydrocortisone 1% for areas of redness

Question 8

What is the first line management of moderate eczema?

Answer 8

Emollients - use liberally
Moderate corticosteroids:
- Eumovate (clobetasone butyrate 0.05%)
- Betnovate (betamethasone valerate 0.025%) - for inflamed areas only

Question 9

What is the first line management of severe eczema?

Answer 9

Emollients - use liberally
Potent corticosteroids:
- Betnovate (betamethasone valerate 0.1%)
- Dermovate (clobetasol propionate 0.05%)

Question 10

What is the steroid latter from least to most potent?

Answer 10

Hydrocortisone - 0.5%, 1% and 2.5%
Eumovate - clobetasone butyrate 0.05%
Betnovate - betamethasone 0.1%
Dermovate - clobetasol propionate 0.05%

Question 11

What thin emollients are available for treatment of eczema?

Answer 11

E45
Diprobase cream
Oilatum
Aveeno
Cetraben cream
Epaderm cream

Question 12

What thick emollients are available for treatment of eczema?

Answer 12

50:50 ointment
Hydromol
Diprobase ointment
Cetraben ointment
Epaderm ointment

Question 13

What secondary care treatments may be used in refractory cases?

Answer 13

Topical tacrolimus
UV therapy
Systemic immunosuppression
- Methotrexate
- Azathioprine

Question 14

When are biologic therapies used for treatment of eczema?

Answer 14

Bioliogic therapies (dupilumab or baricitinib) are used when patients do not respons to 1 traditional systemic therapy

Question 15

What are the complications of eczema?

Answer 15

Psychosocial impact - poor mood, poor sleep, disruption of daily activities
Eczema herpeticum
Opportunistic bacterial infection

Question 16

What is eczema herpeticum?

Answer 16

A severe disseminated infection caused by HSV-1 or HSV-2 in patients with eczema

Question 17

What is the presentation of eczema herpeticum?

Answer 17

Painful eczema on the face and neck
Monomorphic punched out lesions
Widespread lesions that coalesce into large bleeding areas
Fever
Lymphadenopathy
Malaise

Question 18

What is the presentation of bacterial infection in eczema?

Answer 18

Typical impetigo
- Golden-brown sores and blisters
Worsening of eczema

Question 19

What is the management of bacterial infection in eczema?

Answer 19

Antibiotics if systemically unwell
- First line topical - topical fusidic acid 2% for 5 to 7 days
- First line oral antibiotic - flucloxacillin for 5 to 7 days
- Alternative oral antibiotic - clarithromycin for 5 to 7 days

Question 20

What is the treatment of eczema herpeticum?

Answer 20

Urgent emergency admission to hospital
Antiviral drugs - IV aciclovir

Question 21

What are the complications of eczema herpeticum?

Answer 21

Blindness
Septic shock
Meningitis
Encephalitis