Eczema Flashcards
What is the most common type of eczema?
Atopic dermatitis
What are the other types of eczema?
Contact dermatitis
Dyshidrotic eczema
Discoid eczema
Seborrhoeic dermatitis
Venous dermatitis (stasis dermatitis)
What are the clinical features of atopic dermatitis?
Pruritis
Dry skin
Erythema
Vesicles and pustules in acute flares
Lichenification
Excoriations
Where does atopic dermatitis typically occur on the body?
In infants:
- Face and extensor surfaces
In adults:
- Flexural surfaces
How is eczema diagnosed?
Eczema is a clinical diagnosis
How is the severity of eczema classified?
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
What is the first line management of mild eczema?
Emollients - use liberally
Mild corticosteroids:
- Hydrocortisone 1% for areas of redness
What is the first line management of moderate eczema?
Emollients - use liberally
Moderate corticosteroids:
- Eumovate (clobetasone butyrate 0.05%)
- Betnovate (betamethasone valerate 0.025%) - for inflamed areas only
What is the first line management of severe eczema?
Emollients - use liberally
Potent corticosteroids:
- Betnovate (betamethasone valerate 0.1%)
- Dermovate (clobetasol propionate 0.05%)
What is the steroid latter from least to most potent?
Hydrocortisone - 0.5%, 1% and 2.5%
Eumovate - clobetasone butyrate 0.05%
Betnovate - betamethasone 0.1%
Dermovate - clobetasol propionate 0.05%
What thin emollients are available for treatment of eczema?
E45
Diprobase cream
Oilatum
Aveeno
Cetraben cream
Epaderm cream
What thick emollients are available for treatment of eczema?
50:50 ointment
Hydromol
Diprobase ointment
Cetraben ointment
Epaderm ointment
What secondary care treatments may be used in refractory cases?
Topical tacrolimus
UV therapy
Systemic immunosuppression
- Methotrexate
- Azathioprine
When are biologic therapies used for treatment of eczema?
Bioliogic therapies (dupilumab or baricitinib) are used when patients do not respons to 1 traditional systemic therapy
What are the complications of eczema?
Psychosocial impact - poor mood, poor sleep, disruption of daily activities
Eczema herpeticum
Opportunistic bacterial infection
What is eczema herpeticum?
A severe disseminated infection caused by HSV-1 or HSV-2 in patients with eczema
What is the presentation of eczema herpeticum?
Painful eczema on the face and neck
Monomorphic punched out lesions
Widespread lesions that coalesce into large bleeding areas
Fever
Lymphadenopathy
Malaise
What is the presentation of bacterial infection in eczema?
Typical impetigo
- Golden-brown sores and blisters
Worsening of eczema
What is the management of bacterial infection in eczema?
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
What is the treatment of eczema herpeticum?
Urgent emergency admission to hospital
Antiviral drugs - IV aciclovir
What are the complications of eczema herpeticum?
Blindness
Septic shock
Meningitis
Encephalitis
