Eczema

Question 1

What is eczema?

Answer 1

Eczema is a dry, itchy, inflammatory, chronic skin disease that typically begins in early childhood affecting around 30% of children. This condition can worsen and cause intractable pruritus, soreness, infection and sleep disturbance. Eczema is a remitting and relapsing condition.

Question 2

What is the time course of eczema and when should kids grow out of eczema?

Answer 2

Onset of eczema is usually before 12 months and initially presents with facial eczema and the flexures are affected later. 85% of children grow out of eczema by age 5.

Question 3

What is eczema aggravated by? What is the eczematous skin prone to?

Answer 3

Aggravated by heat, prickle (wool, nylon, seams, labels) and dryness.

Eczematous skin is prone to secondary bacterial and viral infection. This should be considered when eczema flares or fails to respond to treatment.

Bacterial infection is suggested by crusts, weeping, erythema and increased itch. Organism is usually staph aureus.

Viral Infection (HSV) is characterised by vesicles (grouped), satellite lesions, pustules and erosions. Tender but not overly itchy.

Question 4

What is atopy triad? Why is this significant?

Answer 4

Eczema, Asthma, Hayfever

Question 5

What are the clinical features of eczema?

Answer 5

Onset during the first year
Distribution on the face, scalp and trunk in infancy and flexures in childhood
Itch
FHx of atopy

Question 6

What is the diagnostic criteria for eczema?

Answer 6

Must have itch

Plus 3 or more of the following:

History of involvement in skin creases
Personal history of asthma or hayfever (or history of atopic disease in 1st degree relative if child is under 4 years of age)
A history of dry skin in the last year
Onset under the age of 2 years (not used if child is under 4 years)
Visible flexural eczema

Question 7

What are the DDx for eczema?

Answer 7

Milaria, scalies, psoriasis, zinc deficiency

Consider immunodeficiency if there is a associated failure to thrive, persistent diarrhoea or repeated infection.

Question 8

What is the management of eczema? 7 points for management

Answer 8

Steroids (to involved areas) – face, nappy areas or generally over the body

Moisturisers – can be applied over the steroid creams

Avoid irritants

Cold Compresses and wet dressings – rehydrate, reduce itch and itch and protect from trauma and friction

Antihistamines – useful sometimes to prevent itch

Diet – breastfed for as long as possible. Some foods may lead to a flare up of eczema so avoidance of these is important

Topical Antibacterial Treatment – if recurrent infection then topical ABx to prevent infection is important.